Algan O, Tabesh T, Hanlon A, Hogan W M, Boente M, Lanciano R M
Fox Chase Cancer Center, Department of Radiation Oncology, Philadelphia, PA 19111, USA.
Int J Radiat Oncol Biol Phys. 1996 Jul 15;35(5):925-33. doi: 10.1016/0360-3016(96)00188-5.
To evaluate prognostic factors and treatment outcome for high risk pathological Stage I and II endometrial cancer patients treated with consistent postoperative radiation therapy (RT) in a single institution and to compare these results to series where RT was variably applied.
Between 1986 and 1993, 98 pathologic Stage I and II endometrial cancer patients received postoperative RT at the Fox Chase Cancer Center. Papillary serous and clear cell histologies were excluded. Fifty-five patients underwent lymph node evaluation. In 17 patients, RT consisted of intracavitary brachytherapy alone to a median dose of 21 Gy, and in 81 patients, RT consisted of external beam RT to a median dose of 45 Gy followed by intracavitary brachytherapy to a median dose of 12 Gy. Intracavitary brachytherapy generally consisted of three high dose rate implants with the dose prescribed to a depth of 0.5 cm. Median follow up was 47 months.
The 5-year overall survival (OS), disease free survival (DFS), and freedom from pelvic recurrence (FPR) rates were 83, 85, and 89%, respectively. Pelvic recurrence either as the sole pattern of failure or combined with distant metastases was seen in 2 and 7% of patients, respectively. Distant metastases alone occurred in 4% of the patients. Univariate analysis of prognostic factors including age, grade, capillary lymphatic space invasion, depth of myometrial invasion, type of lymph node evaluation, pathologic stage, the use of brachytherapy and the number of risk factors was performed for OS, DFS, FPR, and FDM. Capillary lymphatic space invasion was the only statistically significant predictor for reduced DFS. Absence of lymph node dissection as well as a higher number of risk factors showed a trend toward poorer DFS (p = 0.06 for both). Multivariate analysis revealed older age to be the only factor significant for reduced DFS, with the presence of capillary lymphatic space invasion and the absence of a lymph node dissection showing a trend toward poorer outcome (p = 0.07).
The results of this study suggest a continued role for the use of postoperative RT in the treatment of patients with high risk endometrial cancer and will be compared to other series with similar high-risk factors.
评估在单一机构接受一致术后放射治疗（RT）的高危病理I期和II期子宫内膜癌患者的预后因素及治疗结果，并将这些结果与放疗应用方式多样的系列研究进行比较。
1986年至1993年间，98例病理I期和II期子宫内膜癌患者在福克斯蔡斯癌症中心接受了术后放疗。乳头状浆液性和透明细胞组织学类型被排除。55例患者接受了淋巴结评估。17例患者的放疗仅包括腔内近距离放疗，中位剂量为21 Gy，81例患者的放疗包括外照射放疗，中位剂量为45 Gy，随后进行腔内近距离放疗，中位剂量为12 Gy。腔内近距离放疗一般包括三次高剂量率植入，剂量规定至0.5 cm深度。中位随访时间为47个月。
5年总生存率（OS）、无病生存率（DFS）和无盆腔复发率（FPR）分别为83%、85%和89%。分别有2%和7%的患者出现盆腔复发，这是唯一的失败模式或与远处转移合并出现。仅远处转移发生在4%的患者中。对包括年龄、分级、毛细血管淋巴间隙浸润、肌层浸润深度、淋巴结评估类型、病理分期、近距离放疗的使用以及危险因素数量等预后因素进行单因素分析，以评估OS、DFS、FPR和远处转移失败（FDM）情况。毛细血管淋巴间隙浸润是DFS降低的唯一具有统计学意义的预测因素。未进行淋巴结清扫以及危险因素数量较多显示出DFS较差的趋势（两者p = 0.06）。多因素分析显示年龄较大是DFS降低的唯一显著因素，存在毛细血管淋巴间隙浸润和未进行淋巴结清扫显示出预后较差的趋势（p = 0.07）。
本研究结果表明术后放疗在高危子宫内膜癌患者治疗中持续发挥作用，并将与其他具有相似高危因素的系列研究进行比较。
