Irwin C, Levin W, Fyles A, Pintilie M, Manchul L, Kirkbride P
Department of Radiation Oncology, Princess Margaret Hospital/Ontario Cancer Institute, Toronto, Ontario, M5G 2M9, Canada.
Gynecol Oncol. 1998 Aug;70(2):247-54. doi: 10.1006/gyno.1998.5064.
A retrospective analysis of 550 women with pathological stage I carcinoma of the endometrium who were seen between January 1984 and December 1988 was performed in order to assess the value of adjuvant radiation therapy.
Two-hundred twenty-eight patients were treated with surgery alone (S); 97 received adjuvant external beam radiotherapy (S + EXT); 217 received external beam radiotherapy and colpostats (S + EXT + IC); and 8 patients received only colpostats (S + IC). Pelvic radiation therapy, usually 40 Gy in 20 fractions, was administered to 94% of patients whose tumors showed greater than 50% myometrial invasion and to 89% of patients with FIGO grade 3 tumors. Colpostats were used in 40% of patients, the majority of whom had lower uterine segment involvement.
The overall survival rate for the whole group using Kaplan-Meier estimates was 84% at 5 years. The 5-year overall survival rates for each treatment group, excluding the S + IC group, were 90% for S alone, 79% for S + EXT, and 82% for S + EXT + IC. The 5-year disease-free survival rates were 84, 77, and 77%, respectively. Local control rates at 5 years were 93, 94, and 95% in the three treatment groups, but the patterns of relapse were different. Distant metastases occurred more frequently among the patients who received adjuvant radiation therapy (36/49, 73%) than among those who did not (4/19, 21%). Late toxicity was documented in 66 patients. Twelve patients had EORTC/RTOG grade 3 and 4 complications; all had been treated with S + EXT + IC. FIGO grade (P = 0.009), lower uterine segment involvement (P = 0.009), and age (P = 0.03) were significant predictors of worse disease-free survival in a multiple regression analysis.
The addition of vaginal vault brachytherapy to external beam radiotherapy did not appear to improve local cure rates nor survival, but increased the incidence of late radiation toxicity.
对1984年1月至1988年12月期间诊治的550例子宫内膜病理分期为I期癌的女性患者进行回顾性分析，以评估辅助放疗的价值。
228例患者仅接受手术治疗（S组）；97例接受辅助外照射放疗（S + EXT组）；217例接受外照射放疗及阴道内放疗（S + EXT + IC组）；8例仅接受阴道内放疗（S + IC组）。94%肿瘤肌层浸润超过50%的患者及89%国际妇产科联盟（FIGO）3级肿瘤患者接受盆腔放疗，通常20次分割给予40 Gy。40%的患者使用阴道内放疗，其中大多数患者子宫下段受累。
采用Kaplan-Meier法估计，全组5年总生存率为84%。除S + IC组外，各治疗组的5年总生存率分别为：S组90%，S + EXT组79%，S + EXT + IC组82%。5年无病生存率分别为84%、77%和77%。三个治疗组5年局部控制率分别为93%、94%和95%，但复发模式不同。接受辅助放疗的患者远处转移发生率（36/49，73%）高于未接受辅助放疗的患者（4/19，21%）。66例患者记录有晚期毒性反应。12例患者发生欧洲癌症研究与治疗组织（EORTC）/放射肿瘤学组（RTOG）3级和4级并发症；均接受S + EXT + IC治疗。多因素回归分析显示，FIGO分级（P = 0.009）、子宫下段受累（P = 0.009）及年龄（P = 0.03）是无病生存率较差的显著预测因素。
在外照射放疗基础上加用阴道穹窿近距离放疗似乎并未提高局部治愈率及生存率，但增加了晚期放疗毒性的发生率。
