子宫体肉瘤术后放疗的治疗结果。
Results of postoperative radiotherapy in the treatment of sarcoma of the corpus uteri.
作者信息
Knocke T H, Kucera H, Dörfler D, Pokrajac B, Pötter R
机构信息
Department of Radiotherapy and Radiobiology, General Hospital Vienna, University of Vienna, Austria.
出版信息
Cancer. 1998 Nov 1;83(9):1972-9. doi: 10.1002/(sici)1097-0142(19981101)83:9<1972::aid-cncr13>3.0.co;2-m.
BACKGROUND
The role of radiotherapy in the treatment of uterine sarcoma still is not clear. Data from the literature advocating adjuvant radiotherapy most often are based on very small patient groups, whereas larger epidemiologic studies, which appear to show no benefit for the additional radiotherapy, lack information regarding clinical data influencing the choice for adjuvant irradiation.
METHODS
During 1981-1992, 72 patients were referred for postoperative radiotherapy. Histologic diagnoses were leiomyosarcoma (LMS) in 30 patients, endometrial stromal sarcoma (ESS) in 11 patients, mixed müllerian tumors (MMT) in 28 patients, and other sarcoma types in 3 patients. The 1988 International Federation of Gynecology and Obstetrics classification for endometrial carcinoma was applied retrospectively. Forty patients presented with Stage I disease, 9 with Stage II, 17 with Stage III, and 6 with Stage IV. External beam therapy was given with a cobalt-60 unit using a rotation technique with 2 separate arcs in daily fractions of 2 gray (Gy), up to a total dose of 56 Gy to the pelvis. Brachytherapy was given to the vaginal vault either with 2 radium applications (median: 1600 milligram-hours to the applicator surface) or, in the majority of cases, with 3 fractions of high dose rate afterloading applications (iridium-192, 10-Curie source) with 7 Gy each to an isodose 7.5 mm from the applicator surface.
RESULTS
The 5-year actuarial overall survival, disease specific survival, and local control rates for 72 patients were 52.3%, 58.5%, and 77.9%, respectively; in Stage I patients they were 74.8%, 84.6%, and 94.4%, respectively; in Stage II patients they were 53.3%, 53.3%, and 88.9%, respectively; in Stage III patients they were 15.7%, 17.9%, and 55.5%, respectively; and in Stage IV patients they were 0%, 0%, and 0%, respectively. For LMS, the 5-year actuarial overall survival, disease specific survival, and local control rates were 49.4%, 52.0%, and 76.0%, respectively; for ESS they were 81.8%, 81.8%, and 90.9%, respectively; and for MMT they were 42.3%, 54.9%, and 72.4%, respectively.
CONCLUSIONS
These data suggest that adjuvant radiotherapy is an effective treatment for uterine sarcoma with regard to disease specific survival in patients with early stage disease and increases local control, even in patients with advanced stage disease.
背景
放射治疗在子宫肉瘤治疗中的作用仍不明确。文献中支持辅助放疗的数据大多基于非常小的患者群体，而较大规模的流行病学研究似乎显示额外放疗并无益处，但这些研究缺乏影响辅助放疗选择的临床数据信息。
方法
1981年至1992年间，72例患者接受术后放疗。组织学诊断为平滑肌肉瘤（LMS）30例、子宫内膜间质肉瘤（ESS）11例、混合性苗勒管肿瘤（MMT）28例、其他肉瘤类型3例。回顾性应用1988年国际妇产科联盟（FIGO）子宫内膜癌分类标准。40例为Ⅰ期疾病，9例为Ⅱ期，17例为Ⅲ期，6例为Ⅳ期。采用钴-60治疗机外照射，运用旋转技术，分2个独立弧度，每日剂量为2戈瑞（Gy），盆腔总剂量达56 Gy。阴道穹隆近距离放疗，采用2次镭敷贴（中位剂量：敷贴器表面1600毫克·小时），或在大多数情况下，采用3次高剂量率后装治疗（铱-192，10居里源），每次7 Gy，至距敷贴器表面7.5毫米等剂量线处。
结果
72例患者的5年精算总生存率、疾病特异性生存率和局部控制率分别为52.3%、58.5%和77.9%；Ⅰ期患者分别为74.8%、84.6%和94.4%；Ⅱ期患者分别为53.3%、53.3%和88.9%；Ⅲ期患者分别为15.7%、17.9%和55.5%；Ⅳ期患者分别为0%、0%和0%。对于LMS，5年精算总生存率、疾病特异性生存率和局部控制率分别为49.4%、52.0%和76.0%；对于ESS分别为81.8%、81.8%和90.9%；对于MMT分别为42.3%、54.9%和72.4%。
结论
这些数据表明，辅助放疗对于早期疾病患者的疾病特异性生存是子宫肉瘤的有效治疗方法，并且即使对于晚期疾病患者也能提高局部控制率。
Zotero 插件