Nguyen T V, Petereit D G
Department of Radiation Oncology, University of Wisconsin Medical School, Madison, WI 53792, USA.
Gynecol Oncol. 1998 Nov;71(2):196-203. doi: 10.1006/gyno.1998.5148.
The objective of this study was to determine the efficacy of high-dose-rate (HDR) brachytherapy in 36 medically inoperable patients with stage I endometrial cancer.
From October 1989 to August 1997, 36 patients presented with clinical stage I inoperable endometrial cancer. Surgery was precluded because of obesity and/or poor cardio-pulmonary reserve. Obesity was assessed using the body mass index (BMI) scale (kg/m2). Patients received 5 weekly HDR outpatient brachytherapy applications while under intravenous conscious sedation. Three-year clinical endpoints were calculated using the Kaplan and Meier method. Grade 3 and above complications were scored using the Radiation Therapy Oncology Group system.
The median age, Karnofsky performance status, BMI, and weight were 65 years old, 80%, 47 kg/m2, and 268 lbs, respectively. Nineteen patients were inoperable due to morbid obesity (median weight and BMI: 316 lbs and 56 kg/m2) while the remaining patients had other significant medical problems. Two patients died from acute cardiovascular events within 30 days of the last insertion. With a median follow-up of 32 months the 3-year uterine control, disease-free survival, survival, and complications were 88, 85, 65, and 21%, respectively.
Excellent uterine control rates (88%) were achieved using HDR brachytherapy for patients with medically inoperable endometrial cancer, but with significant acute and late morbidities. These toxicities were observed in a previous interim analysis that resulted in major modifications of the HDR program. No severe complications have developed since these changes were implemented. The current approach used for these challenging inoperable patients is a viable alternative to observation or hormonal therapy.
本研究的目的是确定高剂量率（HDR）近距离放射治疗对36例医学上无法手术的I期子宫内膜癌患者的疗效。
1989年10月至1997年8月，36例患者表现为临床I期无法手术的子宫内膜癌。由于肥胖和/或心肺储备功能差而无法进行手术。使用体重指数（BMI）量表（kg/m²）评估肥胖情况。患者在静脉清醒镇静下接受每周5次的门诊HDR近距离放射治疗。使用Kaplan-Meier方法计算三年临床终点。使用放射治疗肿瘤学组系统对3级及以上并发症进行评分。
中位年龄、卡诺夫斯基功能状态、BMI和体重分别为65岁、80%、47kg/m²和268磅。19例患者因病态肥胖而无法手术（中位体重和BMI：316磅和56kg/m²），其余患者有其他严重的医疗问题。2例患者在最后一次植入后30天内死于急性心血管事件。中位随访32个月，三年子宫控制率、无病生存率、生存率和并发症发生率分别为88%、85%、65%和21%。
对于医学上无法手术的子宫内膜癌患者，使用HDR近距离放射治疗可实现出色的子宫控制率（88%），但有明显的急性和晚期发病率。这些毒性在之前的中期分析中观察到，导致HDR方案发生重大修改。自实施这些更改以来，未出现严重并发症。目前用于这些具有挑战性的无法手术患者的方法是观察或激素治疗的可行替代方案。
