The role of postoperative radiation therapy for endometrial cancer: Executive summary of an American Society for Radiation Oncology evidence-based guideline.
The role of postoperative radiation therapy for endometrial cancer: Executive summary of an American Society for Radiation Oncology evidence-based guideline.
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DOI：
10.1016/j.prro.2014.01.003
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发表时间：
2014-05
影响因子：
3.3
通讯作者：
Viswanathan, Akila N
中科院分区：
文献类型：
--
作者：
Klopp, Ann;Smith, Benjamin D;Alektiar, Kaled;Cabrera, Alvin;Damato, Antonio L;Erickson, Beth;Fleming, Gini;Gaffney, David;Greven, Kathryn;Lu, Karen;Miller, David;Moore, David;Petereit, Daniel;Schefter, Tracey;Small, William Jr;Yashar, Catheryn;Viswanathan, Akila N
介绍子宫内膜癌辅助放疗的循证指南。在这份关于子宫内膜癌的循证指南中要解决的关键临床问题已经确定。进行了一项全面的文献综述，以确定不包括辅助治疗或盆腔和/或阴道近距离放射治疗伴或不伴全身化疗的研究。结果包括局部控制，生存率和生活质量的总体评估。1级或2级癌症患者，无浸润或MI <50%，特别是当不存在其他高危特征时，子宫切除术后可以安全观察。对于MI ≥50%的1级或2级癌症或MI <50%的3级肿瘤患者，阴道袖状近距离放射治疗在预防阴道复发方面与盆腔放射治疗一样有效。MI ≥50%或宫颈间质浸润的3级癌症患者可能受益于盆腔放疗，以降低盆腔复发的风险。盆腔放疗后阴道断端近距离放射治疗的益处证据有限。对于淋巴结阳性或累及子宫浆膜、卵巢/输卵管、阴道、膀胱或直肠的患者，建议采用多模式治疗。外照射和阴道近距离放射治疗仍然是子宫内膜癌辅助治疗的组成部分。
To present evidence-based guidelines for adjuvant radiation in the treatment of endometrial cancer. Key clinical questions to be addressed in this evidence-based guideline on endometrial cancer were identified. A comprehensive literature review was performed to identify studies that included no adjuvant therapy, or pelvic and/or vaginal brachytherapy with or without systemic chemotherapy. Outcomes included local control, survival rates, and overall assessment of quality of life. Patients with grade 1 or 2 cancers with either no invasion or <50% MI, especially when no other high risk features are present can be safely observed after hysterectomy. Vaginal cuff brachytherapy is as effective as pelvic radiation therapy at preventing vaginal recurrence for patients with grade 1 or 2 cancers with ≥50% MI or grade 3 tumors with <50% MI. Patients with grade 3 cancer with ≥50% MI or cervical stroma invasion may benefit from pelvic radiation to reduce the risk of pelvic recurrence. There is limited evidence for a benefit to vaginal cuff brachytherapy following pelvic radiation. Multi-modality treatment is recommended for patients with positive nodes or involved uterine serosa, ovaries/fallopian tubes, vagina, bladder, or rectum. External beam and vaginal brachytherapy remain integral aspects of adjuvant therapy for endometrial cancer.