Vaginal vault recurrences of endometrial cancer in non-irradiated patients - Radiotherapy or surgery.
Vaginal vault recurrences of endometrial cancer in non-irradiated patients - Radiotherapy or surgery.
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DOI：
10.1016/j.gore.2015.01.002
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发表时间：
2015-01
影响因子：
1.2
通讯作者：
Jochumsen, Kirsten M
中科院分区：
文献类型：
--
作者：
Hardarson, Hordur Alexander;Heidemann, Lene Nyhoj;dePont Christensen, Rene;Mogensen, Ole;Jochumsen, Kirsten M
局部复发的子宫内膜癌的治疗基于有限的证据。标准治疗是放射治疗(RT)，这对局部控制是有效的，其效果已在前瞻性研究中得到证实。手术治疗(ST)复发的研究很少，而且仅限于既往接受过放射治疗的患者或晚期疾病患者。孤立性阴道穹隆复发的外科治疗研究几乎是空白。本研究的目的是评估RT和ST在一组仅限于阴道穹隆的复发子宫内膜癌患者中的疗效。确定了2003至2012年间在丹麦欧登塞大学医院治疗的复发子宫内膜癌患者，n=1118人。33名患者出现孤立性阴道穹隆复发，接受了RT、ST或两者联合治疗。术后2年复发率和生存率采用Fishers精确检验。26例接受放疗，5例接受ST治疗，2例同时接受RT和ST治疗。平均随访时间(SD)为4.4年(2.99)年(RT)和3.9年(0.90)(ST)。两年复发率分别为40%(95可信区间9.2~48%)和0%(95可信区间0~60%)。两年生存率分别为83%(95可信区间71~100%)和100%(95可信区间40~100%)，ST段复发1次，平均2.3年。本研究表明ST是治疗局部复发子宫内膜癌的一种合适的治疗方法。我们的研究涉及的患者数量有限，而且是回溯性的，因此评估存活率和并发症的前瞻性和理想的随机试验是有必要的。探讨子宫内膜癌阴道穹隆复发的放射治疗和手术治疗。所有患者均未接受放射治疗，其中5例行手术治疗，26例行放射治疗。生存率和复发率相同，但更倾向于手术。
The treatment of locally recurrent endometrial cancer is based on limited evidence. The standard treatment is radiotherapy (RT) which is effective for local control and the effect has been documented in prospective studies. Investigations of surgical treatment (ST) of recurrences are few and limited to previously irradiated patients or patients with advanced disease. Investigation of surgical treatment for isolated vaginal vault recurrence is practically nonexistent. The aim of this study is to evaluate the efficacy of RT and ST in a non-irradiated group with recurrent endometrial cancer limited to the vaginal vault. Patients treated for recurrent endometrial cancer at Odense University Hospital, Denmark between 2003 and 2012 were identified, n = 118. Thirty-three patients had an isolated vaginal vault recurrence and were treated with either RT, ST or both. Re-recurrence rates and survival rates were calculated at 2 year follow-up using Fishers exact test. Twenty-six patients were treated with RT, 5 with ST, 2 with both. The mean (SD) follow-up-time was 4.4 years (2.99) (RT) and 3.9 years (0.90) (ST). Two year re-recurrence rates were 40% (RT) (95 CI 9.2–48%) and 0% (ST) (95 CI 0–60%). Two-year survival rates were 83% (RT) (95 CI 71–100%) and 100% (ST) (95 CI 40–100%) ST had one re-recurrence at 2.3 years. This study indicates that ST is an appropriate treatment for locally recurrent endometrial cancer. Our study involves a limited number of patients and is made retrospectively, therefore prospective and ideally randomized trials evaluating both survival and complications are warranted. Investigate radiotherapy and surgical treatment of vaginal vault recurrences of endometrial cancer. All patients were naïve to radiotherapy and 5 were treated with surgery and 26 with radiotherapy. Rates of survival and re-recurrence were equivalent though in favor of surgery.