Whole abdominal radiotherapy in the adjuvant treatment of patients with stage III and IV endometrial cancer: A Gynecologic Oncology Group study
Whole abdominal radiotherapy in the adjuvant treatment of patients with stage III and IV endometrial cancer: A Gynecologic Oncology Group study
复制标题
DOI：
10.1016/j.ygyno.2005.03.011
复制
发表时间：
2005-06-01
影响因子：
4.7
通讯作者：
King, ME
中科院分区：
文献类型：
--
作者：
Sutton, G;Axelrod, JH;King, ME
Objective.评价局部晚期子宫内膜癌患者术后全腹放射治疗的毒性、生存率和无复发时间。在经腹全子宫切除术、双侧输卵管卵巢切除术、盆腔冲洗和选择性盆腔和腹主动脉旁淋巴结取样后8周内，对符合条件的患者开始全腹照射，同时进行盆腔加或减主动脉旁增强。在180例可评估的患者中，手术分期为III期和IV期子宫内膜癌，最大缩小小于2 cm，77例为典型的子宫内膜腺癌，103例为高危组织学，乳头状浆液性或透明细胞癌。典型的子宫内膜腺癌患者明显更年轻，低分化癌明显更少。按比例，非白人中有高风险组织学的人数是非白人中有典型子宫内膜腺癌的人数的两倍。45%的典型子宫内膜腺癌患者盆腔淋巴结阳性，而高危组织学患者盆腔淋巴结阳性率为51%。两个组织学组在体力状态、主动脉旁淋巴结阳性、疾病部位和程度以及国际妇产科联合会（FIGO）分期方面的分布相似。在174例可评价放射毒性的患者中，重度或危及生命的不良反应频率包括12.6%的骨髓抑制、15%的GI和2.2%的肝毒性。典型子宫内膜腺癌和高危组织学类型的无复发生存率分别为29%和27%（3年）。生存率分别为31%和35%。无肉眼残留病变患者存活。晚期子宫内膜癌最大切除术后全腹照射的毒副反应可耐受，提示对完全切除的患者采用全腹照射可改善预后。(c)2005年由Elsevier Inc.出版
Objective. To evaluate toxicity, survival, and recurrence-free interval in women with loco-regionally advanced endometrial carcinoma treated with postoperative whole abdominal radiation therapy.Methods. Whole abdominal irradiation with pelvic plus or minus para-aortic boost was initiated within 8 weeks of total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic washings, and selective pelvic and para-aortic node sampling in eligible, consenting patients.Results. Of 180 evaluable patients entered on the study with surgically staged III and IV endometrial carcinoma maximally debulked to less than 2 cm, 77 had typical endometrial adenocarcinoma and 103 had high-risk histology, either papillary serous or clear cell carcinoma. Patients with typical endometrial adenocarcinoma were significantly younger and had significantly fewer poorly differentiated cancers. Proportionally, there were twice as many non-Whites with high-risk histologies as non-Whites with typical endometrial adenocarcinoma. Forty-five percent of patients with typical endometrial adenocarcinomas had positive pelvic nodes compared to 51% of those with high-risk histologies. Both histologic groups had similar distribution for performance status, para-aortic node positivity, site and extent of disease, and International Federation of Gynecology and Obstetrics (FIGO) stage. The frequency of severe or life-threatening adverse effects among 174 patients evaluable for radiation toxicity included 12.6% with bone marrow depression, 15% GI, and 2.2% hepatic toxicity. The recurrence-free survival rates were 29% and 27% (at 3 years) for the typical endometrial adenocarcinoma and high-risk histologies, respectively. The survival rates were 31% and 35%, respectively. No patient with gross residual disease survived.Conclusion. Whole abdominal irradiation in maximally resected advanced endometrial carcinoma has tolerable toxicity, and it is suggested that the outcome may be improved by this adjunctive treatment in patients with completely resected disease. (c) 2005 Published by Elsevier Inc.