On the apparent failure of adjuvant pelvic radiotherapy to improve survival for women with uterine sarcomas confined to the uterus
On the apparent failure of adjuvant pelvic radiotherapy to improve survival for women with uterine sarcomas confined to the uterus
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DOI：
10.1097/01.coc.0000156919.04133.98
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发表时间：
2005-06-01
影响因子：
2.6
通讯作者：
Judson, PL
中科院分区：
文献类型：
--
作者：
Dusenbery, KE;Potish, RA;Judson, PL
尽管许多研究记录了辅助盆腔放射治疗I期和11期子宫肉瘤后盆腔复发的减少，但提高存活率仍未得到证实。这篇回顾报告分析了1972至1998年间收治的42例I期妇女和7例11期子宫肉瘤患者的失败、存活和毒性，以确定可能从盆腔或腹部放疗和化疗中受益的患者。其中4名患者还接受了辅助化疗。其中平滑肌肉瘤20例，同种苗勒氏混合瘤18例，异种苗勒氏混合瘤11例。苗勒氏混合瘤的5年无瘤存活率为65%，15年为61%。平滑肌肉瘤5年和15年的无瘤存活率分别为40%和40%。仅远端14例，远端5例，腹部1例，远端1例，盆腔1例，起始点不明2例。急性毒性是可以接受的，以放射治疗后体重减轻1公斤的中位数和2%的治疗失败率来衡量。慢性毒性反应包括3例小肠梗阻和1例乙状结肠梗阻。总而言之，辅助盆腔放疗的疗效是通过没有任何孤立的盆腔衰竭来证明的。尽管腹膜衰竭的频繁发生表明预防性腹部放射对苗勒氏混合瘤的作用，但更有效的系统治疗是必要的，以显著增加患有早期子宫肉瘤的妇女的治愈机会。
Despite numerous studies documenting reduction of pelvic relapses after adjuvant pelvic radiotherapy stage I and 11 uterine sarcomas, improved survival remains unproven. This retrospective report analyzes patterns of failure, survival, and toxicity in 42 women with stage I and 7 patients with stage 11 uterine sarcomas treated from 1972 through 1998 to identify patients likely to benefit from pelvic or abdominal radiotherapy and chemotherapy. Four of these patients also received adjuvant chemotherapy. There were 20 leiomyosarcomas, 18 homologous mixed mullerian tumors, and 11 heterologous mixed mullerian tumors. Disease-free survivals for mixed mullerian tumors were 65% at 5 years and 61% at 15 years. Disease-free survivals for leiomyosarcomas were 40% at 5 years and 40% at 15 years. There were 14 distant only, 5 distant and abdominal, 1 abdominal, 1 distant and pelvic, and 2 unknown initial sites of failure. Acute toxicity was acceptable as measured by a median 1-kg weight loss from radiotherapy and a 2% rate of failure to complete therapy. Chronic toxicity consisted of 3 small bowel obstructions and 1 sigmoid colon obstruction. In conclusion, the efficacy of adjuvant pelvic radiation is demonstrated by the absence of any isolated pelvic failures. Although the frequent occurrence of peritoneal failures suggests a role for prophylactic abdominal radiation for mixed mullerian tumors, more effective systemic therapy is necessary to substantially increase the chance of cure for women with early-stage uterine sarcomas.