Ⅰ期子宫内膜癌术后放疗的临床分析

目的 回顾分析265例Ⅰ期子宫内膜癌术后放疗疗效和不良反应。方法 1999—2012年进行术后放疗的Ⅰ期子宫内膜癌患者共265例。病理类型为子宫内膜样腺癌占85.3%(226例)。根据FIGO2009手术—病理分期。术后辅助放疗方式包括盆腔外照射35例(13.2%)、单纯阴道内照射107例(40.4%)和内外照射联合治疗123例(46.4%)。Kaplan-Meier法计算生存率并Logrank检验差异,Cox模型进行预后因素分析。结果 5年随访率为85.7%。5年OS、PFS、局部复发、远处转移率分别为92.8%、89.7%、4.5%、6.4%。发生3级急性放射性肠炎者仅1例(0.4%),3、4级骨髓抑制者分别为4例(1.5%)、1例(0.4%),1例(0.4%)出现3级慢性肠炎。多因素分析显示子宫下段受累是影响OS和PFS的预后因素(P=0.041、0.001),放疗前贫血是影响OS的因素(P=0.048)。 结论 子宫内膜样腺癌为主的Ⅰ期内膜癌患者进行术后辅助放疗的疗效良好,不良反应轻微,放疗前贫血和子宫下段受累是影响OS的重要因素。

Treatment outcome of postoperative radiotherapy for patients with stage I endometrial carcinoma

Objective To retrospectively analyze the treatment outcomes and adverse reactions of265 patients with stage I endometrial carcinoma (EC) treated with postoperative radiotherapy. Methods
Two hundred and sixty-five patients with stage I EC were treated with hysterectomy and postoperative adjuvant radiotherapy from 1999 to 2012. The most common histological subtype of EC was adenocarcinoma (85.3%), and patients were staged according to the FIGO 2009 guidelines. The postoperative adjuvant radiotherapy methods included pelvic external beam radiotherapy (35 patients, 13.2%), vaginal brachytherapy (107 patients, 40.4%), and a combination of them (123 patients, 46.4%).The Kaplan-Meier method was used to caculate survival rate,the log-rank test was used to for survival difference analysis,the Cox regression model was used for multivariate prognostic analysis. Results The 5-year following-up rate was 85.7%.The 5-year overall survival (OS), progression-free survival (PFS), local recurrence, and distant metastasis rates for all patients were 92.8%, 89.7%, 4.5%, and 6.4%, respectively. One patient (0.4%) developed grade 3 acute radiation enteritis, 4 patients (1.5%) and 1 patient (0.4%) developed grade 3 and 4 myelosuppression, and 1 patient (0.4%) developed grade 3 chronic enteritis;no grade 3 or greater toxicities were noted. The multivariate analysis showed that involvement of the lower uterine was a significant predictor of OS (P=0.041) and PFS (P=0.001), whereas anemia before radiotherapy was a significant predictor of OS (P=0.048). Conclusions For patients with stage I EC (mostly adenocarcinoma), postoperative radiotherapy has good efficacy and mild toxicities. Anemia before radiotherapy and involvement of the lower uterine are important predictors of OS.