Ⅰ期子宫内膜癌术后放疗的临床分析  

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

作　　者：侯晓荣[1,2] 胡克[2] 沈捷[2] 连欣[2] 孙帅[2] 晏俊芳[2] 刘志凯[2] 张福泉[2] 李晔雄[1,2] 

机构地区：[1]北京协和医学院中国医学科学院肿瘤医院放疗科,100021 [2]北京协和医学院中国医学科学院北京协和医院放疗科,100730

出　　处：《中华放射肿瘤学杂志》2015年第1期48-53,共6页Chinese Journal of Radiation Oncology

摘　　要：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手术一病理分期.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.Objective To retrospectively analyze the treatment outcomes and adverse reactions of 265 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.

关 键 词：子宫内膜肿瘤/术后放射疗法 放射疗法 盆腔外照射 近距离治疗 预后 

分 类 号：R737.33[医药卫生—肿瘤]