Arif ARAS, Özlem DEMİR, Ayfer HAYDAROĞLU

Postoperatif radyoterapi uygulanan endometrium kanserli olgularda tedavi sonuçları ve prognostik faktörler: 509 olgunun değerlendirilmesi

Ocak 1992-Aralık 2001 tarihleri arasında postopratif radyoterapi uygulanan 509 olgu genel sağkalım,hastalıksız sağkalım ve lokal kontrol oranları ve bu sonuçları etkileyen prosnostik faktörler açısından geriye dönük olarak değerlendirilmiştir.Olguların medyan yaşı 58(aralık:31-83) olup histolojik olarak %88.0'ı adenokarsinom,%6.1'i adenoskuamöz karsinom.%4.3'ü clear cell karsinom,%1.6'ı papillar seröz karsinomdur.Evrelere göre dağılım %65.1 evre I,%17.7 evre II ,%14.6 evre III,%2.8 evre IVa şeklindedir.Tün olgulara 1.8-2 Gy'lik günlük fraksiyonlarda medyan 54 Gy eksternal radyoterapi (RT)sonrasıbrakiterapi uygulanmıştır. Medyan takip süresi 68 ay (aralık 6-141)'dir. Sağkalım analizlerinde Kaplan-Meier yöntemi kullanılmış, tekdeğişkenli analizler için Log-rank, çok değişkenli analizler için Cox regresyon testi yapılmıştır. Beş yıllık genel, hastalıksız ve lokal nüksüz sağkalım oranları sırasıyla %80.5, %85.1 ve %91.2' dir. Tek değişkenli analizlerde lokal kontrolü etkileyen faktörlerin histoloji (p=0.001), evre (p

Anahtar Kelimeler:

Seyir, Radyoterapi, Geriyedönük çalışma, Endometriyum neoplazmları, Tedavi sonucu

Postoperative radiotherapy in endometrial carcinoma: Analysis of treatment results and prognostic factors in 509 patients

Five-hundred-nine patients with endometrial carcinoma who received postoperative radiotherapy between January 1992-December 2001 were evaluated retrospectively to determine the overall disease-free and local-recurrence free survival rates and prognostic factors affecting survival. Mediag age was 58 (range: 31-83). Histologically 88.0% were adenocarcinoma, 6.1% adenosquamous carcinoma, 4.3% clear-cell carcinoma and 1.6% serous papillary carcinoma. The distribution by stages were: 65.1% Stage I, 17.7% Stage II, 14.6% Stage III, 2.8% Stage IVA. All patients received median 54 Gy external radiotherapy with 1.8-2.0 Gy daily fractions. Intracavitary brachytherapy was applied to 463 cases. Median follow-up time was 68 months (range: 6-141 months). Survival analysis was performed using the Kaplan-Meier method. Log-rank test was used for univariate analysis and Cox regression test was used for multivariate analysis. Five-year overall, disease-free and local recurrence-free survival rates were 80.5%, 85.1% and 91.2% respectively. According to univariate analysis prognostic factors influencing local control were histology (p=0.001),stage (p<0.001), histologic grade (p=0.03), positive peritoneal cytology (p<0.001) while the factors affecting overall survival were stage (p<0.001), histologic grade (p=0.014), histology (p<0.001), myometrial invasion (p=0.004), lymphovascular invasion (p=0.004), positive peritoneal cytology (p<0.001). When multivariant analyses were done only histology (p=0.004) and stage (p<0.001) appeared to be prognostic factors, whereas no prognostic factors for local control appeared in multivariant analyses.Postoperative radiotherapy is a highly effective adjuvant treatment providing high Içcoregional control rates. The important prognostic factors influencing treatment results were stage, histologic grade, positive peritoneal cytology and lymphövasculer invasion.

Keywords:

Prognosis, Radiotherapy, Retrospective Studies, Endometrial Neoplasms, Treatment Outcome,

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