Şimay GÜROCAK, Ersoy KEKİLLİ, Kemal EKİCİ, Öztun TEMELLİ

Postoperative Radiotherapy for Endometrial Cancer: Treatment Results and Prognostic Factors

Amaç: Bu çalışmayla postoperatif radyoterapi uygulanan hastalarda, tümöre ve tedaviye bağlı prognostik faktörlerin, lokal ve bölgesel kontrol, genel sağkalım ve hastalıksız sağkalım üzerindeki etkisinin araştırılması amaçlanmıştır. Gereç ve Yöntemler: Adjuvan eksternal radyoterapi ve brakiterapi uygulanan 61 endometrium kanserli hasta retrospektif olarak değerlendirilmiştir. Hastaların yaşı, tümör diferansiasyonu, tümör evresi, lenfovasküler invazyon, seroza invazyonu, myometrial invazyon, endoservikal tutulum, adneks tutulumu, lenf nodu tutulumu, sigara kullanımı, hipertansiyon ve diyabet hastalığı, hormon replasman tedavisi alıp almaması, doğum sayısı, menopoz yaşı, kemoterapi durumu, vajinal brakiterapi, radyoterapi şekli ve dozları, lokal nüks değerlendirilmiştir. Bulgular: Altmış bir hastanın 53ü (%87) endometrioid adenokarsinom, 8i (%13) ise diğer adenokarsinom (seröz, müsinöz, clear cell, mikst tip) histolojisine sahipti. Hastaların 53üne (%87) Total abdominal histerektomi+ bilateral salfingooferektomi + bilateral pelvik lenf nodu diseksiyonu (TAH+BSO+BPLND), 8 hastaya (%13) sadece TAH+BSO yapılmış. Otuz hastaya konvansiyonel, 23 hastaya ise konformal radyoterapi uygulanmıştır. Sekiz hastaya ise eksternal radyoterapi uygulanmamış sadece brakiterapi uygulaması yapılmıştır. İki yıllık genel sağkalım %93.4; 5 yıllık genel sağkalım %80.3 olarak bulunmuştur. Ortalama sağkalım 51 aydır. Hastalıksız sağkalım 2 yıllık ve 5 yıllık sırasıyla %85.2 ve %77 olarak tespit edildi. Genel sağkalım üzerine, serozal invazyon olması (p=0.034) anlamlı bulundu. Sonuç: Endometrium kanserinde postoperatif radyoterapi efektif ve güvenli bir yöntemdir.

Endometrium Kanserinde Postoperatif Radyoterapi: Tedavi Sonuçları ve Prognostik Faktörler

Introduction and Purpose: In this study, we aim to investigate the effects of the prognostic factors related to tumour, treatment, local and regional controls, overall survival, and disease free survival in postoperative radiotherapy patients. Materials and Methods: Sixty-one patients admitted to suffering from adenocarcinom of endometrium were analyzed retrospectively following surgical operation, adjuvant radiotherapy, and brachytherapy. We evaluated the patients in trems of age, tumour differentiations, tumour stage, lymphovascular invasion, serosal invasion, myometrial invasion, endocervical invasion, adnex involvement, lymph node involvement, menopausal age, hypertension, diabetes mellitus, smoking history, parity, hormone replacement therapy, chemotherapy process, vaginal brachitherapy, the type and doses of radiotherapy and local relapses. Throughout our research, we studied how overall survival and disease-free survival are influenced by factors like age, stage, tumour differentiation, histological type, lymph node involvement, lymphovascular invasion (LVI), endocervical invasion, serosal invasion, menopausal age, hypertension, diabetes mellitus, smoking history, parity, hormone replacement therapy (HRT), operation type, depth of myometrial invasion, and adnexal involvement. Results: Fifty three patiens (87%) were exposed to total abdominal hysterectomy+bilateral saphingo oohporectomy+bilateral pelvic lymp node dissection (TAH+BSO+BPLND), while 8 patients (13%) were exposed to TAH-BSO. Thirty patients were treated by conventional methods, 23 patients were treated by conformal methods. Eight patients were treated only by brachytherapy. The five-year overall survival rate was 80.3% and disease-free survival rate was found to be 77%. Two year overall survival rate was 93.4% and disease-free survival rate was 85.2%. It was noticed that serosal invasion (p=0.034) affect overall survival. Conclusion: Postoperative radiation therapy is an effective and safe treatment option in endometrium cancer.

PDF

___

1. 2. 3. 4. 5. 6. 7. 8. 9. Buldanlı N, Uslu T, Saygılı U, Çağlıyan E, Pırpanlar S. Jinekolojik Tümörlerde Sağkalım ve Buna Etki Etki Eden Faktörler: Dejog Serisi. Türk Jinekolojik Onkoloji Dergisi 2006;9 (3):67-74.
Sartori E, Gadducci A, Landoni F, Lissoni A, Maggino T, Zola P, et al. Clinical behavior of 203 stage II endometrial cancer cases: the impact of primary surgical approach and of adjuvant radiation therapy. Int J Gynecol Cancer 2001;11:430437.
Ayhan A, Taskiran C, Celik C, Yüce K. The long-term survival of women with surgical stage II endometrioid type endometrial cancer. Gynecol Oncol 2004;93:913.
Choi E, Kim J, Kim O, Byun S, Park S, Kwon S. Postoperative radiotherpy for endometrial cancer. Radiation Oncology Journal 2012;30(3):108-16.
Creutzberg CL, van Putten WL, Koper PC, Creutzberg CL, van Putten WL, Koper PC, et al. Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC Study Group. Post Operative Radiation Therapy in Endometrial Carcinoma. Lancet 2000;355:140411.
Keys HM, Roberts JA, Brunetto VL, Zaino RJ, Spirtos NM, Bloss JD, et al. Gynecologic Oncology Group. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study. Gynecol Oncol 2004;92(3):744-51.
ASTEC/EN.5 Study Group, Blake P, Swart AM, Orton J, Kitchener H, Whelan T, Lukka H, et al. Adjuvant external beam radiotherapy in the treatment of endometrial cancer (MRC ASTEC and NCIC CTG EN.5 randomised trials): pooled trial results, systematic review, and meta-analysis. Lancet 2009;373:137-46.
Nout RA, Smit VT, Putter H, Jürgenliemk-Schulz IM, Jobsen JJ, Lutgens LC, et al. Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): an open-label, non-inferiority, randomised trial. Lancet 2010;375:816-23.
Aalders J, Abeler V, Kolstad P, Onsrud M. Postoperative external irradiation and prognostic parameters in stage I endometrial carcinoma. Clinical and histopathologic study of 540 patients. Obstet Gynecol 1980;56:419-27. 284 www.jtomc.org
10. Park H.J, Nam E, Kim S, Kim Y, Kim Y.T. The benefit of adjuvant chemotherapy combined with postoperative radiotherapy for endometrial cancer: a meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology 2013;170(1):3944.
11. Randall ME, Filiaci VL, Muss H, Spirtos NM, Mannel RS, Fowler J, et al. Randomized phase III trial of whole- abdominal irradiation versus doxorubicin and cisplatin chemotherapy in advanced endometrial carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol 2006;24:3644.
12. Hogberg T, Signorelli M, De Oliveira CF, Fossati R, Lissoni AA, Sorbe B, et al. Sequential adjuvant chemotherapy and radiotherapy in endometrial cancer: Results from two randomised studies, Eur J Cancer 2010;46:22-2431.