John Michael P. Tomagan , Charles Cedy C. Lo , Alyssa Anne E. Granda , Mae M. Panaligan , Candice Chin-Chin C. Yu , Veronica T. Vera Cruz
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Clinical data, pathologic response, and survival outcomes were assessed, along with factors associated with pathologic response.</p></div><div><h3>Results</h3><p>Most patients (86%) had stage III disease with cervical extension, 93% had parametrial involvement, and 14% had nodal involvement. Chemotherapy was given to 86% either concurrently or adjuvantly. Post-surgery, 86% had no pathologic cervical involvement, and 93% had negative surgical margins. Pathologic complete response was seen in 43%. Locoregional recurrence occurred in 14%. Median follow-up was 30 months, with recurrence-free survival and overall survival rates of 86% and 100%, respectively. Lower grade tumors significantly correlated with pathologic complete response (Φ = 0.72, p = 0.026). No significant correlation was found between pathologic complete response and other factors. No late grade 3–4 toxicities were reported.</p></div><div><h3>Conclusion</h3><p>Neoadjuvant radiation followed by hysterectomy, with or without chemotherapy, is a viable strategy for managing endometrial cancer with cervical and/or parametrial involvement. 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引用次数: 0
摘要
目的对疑似或严重累及宫颈的子宫内膜癌的治疗缺乏标准方法。本研究评估了宫颈和/或宫旁受累患者接受新辅助放疗后进行子宫切除术的疗效。方法回顾性分析了2007年至2022年期间14例局部晚期子宫内膜癌且宫颈和/或宫旁受累的患者。他们接受了新辅助外照射放疗(45-50.4 Gy,25-30次分次)和高剂量率近距离放射治疗(5.5-7.0 Gy/次,3-4次分次),随后进行了筋膜外子宫切除术。对患者的临床数据、病理反应、生存结果以及与病理反应相关的因素进行了评估。结果大多数患者(86%)为宫颈扩展的 III 期疾病,93%的患者宫旁受累,14%的患者结节受累。86%的患者同时或辅助接受了化疗。手术后,86%的患者没有病理上的宫颈受累,93%的患者手术边缘阴性。43%的患者出现了病理完全反应。14%的患者出现局部复发。中位随访时间为30个月,无复发生存率和总生存率分别为86%和100%。低分级肿瘤与病理完全反应有明显相关性(Φ = 0.72,p = 0.026)。病理完全反应与其他因素无明显相关性。结论对于宫颈和/或宫旁受累的子宫内膜癌,新辅助放疗后进行子宫切除术(无论有无化疗)是一种可行的治疗策略。这种方法提高了可切除性,病理完全反应率高,切除边缘阴性,为这一具有挑战性的患者群体带来了希望。
Neoadjuvant radiotherapy followed by hysterectomy in locally advanced endometrial cancer: Outcomes from a tertiary government hospital in the Philippines
Objective
Managing endometrial cancer with suspected or gross cervical involvement lacks a standard approach. This study evaluated outcomes in patients with cervical and/or parametrial involvement treated with neoadjuvant radiation followed by hysterectomy.
Methods
Fourteen patients from 2007 to 2022 with locally advanced endometrial cancer and cervical and/or parametrial involvement were retrospectively analyzed. They received neoadjuvant external beam radiotherapy (45–50.4 Gy in 25–30 fractions) and high-dose rate brachytherapy (5.5–7.0 Gy per fraction in 3–4 fractions), followed by extrafascial hysterectomy. Clinical data, pathologic response, and survival outcomes were assessed, along with factors associated with pathologic response.
Results
Most patients (86%) had stage III disease with cervical extension, 93% had parametrial involvement, and 14% had nodal involvement. Chemotherapy was given to 86% either concurrently or adjuvantly. Post-surgery, 86% had no pathologic cervical involvement, and 93% had negative surgical margins. Pathologic complete response was seen in 43%. Locoregional recurrence occurred in 14%. Median follow-up was 30 months, with recurrence-free survival and overall survival rates of 86% and 100%, respectively. Lower grade tumors significantly correlated with pathologic complete response (Φ = 0.72, p = 0.026). No significant correlation was found between pathologic complete response and other factors. No late grade 3–4 toxicities were reported.
Conclusion
Neoadjuvant radiation followed by hysterectomy, with or without chemotherapy, is a viable strategy for managing endometrial cancer with cervical and/or parametrial involvement. This approach enhances resectability, yielding high rates of pathologic complete response and negative resection margins, showing promise for this challenging patient group.
期刊介绍:
Gynecologic Oncology Reports is an online-only, open access journal devoted to the rapid publication of narrative review articles, survey articles, case reports, case series, letters to the editor regarding previously published manuscripts and other short communications in the field of gynecologic oncology. The journal will consider papers that concern tumors of the female reproductive tract, with originality, quality, and clarity the chief criteria of acceptance.