GSOR12 演讲时间：下午 5:55

IF 1.7 4区医学 Q4 ONCOLOGY

Brachytherapy Pub Date : 2024-10-25 DOI:10.1016/j.brachy.2024.08.058

Sai Nikitha Prattipati MScGH , Muhammad M. Qureshi MBBS, MPH , Katrin Eurich MD , Stephen Fiascone MD , Andrea Negroiu MD , Sherry X. Yan MD

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引用次数: 0

摘要

目的我们评估了辅助性体外放射（EBRT）和阴道近距离放疗（VBT）的使用情况以及对IB期至IVA期子宫癌肉瘤患者生存获益的影响。材料与方法从2004年至2017年的美国国家癌症数据库数据中确定了接受子宫切除术和辅助化疗的FIGO IB期至IVA期子宫癌肉瘤患者。主要研究结果是基于辅助治疗方式的总生存期：单纯化疗与加用EBRT或VBT。中位生存期采用卡普兰-梅耶法估算，统计显著性采用对数秩检验。使用多变量考克斯回归模型计算调整后的危险比（HR）及 95% 置信区间（CI）。该模型对以下事先选定的协变量进行了调整：诊断时的年龄、种族、诊断年份、保险状况、合并症、治疗机构类型和病理分期。结果我们确定了3038名符合资格标准的子宫癌肉瘤患者（26%为IB期，12%为II期，19%为IIIA/B期，41%为IIIC期，3%为IVA期），其中1567人（51.6%）接受了单纯辅助化疗，1046人（34.4%）接受了有或无VBT的EBRT辅助治疗，425人（14.0%）接受了VBT辅助治疗。接受放射治疗的患者更年轻；接受VBT治疗的患者更有可能罹患早期疾病，更有可能在学术/研究项目中接受治疗，而且更有可能是白人（所有P均为0.001）。中位随访时间为 39 个月，无辅助放射治疗、EBRT 和 VBT 的中位生存期分别为 32.7、59.8 和 127.4 个月（p <0.001）。多变量分析显示，辅助放射治疗的生存获益得以保持，EBRT 的 HR 为 0.69 [0.62-0.76，p <0.001)，VBT 的 HR 为 0.58 [0.49-0.68]，p <0.001（表 1）。在子宫癌肉瘤IB至IVA的所有分期中，辅助放疗比单纯化疗更有优势。具体而言，辅助 EBRT 可提高 II 期至 IVA 期的生存率，而辅助 VBT 可提高 IB 期至 IIIC 期的生存率。辅助近距离放射治疗在这类患者中可能未得到充分利用。

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GSOR12 Presentation Time: 5:55 PM

Purpose

We evaluated the utilization of adjuvant external beam radiation (EBRT) and vaginal brachytherapy (VBT) and the impact on survival benefit in stage IB to IVA uterine carcinosarcoma.

Materials and Methods

Patients with FIGO stage IB to IVA uterine carcinosarcoma who underwent hysterectomy and received adjuvant chemotherapy were identified from the National Cancer Database data from 2004 to 2017. The primary outcome of interest was overall survival based on adjuvant treatment modality: chemotherapy alone versus the addition of EBRT or VBT. Median survival was estimated using the Kaplan-Meier method, and the log-rank test was used to determine statistical significance. Adjusted hazard ratio (HR) with a 95% confidence interval (CI) was calculated using the multivariable Cox regression model. The model adjusted for following a priori selected covariates: age at diagnosis, race, year of diagnosis, insurance status, comorbidities, treatment facility type and pathologic stage.

Results

We identified 3038 patients diagnosed with uterine carcinosarcoma who met eligibility criteria (26% stage IB, 12% stage II, 19% stage IIIA/B, 41% stage IIIC, 3% stage IVA), of whom 1567 (51.6%) received adjuvant chemotherapy alone, 1046 (34.4%) received adjuvant EBRT with or without VBT, and 425 (14.0%) received adjuvant VBT. Patients who received radiation were younger; patients who received VBT were more likely to have earlier-stage disease, be treated at academic/research programs, and be white (all p <0.001). With a median follow-up of 39 months, median survival was 32.7, 59.8, and 127.4 months for no adjuvant radiation, EBRT, and VBT, respectively (p <0.001). The survival benefit of adjuvant radiation was maintained on multivariate analysis with HR 0.69 [0.62-0.76, p <0.001) for EBRT and HR 0.58 [0.49-0.68], p <0.001) for VBT (Table 1). The benefit of adjuvant radiation over chemotherapy alone persisted across all stages of uterine carcinosarcoma IB to IVA. Specifically, adjuvant EBRT improved survival in stage II to IVA, and adjuvant VBT improved survival in stage IB to IIIC.

Conclusions

Adjuvant radiation therapy, in addition to chemotherapy, improved overall survival in uterine carcinosarcoma. Adjuvant brachytherapy may be underutilized in this patient population.

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来源期刊

Brachytherapy 医学-核医学

CiteScore

3.40

自引率

21.10%

发文量

119

审稿时长

9.1 weeks

期刊介绍： Brachytherapy is an international and multidisciplinary journal that publishes original peer-reviewed articles and selected reviews on the techniques and clinical applications of interstitial and intracavitary radiation in the management of cancers. Laboratory and experimental research relevant to clinical practice is also included. Related disciplines include medical physics, medical oncology, and radiation oncology and radiology. Brachytherapy publishes technical advances, original articles, reviews, and point/counterpoint on controversial issues. Original articles that address any aspect of brachytherapy are invited. Letters to the Editor-in-Chief are encouraged.