子宫肉瘤放射治疗的临床观察

Radiotherapy in the treatment of uterine sarcomas

目的 观察子宫肉瘤对手术后辅助放射治疗 (放疗 )的疗效 ,及原发肿瘤或复发肿瘤对放疗的反应。方法 回顾分析我院 196 0年 5月～ 1999年 6月收治的子宫肉瘤 10 2例 ,其中单纯手术组 45例 ,手术 +放疗组 2 9例 ,单纯放疗组 4例 ,复发肿瘤放疗组 2 4例。结果 5年生存率 ,单纯手术组为 5 6 7% ,手术 +放疗组为 5 8 6 % ,两组比较 ,差异无显著性 (P >0 0 5 )。局部复发率 ,单纯手术组为 42 2 % ,手术 +放疗组为 2 0 7% ,两组比较 ,差异有显著性 (P <0 0 5 )。单纯放疗组 4例中有 3例肿瘤完全消失 ,其中 1例生存时间达 36个月 ,另 2例于放疗后 9个月和 11个月死于远处转移。复发肿瘤放疗组有效率达 5 0 0 %。放射敏感性依次为子宫内膜间质肉瘤、子宫恶性苗勒管混合瘤、子宫平滑肌肉瘤。结论 子宫肉瘤手术后放疗可明显减少盆腔复发 。

Objective To study radiotherapy in the treatment of uterine sarcomas and response to radiation in primary or recurrent uterine sarcomas. Methods A total of 102 uterine sarcomas treated in the Cancer Hospital from May 1960 to June 1999. A retrospective review of 45 patients receiving surgery alone, 29 patients for postoperative radiotherapy, 4 radiotherapy alone, 24 recurrent sarcomas receiving radiotherapy. Results The 5 year overall survival for 45 patients treated with surgery alone and 29 patients managed by postoperative radiotherapy were 56 7% and 58 6% respectively ( P >0 05). The addition of radiotherapy significantly reduced the local recurrence rate from 42 2% to 20 7% ( P <0 05). The tumor was disappeared completely by treatment of radiotherapy alone in 3 patients of primary uterine cervix sarcomas. 1 patient was free of disease at 36 months. Other 2 patients died 9 and 11 months later because of distant metastases. The complete and partial response rate of radiotherapy was 50 0% for recurrent tumors. The radiotherapetic sensibility of endometrial stromal sarcomas, mixed mesodermal sarcomas and leiomyosarcomas was downward tendency in turn.Couclusions The postoperation adjuvant radiotherapy reduced the pelvic recurrent significantly. Radiotherapy should be used in the treatment of uterine sarcomas as an important part of combination therapy.