Ⅰ期低级别子宫内膜间质肉瘤术后序贯放化疗的临床分析

Clinical analysis of postoperative sequential chemoradiotherapy in patients with stage Ⅰ low-grade endometrial stromal sarcoma

目的 探讨术后序贯放化疗对Ⅰ期低级别子宫内膜间质肉瘤（LGESS）预后的影响及安全性。方法 回顾性分析1995年6月至2010年12月术后接受序贯放化疗的Ⅰ期LGESS患者28例及同期接受单纯手术者24例。序贯放化疗组术后先给予2个周期化疗（化疗采用CYVADIC、VAD或IAP方案）,之后行盆腔外照射（DT 40-50 Gy）,放疗结束后再行2个周期化疗。比较两组患者的生存和复发情况,同时评价术后序贯放化疗的不良反应。结果 中位随访118个月（20-185个月）,随访率为92.3%。52例患者中,复发9例,其中单纯手术组复发7例。序贯放化疗组5年和10年无复发生存率分别为96.4%和91.4%,优于单纯手术组的75.0%和70.3%,差异有统计学意义（P=0.035）;两组5年和10年生存率的差异无统计学意义（P〉0.05）。所有接受序贯放化疗的患者均顺利完成治疗,化疗的不良反应主要为胃肠道反应及骨髓抑制,胃肠道反应均为1-2级,发生骨髓抑制者13例,其中5例发生3级及以上骨髓抑制,经积极处理后恢复正常。放疗的不良反应主要为放射性直肠炎及阴道炎,无3级以上急性不良反应发生。结论 LGESS预后较好,但有远期复发倾向。Ⅰ期LGESS的治疗以手术为主,术后序贯放化疗可能有助于减少盆腔复发,不良反应可耐受,是Ⅰ期LGESS可供参考的一种治疗选择。

Objective To investigate the effect of sequential chemoradiotherapy after surgery on survival of patients with stage I low-grade endometrial stromal sarcoma（ LGESS） , and evaluate side effects. Methods A total of 52 patients were collected from June 1995 to December 2010. Twenty-eight patients received sequential chemoradiotherapy following surgery, and 24 patients received sur-gery alone as control. Patients in sequential chemoradiotherapy group received 2 cycles of chemotherapy（ CYVADIC, VAD or IAP regi-men） , and then pelvic external radiation was applied with DT of 40-50 Gy. Two cycles of chemotherapy was followed by radiation. The survival and recurrence were evaluated, as well as side effects. Results The median follow-up was 118 months（20-185 months）with the follow-up rate of 92. 3%. In 52 patients, 9 cases developed recurrence, with 7 cases relapsed in control group. The 5-,10-year re-currence-free survival rates were 96. 4% and 91. 4% in sequential chemoradiotherapy after surgery group, higher than 75. 0% and 70. 3% in control group（P=0. 035）;the 5-,10-year overall survival rates had no statistical difference between the two groups（P〉0. 05） . All 28 patients with sequential chemoradiotherapy completed treatment. The chemotherapy-related toxic effects were mainly gas-trointestinal reactions and hematologic toxicities, and the gastrointestinal reactions were all grade 1 or 2. Thirteen patients experienced hematologic toxicities and grade 3 or 4 hematologic toxicities were observed in 5 patients, which could recovered after expectant treat-ment. The radiation reaction was mainly radiation proctitis and vaginitis of grade 1 or 2. No acute grade 3 or 4 radiation toxicities were observed. There was no treatment-related death. Conclusion LGESS has good prognosis, but it is with a tendency to develop late re-currence, even for stage Ⅰ patients. The main treatment is surgery. Sequential chemoradiotherapy after surgery is suggested to reduce the pelvic recurrence, and the toxic effects can be well tolerated.