早期子宫内膜癌术后单纯腔内近距离治疗的结果

Efficacy of postoperative vaginal vault brachytherapy alone for early？stage endometrial carcinoma

目的 回顾分析术后单纯腔内近距离治疗的早期内膜癌患者临床结果.方法 2004—2013年在我院行术后单纯腔内近距离治疗的早期子宫内膜癌患者共158例.根据2009年FIGO手术—病理分期,Ⅰa期105例,Ⅰb期53例.主要病理类型为子宫内膜样腺癌（142例,占899%）,病理分级为G3级者17例（108%）.使用192Ir源后装治疗机,照射区域为阴道顶端及上1/2段阴道,参考点定义为阴道黏膜下05 cm,照射剂量25-30 Gy分5-6次.Kaplan？Meier法计算生存率并Logrank检验差异,Cox模型进行预后多因素分析.结果 5年样本量63例.5年OS、PFS、LR、DM率分别为976%、919%、29%、28%.全组病例均未出现阴道复发.未出现≥3级急慢性胃肠道、泌尿系反应.多因素分析显示淋巴脉管间隙侵犯仍是影响OS率（OR=0087,95%CI为0.009-0813,P=0032）和PFS率（OR=0091,95%CI为0.018-0459,P=0004）的因素.结论 术后单纯腔内近距离治疗早期内膜癌患者的疗效良好,淋巴脉管间隙侵犯是影响OS和PFS的重要因素.

Objective To retrospectively analyze the efficacy of postoperative vaginal vault brachytherapy for early-stage endometrial carcinoma （ EC） . Methods One hundred and fifty-eight patients with early-stage EC who were treated with postoperative vaginal vault brachytherapy alone from 2004 to 2013 were enrolled as subjects. According to the 2009 International Federation of Gynecology and Obstetrics staging system, 105 patients had stage Ⅰa disease and 53 had stage Ⅰb disease. Most （ 142/158, 899%） patients had the histological subtype of adenocarcinoma. Seventeen patients were pathologically diagnosed with grade 3 disease. Iridium-192 high-dose radiation brachytherapy was applied to the top and upper 1/2 part of the vagina with a reference point at 5 mm depth of vaginal mucosa. The radiation dose was 25-30 Gy in 5-6 factions. The survival rate was calculated by the Kaplan-Meier method and analyzed by log-rank test. The Cox regression model was used for multivariate prognostic analysis. Results The 5-year sample size was 63. The 5-year overall survival （ OS ） , progression-free survival （ PFS ） , local recurrence, and distant metastasis rates in all patients were 976%, 919%, 29%, and 28%, respectively. No vaginal recurrence, grade≥3 acute and chronic gastroenteritis, or grade≥3 urethritis were found in those patients. The multivariate analysis showed that lymphovascular space involvement was an independent prognostic predictor of OS （ OR=0087, 95% CI=0009-0813, P=0032） and PFS （ OR=0091, 95% CI=0018-0459, P= 0004 ） . Conclusions Postoperative vaginal vault brachytherapy alone achieves satisfactory treatment outcomes in the treatment of patients with early-stage EC. Lymphovascular space involvement is an important prognostic predictor of OS and PFS.