83例子宫内膜腺癌单纯放射治疗疗效及其影响因素分析

Endometrial Adenocarcinoma Treated by Radiotherapy Alone:An Analysis of 83 Cases

[目的]分析单独放疗在子宫内膜腺癌治疗中的应用价值及影响疗效的因素;探讨以A点、F点为参照点进行子宫内膜癌单独放射治疗的可行性。[方法 ]回顾性分析83例单纯放射治疗的子宫内膜腺癌患者的临床资料。腔内治疗均应用铱-192腔内治疗机,体外照射应用钴-60体外照射治疗机,其中腔内治疗选取A点及F点为剂量参照点。对年龄、家族史、孕产次、体质指数、临床分期、组织学分级、宫腔深度等预后影响因素进行单因素分析及多因素分析。应用Kaplan-Meier方法计算5年生存率。[结果]83例应用单纯放射治疗患者的5年生存率为51.8%,其中Ⅰ期为70.8%,Ⅱ期为60.6%,Ⅲ期为23.1%。临床分期、组织学分级、宫腔深度（以8cm为界）对子宫内膜癌单独放疗预后影响有统计学意义（P〈0.05）。[结论]单纯放疗是子宫内膜癌可供选择的安全有效的治疗方法,尤其是临床分期为Ⅰ~Ⅲ期不能接受手术治疗的患者。但对于晚期、低分化以及宫腔深度〉8cm的子宫内膜癌患者,单纯放疗疗效欠佳,治疗方案尚需进一步改进。以A点及F点为参照点进行子宫内膜癌二维腔内治疗,方法简单、易于操作。

[Objective] To assess the efficacy of radiotherapy alone in the treatment of endometrial adenocarcinoma and influencing factors. [Methods] Eighty-three patients with endometrial adenocarcinoma receiving radiotherapy alone were analyzed retrospectively. Patients underwent Iridium-192 intracavitary treatment and Cobalt-60 external irradiation. Point A and point F were chosen as the dose reference points in intracavitary treatment. The association of efficacy with age,family history,gravidity and parity history,body mass index,clinical stages,histological grades,and depth of uterine cavity was analyzed by univariate and multivariate regression. Kaplan-Meier method was used to calculate the 5-year survival rate,and chi-square test on relevant factors was conducted to compare the difference in 5-year survival. [Results] The 5-year survival of 83 patients with endometrial cancer was 51.8%,and that of stage Ⅰ, Ⅱ,and Ⅲ patients was 70.8%,60.6% and 23.1%,respectively. The prognosis of patients was significantly correlated with clinical stage,histological grad,and depth of uterine cavity（cut-off point：8 cm）（P〈0.05）. [Conclusions]Radiotherapy alone is safe and effective for endometrial cancer,especially for stage Ⅰ,Ⅱ,and Ⅲpatients who could not tolerate surgical treatment. Point A and point F can be applied as dose reference points in intracavitary treatment for endometrial cancer.