欧洲肿瘤内科学会(ESMO)基于其开发的临床诊疗指南制定标准方案[ESMO standard operating procedures for Clinical Practice Guidelines development(https://www.esmo.org/Guidelines/ESMO-Guidelines-Methodology)]在2022年6月推出...欧洲肿瘤内科学会(ESMO)基于其开发的临床诊疗指南制定标准方案[ESMO standard operating procedures for Clinical Practice Guidelines development(https://www.esmo.org/Guidelines/ESMO-Guidelines-Methodology)]在2022年6月推出了子宫内膜癌诊断、治疗和随访临床指南[1]。该指南与2020年底欧洲妇科肿瘤学会(ESGO)-欧洲放射肿瘤学会(ESTRO)-欧洲病理学会(ESP)子宫内膜癌指南大体相近。展开更多
Objective. A phase II study was conducted to evaluate the role of adjuvant intraperitoneal radioactive phosphorus (32P) and vaginal brachytherapy in patients with uterine papillary serous carcinoma （UPSC） and clear ...Objective. A phase II study was conducted to evaluate the role of adjuvant intraperitoneal radioactive phosphorus (32P) and vaginal brachytherapy in patients with uterine papillary serous carcinoma （UPSC） and clear cell carcinoma （CCC）, after complete surgical staging. Methods. Patients were required to have undergone complete surgical staging including maximal surgical resection. Residual ≤ 3 mm intraperitoneal disease, and pelvic and para- aortic lymph node dissection with negative nodes, were required. A dose of 15 mCi of intraperitoneal 32P was administered within 8 weeks of surgery. Vaginal brachytherapy was delivered using either high dose rate, total dose of 2100 cGy in 3 fractions （700 cGy per fraction prescribed to 0.5 cm depth from the vaginal surface） or low dose rate to 6500 cGy （prescribed to the vaginal surface） in 1- 2 fractions. Results. For the 21 evaluable patients, distribution by FIGO stage was as follows: Stages I- IIB （17）, Stages III- IV （4）. The median follow- up was 39.6 months （range: 5- 63 months）. No patients experienced grade 2- 4 complications from their adjuvant therapy. Five patients suffered a recurrence: intraperitoneal [n = 2], distal vaginal [n = 2], and one at the surgical scar. Following the 2 distal vagina recurrences early in the trial, the entire length of the vagina was treated with intracavitary brachytherapy. No additional vaginal recurrences were observed. The two- year overall survival, cause- specific survival, and disease- free survival for the entire series were 89.2% , 89.2% , and 79.7% , respectively. Conclusions. Adjuvant therapy for UPSC and CCC with intraperitoneal 32P and vaginal brachytherapy after comprehensive surgical staging is feasible, well tolerated, and warrants further study on a larger scale.展开更多
Objective. To evaluate treatment outcomes in women with early-stage endometrial cancer (FIGO IA, IB, IC, or IIA)-surgically managed by a general gynecologist (GYN) or a gynecologic oncologist (GYO). Methods and result...Objective. To evaluate treatment outcomes in women with early-stage endometrial cancer (FIGO IA, IB, IC, or IIA)-surgically managed by a general gynecologist (GYN) or a gynecologic oncologist (GYO). Methods and results. 349 women treated from 1990-2003 were studied. Median follow-up was 3.7 years. Ninety-five were classified as highintermediate risk (HIR: stages IB grade III, IC grade II or III, any stage IIA). 110 women received adjuvant radiotherapy. The GYO group had more unfavorable tumor characteristics based on stage and grade (P < 0.0001), shorter follow-up (median 3.1 vs. 5.1 years, P = 0.0002), and an absolute 12%less likelihood of receiving adjuvant radiotherapy (P = 0.04). Local and distant failures were not significantly different. Overall survival favored GYN patients (P = 0.02) with no difference in disease-specific survival (P = 0.38). Multivariate analysis for disease-free survival revealed HIR disease (P = 0.04) and GYO treatment (P = 0.049) to be significant, with a trend for age ≤64 (P = 0.05). Multivariate analysis for overall survival found age ≤64 (P = 0.0001), HIR disease (P = 0.01), and adjuvant radiotherapy (P = 0.0055) to be significant. Conclusions. Women primarily managed by a GYO for early-stage disease were significantly less likely to receive adjuvant radiotherapy. Despite significantly more unfavorable disease characteristics among GYO-managed women,disease-free and cause-specific survival were equivalent between the two groups. Favorable disease characteristics and adjuvant radiotherapy correlated with improved survival on multivariate analysis.展开更多
文摘欧洲肿瘤内科学会(ESMO)基于其开发的临床诊疗指南制定标准方案[ESMO standard operating procedures for Clinical Practice Guidelines development(https://www.esmo.org/Guidelines/ESMO-Guidelines-Methodology)]在2022年6月推出了子宫内膜癌诊断、治疗和随访临床指南[1]。该指南与2020年底欧洲妇科肿瘤学会(ESGO)-欧洲放射肿瘤学会(ESTRO)-欧洲病理学会(ESP)子宫内膜癌指南大体相近。
文摘Objective. A phase II study was conducted to evaluate the role of adjuvant intraperitoneal radioactive phosphorus (32P) and vaginal brachytherapy in patients with uterine papillary serous carcinoma （UPSC） and clear cell carcinoma （CCC）, after complete surgical staging. Methods. Patients were required to have undergone complete surgical staging including maximal surgical resection. Residual ≤ 3 mm intraperitoneal disease, and pelvic and para- aortic lymph node dissection with negative nodes, were required. A dose of 15 mCi of intraperitoneal 32P was administered within 8 weeks of surgery. Vaginal brachytherapy was delivered using either high dose rate, total dose of 2100 cGy in 3 fractions （700 cGy per fraction prescribed to 0.5 cm depth from the vaginal surface） or low dose rate to 6500 cGy （prescribed to the vaginal surface） in 1- 2 fractions. Results. For the 21 evaluable patients, distribution by FIGO stage was as follows: Stages I- IIB （17）, Stages III- IV （4）. The median follow- up was 39.6 months （range: 5- 63 months）. No patients experienced grade 2- 4 complications from their adjuvant therapy. Five patients suffered a recurrence: intraperitoneal [n = 2], distal vaginal [n = 2], and one at the surgical scar. Following the 2 distal vagina recurrences early in the trial, the entire length of the vagina was treated with intracavitary brachytherapy. No additional vaginal recurrences were observed. The two- year overall survival, cause- specific survival, and disease- free survival for the entire series were 89.2% , 89.2% , and 79.7% , respectively. Conclusions. Adjuvant therapy for UPSC and CCC with intraperitoneal 32P and vaginal brachytherapy after comprehensive surgical staging is feasible, well tolerated, and warrants further study on a larger scale.
文摘Objective. To evaluate treatment outcomes in women with early-stage endometrial cancer (FIGO IA, IB, IC, or IIA)-surgically managed by a general gynecologist (GYN) or a gynecologic oncologist (GYO). Methods and results. 349 women treated from 1990-2003 were studied. Median follow-up was 3.7 years. Ninety-five were classified as highintermediate risk (HIR: stages IB grade III, IC grade II or III, any stage IIA). 110 women received adjuvant radiotherapy. The GYO group had more unfavorable tumor characteristics based on stage and grade (P < 0.0001), shorter follow-up (median 3.1 vs. 5.1 years, P = 0.0002), and an absolute 12%less likelihood of receiving adjuvant radiotherapy (P = 0.04). Local and distant failures were not significantly different. Overall survival favored GYN patients (P = 0.02) with no difference in disease-specific survival (P = 0.38). Multivariate analysis for disease-free survival revealed HIR disease (P = 0.04) and GYO treatment (P = 0.049) to be significant, with a trend for age ≤64 (P = 0.05). Multivariate analysis for overall survival found age ≤64 (P = 0.0001), HIR disease (P = 0.01), and adjuvant radiotherapy (P = 0.0055) to be significant. Conclusions. Women primarily managed by a GYO for early-stage disease were significantly less likely to receive adjuvant radiotherapy. Despite significantly more unfavorable disease characteristics among GYO-managed women,disease-free and cause-specific survival were equivalent between the two groups. Favorable disease characteristics and adjuvant radiotherapy correlated with improved survival on multivariate analysis.
