子宫内膜癌治疗教案.ppt

PORTEC?2 (2010): EBRT vs VBT 入选条件：HIR of endometrial cancer (age 60 years and above and stage IC grade 1 or 2 or stage IB grade 3, and any age with stage IIA grade 1,2 or grade 3 with less than 50% invasion (FIGO 1988)) 427例。 所有患者随机给予VBT vs EBRT。 5年总生存期和局部复发在两组无差异。 生活质量：VBT组显著高于EBRT，后者腹泻和肠瘘的发生率显著升高。 放射治疗：中危患者 Lancet 2010, 375: 816–823 Maggi et al. (2006): chemotherapy vs radiation 入选条件：stage III (two-thirds), stage IC/grade 3 and stage II/grade 3 with more than 50% myometrial invasion (FIGO 1988) 例 。 所有患者随机给予PAC方案化疗 vs EBRT。 两组的5年总生存率和无瘤生存率无差异。 放射治疗：高危患者 Br J Cancer. 2006, 95: 266–271 Hogberg et al. (2007): EBRT ± VBT + chemotherapy vs EBRT ± VBT 入选条件：stage I, II, IIIA (positive for peritoneal fluid cytology only) or IIIC (FIGO 1988)(positive pelvic lymph nodes only) , with two or more risk factors: grade 3, deep myometrial invasion or DNA non diploidy.共367例。 所有患者随机给予EBRT ± vaginal brachytherapy + chemotherapy vs EBRT ± vaginal brachytherapy 。 PFS的HR为 0.58 ，EBRT + chemotherapy有利 (95% CI: 0.34–30.99; p = 0.046) 。 作者认为放疗+化疗优于放疗。 放射治疗：高危患者之早期病例 J Clin Onol. ASCO Annual Meeting Proceedings, 2007, 25(18): S5503 Japanese GOG (2008): EBRT vs chemotherapy 入选条件：stage IC–IIIC endometrial carcinoma with deeper than 50% myometrial invasion (FIGO 1988) 475例。 所有患者随机给予EBRT vs PAC chemotherapy 。 总生存期和无瘤生存期在两组无差异。 亚组分析：高危组(1) stage IC patients over age 70 years or G3 endometrioid adenocarcinoma or (2) stage II or IIIA (positive cytology) patients with deeper than 50% myometrial invasion in the corpus 化疗组优于放疗组：PFS (HR: 0.44; 95% CI: 0.20–20.97; p = 0.024) and OS (HR: 0.24; 95% CI: 0.09–00.69; p = 0.006) 放射治疗：高危患者之早期病例 Gynecol Oncol. 2008, 108: 226–233 Japanese GOG (2008): EBRT vs chemotherapy 放射治疗：高危患者之早期病例 Gynecol Oncol. 2008, 108: 226–233 GOG 122 (2006) : WAI vs chemotherapy 入选条件：stage III or IV endometrial cancer (FIGO 1988) 422 例 。 所有患者随机给予whole abdominal irradiation therapy (WAI) vs PA化疗。 The progression and death HR relative to the WAI arm, 0.71 (95% CI: 0.55–0.91; p = 0