ENDOMETRİUM KANSERİNDE RADYOTERAPİ- KEMOTERAPİNİN ROLÜ: RANDOMİZE ÇALIŞMALAR EŞLİĞİNDE DEĞERLENDİRME
Öz
Endometrium kanseri genellikle olguların erken evrede tanı alması
nedeniyle iyi prognoza sahiptir. Pelvik radyoterapi (RT) evre I
olgularda oldukça yüksek lokal kontrol oranları sağlarken, sağkalım
avantajı yoktur. Yüksek ve orta riskli endometrium kanserinde ise RT
‘nin yeri sınırlıdır. Geleneksel olarak bu olgularda RT kullanılmasına
karşın 5 yıllık sağkalım oranları %80’lerin altında kalmaktadır. Bu
yüksek riskli ve ileri evre olgularda tedavi başarını arttırmak için adjuvan
sistemik tedaviye ihtiyaç vardır.
Endometrium kanserinde eskiden gelen genel görüş kemoterapiye
dirençli olduğu yönünde olsa da günümüzde bu düşünce değişime
uğramıştır. Tamamlanmış ve yürümekte olan çalışmalar kemoterapi
ve RT’nin birlikteliğini, yalnız kemoterapi ya radyoterapinin rolünü
açıklamaktadır. Bu derlemede randomize çalışmalar ışığı altında endometrium
kanserinde kemoterapi ve radyoterapinin yeri araştırılmıştır.
Anahtar Kelimeler
Kaynakça
- 1. Hogberg T. What is the Role of Chemotherapy in Endometrial Cancer. Curr Oncol Rep 2011,13;433-441.
- 2. Kitchener H, Swart AM, Qian Q et al. Effcacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC TR‹AL): a randomised study. Lancet 2001;373:125-136.
- 3. Benedetti PP, Basile S, Maneschi F et al. Systematic pelviz lymphadenectomy vs no lymphadenectomy in early stage endometrial carcinoma:randomised clinical trial. J Natl Cancer Inst 2008;100:1707-17016.
- 4. Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix and endometrium. Int J Gynecol Obstet 2009;105: 103-104.
- 5. Cruetzberg CI, van Putten WI, Koper PC et al. Surgery and postoperative radiotherapy versus surgery alone for patients with stage I endometrial carcinoma: multicentre randomised trial.PORTEC study group. Postoperative radiation therapy in endometrial carcinoma. Lancet 2000;355:1404-1411.
- 6. Keys HM, Roberts JA, Brunetto VL et al. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma:a Gyneacologic Oncology Group study. Gynecol Oncol 2004;92:744-751.
- 7. Aalders J, Abeler V, Kolstad P et al. Postoperative external irradiation and prognostic parametres in stage I endometrial carcinoma:clinical and histopathologic study of 540 patients. Obstet Gyneacol 1980;56:419-427.
- 8. Blafe P, Swart AM, Orton J et al. Adjuvant external beam radiotherapy in the treatment of endometrial cancer (MRC ASTEC and NCIC CTG EN.5 randomised trials): pooled trial results, systematic review and metaanalysis. Lancet 2009;373:137-146.
- 9. Scholten AN, van Putten WL, Beerman H et al. Postoperative radiotherapy for stage I endometrial carcinoma: long term outcome of the randomised PORTEC trial with central pathology review. Int J Radiat Oncol Biol Phys 2005;63:834-838.
- 10. Nout RA, Smit VTHB, Putter H et al. Vaginal brachitherapy versus pelvic external beam radiotherapy for endometrial cancer:first results of the randomized (PORTEC-2 trial. J Clin Oncol 2009;27:3547-3456.
- 11. Morrow CP, Bundy BN, Homesley HD et al. Doxorubicine as an adjuvant following surgery and radiation therapy in patients with high risk endometrial carcinoma, stage I and occult stage II;a Gyneacologic Oncology Group study. Gynaecol Oncol 1990;36 (2):166-177.
- 12. Susumu N, Sagae S, Udagawa Y et al. Randomized phase IIItrial of pelvic radiotherapy versus cisplatinbased combined chemotherapy in patients with intermediate and high risk endometrial cancer:a japanese Gynecologic Oncology Group study. Gynaecol Oncol 2008;108:226-233.
- 13. Maggi R, Lissoni A, Spina F et al. Adjuvant chemotherapy vs radiotherapy in high risk endometrial carcinoma:results of a randomised trial. Br J Cancer 2006;95 (3): 266-271.
- 14. Randal ME, Filiaci VL, Muss H et al. Randomized phase III trial of whole-abdominal irradiation versus doxorubicine and cisplatin chemotherapy in advanced endometrial carcinoma:a Gynaecologic Oncology group study. J Clin Oncol 2006;24 (1):36-44.
- 15. Hogberg T, Rosenberg P, kristensen G et al. A randomized phase III study on adjuvant treatment with radiation (RT)+/- chemotherapy (CT) in early stage high risk endometrial cancer (NSGO-EC-9501/EORTC 55991). J Clin Oncol 2007;25 (18S) 8abstract 5503).
- 16. Signorelli M, Lissoni AA, Cormio G et al. Modified radical hysterectomy versus extrafacial hysterectomy in the treatment of stage I endometrial cancer:results from the ILIADE randomized study. Ann Surg Oncol 2009;16:3431-3441.
Öz
Endometrial carcer generally has a good prognosis because most
cases are diagnosed in stage I. Pelvic radiotherapy (RT) for stage I
endometrial cancer provides a highly significant improvement of local
control, but without survival advantage. Use of adjuvant RT is limited
to patients with high-intermediate or high risk factors. Despite a
tradiational generous use of adjuvant radiotherapy those patients
have less than an %80 5 year overall survival. In those high-risk
patients and locally advanced endometrial carcinomas there is a need
for systemic adjuvant therapy.
Endometrial cancer has traditionally been thought to be a rather
chemotherapy intensitive tumour, but gradually this view has
changed. Current ongoing trials are exploring the role of combined
radiotherapy and chemotherapy, compared to chemotherapy or RT
alone. This is a review of the randomised studies carried out on adjuvant
chemotherapy and radiotherapy in endometrial cancer
Anahtar Kelimeler
Kaynakça
- 1. Hogberg T. What is the Role of Chemotherapy in Endometrial Cancer. Curr Oncol Rep 2011,13;433-441.
- 2. Kitchener H, Swart AM, Qian Q et al. Effcacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC TR‹AL): a randomised study. Lancet 2001;373:125-136.
- 3. Benedetti PP, Basile S, Maneschi F et al. Systematic pelviz lymphadenectomy vs no lymphadenectomy in early stage endometrial carcinoma:randomised clinical trial. J Natl Cancer Inst 2008;100:1707-17016.
- 4. Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix and endometrium. Int J Gynecol Obstet 2009;105: 103-104.
- 5. Cruetzberg CI, van Putten WI, Koper PC et al. Surgery and postoperative radiotherapy versus surgery alone for patients with stage I endometrial carcinoma: multicentre randomised trial.PORTEC study group. Postoperative radiation therapy in endometrial carcinoma. Lancet 2000;355:1404-1411.
- 6. Keys HM, Roberts JA, Brunetto VL et al. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma:a Gyneacologic Oncology Group study. Gynecol Oncol 2004;92:744-751.
- 7. Aalders J, Abeler V, Kolstad P et al. Postoperative external irradiation and prognostic parametres in stage I endometrial carcinoma:clinical and histopathologic study of 540 patients. Obstet Gyneacol 1980;56:419-427.
- 8. Blafe P, Swart AM, Orton J et al. Adjuvant external beam radiotherapy in the treatment of endometrial cancer (MRC ASTEC and NCIC CTG EN.5 randomised trials): pooled trial results, systematic review and metaanalysis. Lancet 2009;373:137-146.
- 9. Scholten AN, van Putten WL, Beerman H et al. Postoperative radiotherapy for stage I endometrial carcinoma: long term outcome of the randomised PORTEC trial with central pathology review. Int J Radiat Oncol Biol Phys 2005;63:834-838.
- 10. Nout RA, Smit VTHB, Putter H et al. Vaginal brachitherapy versus pelvic external beam radiotherapy for endometrial cancer:first results of the randomized (PORTEC-2 trial. J Clin Oncol 2009;27:3547-3456.
- 11. Morrow CP, Bundy BN, Homesley HD et al. Doxorubicine as an adjuvant following surgery and radiation therapy in patients with high risk endometrial carcinoma, stage I and occult stage II;a Gyneacologic Oncology Group study. Gynaecol Oncol 1990;36 (2):166-177.
- 12. Susumu N, Sagae S, Udagawa Y et al. Randomized phase IIItrial of pelvic radiotherapy versus cisplatinbased combined chemotherapy in patients with intermediate and high risk endometrial cancer:a japanese Gynecologic Oncology Group study. Gynaecol Oncol 2008;108:226-233.
- 13. Maggi R, Lissoni A, Spina F et al. Adjuvant chemotherapy vs radiotherapy in high risk endometrial carcinoma:results of a randomised trial. Br J Cancer 2006;95 (3): 266-271.
- 14. Randal ME, Filiaci VL, Muss H et al. Randomized phase III trial of whole-abdominal irradiation versus doxorubicine and cisplatin chemotherapy in advanced endometrial carcinoma:a Gynaecologic Oncology group study. J Clin Oncol 2006;24 (1):36-44.
- 15. Hogberg T, Rosenberg P, kristensen G et al. A randomized phase III study on adjuvant treatment with radiation (RT)+/- chemotherapy (CT) in early stage high risk endometrial cancer (NSGO-EC-9501/EORTC 55991). J Clin Oncol 2007;25 (18S) 8abstract 5503).
- 16. Signorelli M, Lissoni AA, Cormio G et al. Modified radical hysterectomy versus extrafacial hysterectomy in the treatment of stage I endometrial cancer:results from the ILIADE randomized study. Ann Surg Oncol 2009;16:3431-3441.
Ayrıntılar
| Diğer ID | JA77SJ37BF |
|---|---|
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Ekim 2013 |
| Gönderilme Tarihi | 1 Ekim 2013 |
| Yayımlandığı Sayı | Yıl 2013 Cilt: 16 Sayı: 4 |