EVRE I ENDOMETRİUM KANSERİNDE UYGULANAN RADYOTERAPİ ŞEKLİNİN UZUN DÖNEM YAN ETKİ SONUÇLARINA ETKİSİ: PELVİK EKSTERNAL RADYOTERAPİ VEYA VAGİNAL BRAKİTERAPİ?

Öz

Endometrium kanseri kadınlarda en çok görülen jinekolojik kanser tipidir. Primer tedavisi cerrahidir. Evre I endometrium kanserinde cerrahi

sonrası vajinal brakiterapi (BT) veya eksternal pelvik radyoterapi (RT) kararı hastanın yaşı, tümörün boyutu, myometrial invazyon derinliği,

operasyon tipi, tümörün derecesi, lenfovasküler invazyon olup olmaması gibi prognostik faktörler göz önüne alınarak verilmektedir.

Amacımız evre I endometrium kanseri tanısı ile postoperatif pelvik eksternal RT veya vajinal BT uygulanmış hastaların uzun dönem yan etki

sonuçlarını objektif veriler eşliğinde sunmaktır. Çalışmaya Ocak 2010-Aralık 2013 arasında, FIGO 2009’a göre evre I endometrium kanseri

tanılı, kliniğimizde postoperatif vajinal BT veya pelvik eksternal RT uygulanmış, en az 12 ay takip süresine sahip, 67 hasta dahil edilmiştir.

Hastaların yaş ortalaması 60 (aralık 37-80)’dır. Yirmi bir (%31,3)’inde tek başına Total Abdominal Histerektomi+Bilateral Salfingooferektomi

(TAH+BSO) operasyonu şeklinde iken; 46 (%68,7)’sına pelvik, paraaortik lenf nodu disseksiyonu (LND) da eklenmiştir. Histopatolojik olarak

42 (%62,7)’si endometrioid adenokarsinom, 25 (%37,3)’i non-endometrioid adenokarsinomdur. Hastaların 37 (%55,2)’sine vaginal BT, 30

(%44,8)’una pelvik eksternal RT uygulanmıştır. Mesane, rektum, cilt ve ciltaltı dokular için vajinal BT uygulanan grupta pelvik RT’ye göre

anlamlı seviyede az geç yan etkiler izlenirken (p<.001), vaginal yan etkiler açısından iki grup arasında farklılık gösterilememiştir (p=.572).

Myometrial invazyon derinliği, LVİ varlığı, hastanın yaşı ve lenf nodu disseksiyonu durumu göz önüne alınarak vaginal BT yada pelvik RT

kullanılabilir.

Anahtar Kelimeler

• Endometium Kanseri,Pelvik Radyoterapi,Brakiterapi,Geç yan etki

THE EFFECT OF APPLIED RADIOTHERAPY TYPE OVER LONG TERM TOXICITY IN STAGE I ENDOMETRIUM CARCINOMA: PELVIC EXTERNAL BEAM OR VAGINAL BRACHYTHERAPY?

Öz

Endometrium carcinoma is the most commonly seen gynecologic cancer type for women. Primary treatment is surgery. Adjuvant treatment

decision between vaginal brachytherapy (BT) and pelvic external radiotherapy (RT) is given according to the prognostic factors like

patient’s age, tumor size, myometrium invasion depth, type of surgery, tumor grade and the presence of lymphovascular space invasion.

We aim to present long term toxicity results of the patients with stage I endometrium carcinoma treated with postoperative pelvic external

RT or vaginal BT with the light of objective data. Between January 2010 and December 2013, totally 67 patients with stage I endometrium

carcinoma according to FIGO 2009, who were treated with postoperative vaginal brachytherapy or pelvic external RT, were evaluated

for this trial. Minimum 12 months follow up time was required for inclusion. Mean age was 60 (range, 37-80) years. Total Abdominal

Hysterectomy+Bilateral Salphyngooferectomy (TAH+BSO) was applied to 21 (31,3%) patients, pelvic para-aortic lymph node dissection

was added to 46 (68,7%) patients. In pathologic evaluation, endometrioid and non-endometriod adenocarcinoma was detected in 42

(62,7%) and 25 (37,3%) patients, respectively. Vaginal BT used to 37 (55,2%) of patients and pelvic external RT used to 30 (44,8%) patients.

Long-term toxicities in terms of bladder, rectum, cutaneous and subcutaneous tissues were significantly lower in vaginal BT than pelvic

external RT (all p values <.001). On the other hand, there could not be shown any difference for vaginal toxicities between two groups

(p=.572). Pelvic External RT or vaginal BT can be used safely according to the physician’s preference by considering patient’s age, tumor

size, myometrium invasion depth, type of surgery, tumor grade and the presence of lymphovascular space invasion.

Anahtar Kelimeler

• Endomerium Carcinoma,Pelvic Radiotherapy,Brachytherapy,Late toxicity

Kaynakça

1. 1. Creutzberg CL, van Putten WL, Koper PC, et al. Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC Study Group. Post Operative Radiation Th erapy in Endometrial Carcinoma. Lancet. 2000 Apr 22;355(9213):1404-11.
2. 2. Nout RA, Smit VT, Putter H, et al; PORTEC Study Group. Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): an open-label, non-inferiority, randomised trial. Lancet. 2010 Mar 6;375(9717):816-23. doi: 10.1016/S0140-6736(09)62163- 2.
3. 3. Sorbe B, Horvath G, Andersson H, Boman K, Lundgren C, Pettersson B. External pelvic and vaginal irradiation versus vaginal irradiation alone as postoperative therapy in medium-risk endometrial carcinoma--a prospective randomized study. Int J Radiat Oncol Biol Phys. 2012 Mar 1;82(3):1249-55. doi: 10.1016/j.ijrobp.2011.04.014.
4. 4. ASTEC/EN.5 Study Group, Blake 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 meta-analysis. Lancet. 2009 Jan 10;373(9658):137-46. doi: 10.1016/S0140-6736(08)61767-5.
5. 5. Nout RA, van de Poll-Franse LV, Lybeert ML, et al. Longterm outcome and quality of life of patients with endometrial carcinoma treated with or without pelvic radiotherapy in the post operative radiation therapy in endometrial carcinoma 1 (PORTEC-1) trial. J Clin Oncol. 2011 May 1;29(13):1692-700. doi: 10.1200/JCO.2010.32.4590.
6. 6. Nout RA, Putter H, Jürgenliemk-Schulz IM, et al. Fiveyear quality of life of endometrial cancer patients treated in the randomised Post Operative Radiation Th erapy in Endometrial Cancer (PORTEC-2) trial and comparison with norm data. Eur J Cancer. 2012 Jul;48(11):1638-48. doi: 10.1016/j.ejca.2011.11.014.
7. 7. Miles T, Johnson N. Vaginal dilator therapy for women receiving pelvic radiotherapy. Cochrane Database Syst Rev. 2014 Sep 8;(9):CD007291. doi: 10.1002/14651858. CD007291.pub3.
8. 8. Park HS, Ratner ES, Lucarelli L, Polizzi S, Higgins SA, Damast S. Predictors of vaginal stenosis aft er intravaginal high-dose-rate brachytherapy for endometrial carcinoma. Brachytherapy. 2015 Jul-Aug;14(4):464-70. doi: 10.1016/j.brachy.2015.03.001.

9. 9. Nout RA, Putter H, Jürgenliemk-Schulz IM, et al. Quality of life aft er pelvic radiotherapy or vaginal brachytherapy for endometrial cancer: first results of the randomized PORTEC-2 trial. J Clin Oncol. 2009 Jul 20;27(21):3547- 56. doi: 10.1200/JCO.2008.20.2424.
10. 10. de Boer SM, Nout RA, Jürgenliemk-Schulz IM, et al Long-Term Impact of Endometrial Cancer Diagnosis and Treatment on Health-Related Quality of Life and Cancer Survivorship: Results From the Randomized PORTEC-2 Trial. Int J Radiat Oncol Biol Phys. 2015 Nov 15;93(4):797- 809. doi: 10.1016/j.ijrobp.2015.08.023.