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題名 | 晚期子宮內膜癌=Advanced Endometrial Cancer |
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作者 | 吳孟浩; 張國華; 賴允亮; 王銘志; Wu, Meng-hao; Chang, Kuo-hwa; Lai, Yuen-liang; Wang, Ming-chin; |
期刊 | 放射治療與腫瘤學 |
出版日期 | 19970300 |
卷期 | 4:1 1997.03[民86.03] |
頁次 | 頁49-56 |
分類號 | 417.27 |
語文 | chi |
關鍵詞 | 子宮內膜癌; 手術後放射治療; 預後; Endometrial cancer; Post-operative radiotherapy; Prognosis; |
中文摘要 | 目的:本文以回溯性研究將馬偕紀念醫院十一年來的病患重新病理分期為晚期子 子宮內膜癌病患的存活與治療的狀況做一分析整理,以提供未來治療方向的依據。 材料與方法:從 1985 年 6 月到 1996 年 7 月, 在馬偕紀念醫院癌症登記中共有 174 名 子宮內膜癌的病患,重新將手術後病理報告及腹腔癌細胞檢查結果以國際婦產科聯盟期別 系統分期後,25 名病患為第 III 期子宮內膜癌患,4 名為第四期病人;年齡由 40 歲到 79 歲,中位數為 56 歲;臨床表現症狀中以不正常出血最為常見,佔 21/29;28 名病患經 過手術探查,有 18 位病患接受手術後輔助性放射治療,包括體外照射及陰道殘端腔內治療 ,照射總劑量分別為 5040 cGy 到 5940 cGy 與 2000 cGy 到 3000 cGy;追蹤期為 2.5 個 月到 161.3 個月(中值為 37.3 個月), 實際的累計存活曲線則依照 Kaplan-Meier 分析 法求得,並採用 Gehans Generalized Wilcoxon test 來檢測不同存活曲線的差異性。 結果: 重新病理分期後有 14 名患者為第 III A 期、11 名患者為第 III C 期、1 名為第 IVN A 期、3 名為第 IV B 期。全部病患五年整體的存活率為 48.3%;第三期病患的五年存 活率為 52%;而 4 名第四期的患者有 3 名死亡;五年存活率在細胞分化度佳、淺肌層侵犯 、輔助放療等情形下有顯著差異;高齡病患亦可見低的五年存活率,但未達顥著差異。 結論:本研究分析可知對晚期子宮內膜癌手術後放療的給與可提高存活率;年齡大者,病理 期別與細胞分化度差的比率均較高,因而可能有較差的存活率;深部子宮肌層侵犯會明顯影 響存活率,但可能與高比率的差細胞分化度與淋巴轉移有關;對於單獨的輸卵管或卵巢侵犯 的病患,應鼓勵其完成骨盆腔放療以取得較佳的存活機會;但是若有巨觀的子宮旁組織的侵 犯,主動脈旁淋巴結轉移,第三級分化度與透明細胞癌或乳突狀漿液癌,更積極的輔助性治 療如更大範圍的放療或化學治療等應即早使用。 |
英文摘要 | Purpose:To evaluate the therapeutic results of stage III and IV advanced endometrial carcinoma treated at Mackay Momorial Hospital over the past ten years.To address the future direction in the management of this disease. Materials and methods: From July 1985 to June 1996, 174 patients with pathologically proven endometrial cancer were registered. All patients were staged according to the 1988 FIGO staging system. There were 25 casse with stage III disease and 4 patients with stage IV disease. The median age was 57 years with a range of 40-79 years. Abnormal vaginal bloody discharge (21/29) was the most common symptom. Twenty-eight patients received a surgical approach initially. Seventeen patients received adjuvant radiotherapy to the whole pelvis with doses ranging from 5040 cGy to 5940 cGy and vaginal cuff irradiation with doses ranging from 2000 cGy to 3000 cGy, respectively. The follow-up period ranged from 2.5 months to 161.3 months. The acturial five-year cumulative survival rate was evaluated according to the Kaplan-Meier method and significance was calculated according to the Gehans General Wilcoxon test. Results:Restaging showed 14 cases with stage IIIA disease, 11 with stage IIIC, 1 with stage IVA and 3 with stage IVB. The overall 5-year survival for all patients was 48.3%, and for stage III patients was 52%. There were four patients with stage IV disease, three of them died during the follow-up. In addition, the overall 5-year survival rate was statistically higher in grade 1 and 2 than in grade 3 in superficial myometrial invasion and in the radiation group. Older aged patients did have a lower 5-year survival rate but it was not statistically significant. Conclusion:In patients with solitary extrauterine involvement, whole pelvis irradiation results in better survival. Gross adnexic involvement, para-aortic lymph node metastases and poordifferentiation or clear cell or papillary serous farcinoma have a more aggressive character, and so pelvic irradiation only as adjuvant therapy diation, hormonal therapy and chemotherapy should be considered. |
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