연세의대, 가천의대 / 김현주, 이준교, 김용배*, 김영생*
Abstract
Objective: The optimal adjuvant treatment for patients with locally advanced endometrial cancer (EC) remains debatable. We comparatively analyzed recurrence patterns and survival outcomes in patients with stage III-IVA EC treated with adjuvant chemotherapy (CT) exclusively or combined with radiotherapy (CRT).
Methods: We retrospectively analyzed 184 patients treated for stage III-IVA EC at 2 tertiary institutions between 2010 and 2021. All patients underwent standard primary surgery and received either CT alone (n = 89) or CRT (n = 95) as an adjuvant treatment. We compared the failure patterns, recurrence-free survival (RFS), and overall survival (OS) between the CT and CRT groups.
Results: The median follow-up period was 54.8 months. Most patients underwent pelvic (94.6%) or para-aortic (75.5%) lymphadenectomies. The 5-year RFS was 69.2% with CRT versus 56.3% with CT (P = 0.038), and 5-year OS was 86.1% versus 78.9% (P = 0.357). Pelvic and para-aortic recurrence rates were significantly higher in the CT group (pelvic: 29.2%; para-aortic: 20.2%) than in the CRT group (pelvic: 10.5%; para-aortic: 6.3%). The CRT group showed a higher rate of distant recurrence (CRT, 23.2% vs. CT, 14.6%) however, the 5-year cumulative incidence of distant recurrence was not significantly different between the two groups (CRT, 28% vs. CT, 35%).
Conclusions: This study highlights the potential benefits of adjuvant CRT in patients with stage III-IVA EC. The incorporation of molecular classification is necessary to derive optimal personalized adjuvant treatment strategies for this patient population.
Affiliations
Hyun Ju Kim 1, Joongyo Lee 2, Kwang-Beom Lee 3, KiHoon Sung 1, Yong Bae Kim 4, Young Saing Kim 5
1Department of Radiation Oncology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea.
2Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
3Department of Obstetrics and Gynecology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea.
4Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: ybkim3@yuhs.ac.
5Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea. Electronic address: zoomboom@hanmail.net.
편집위원
국소진행된 자궁내막암(병기 III-IVA)에서 수술후 보조적 항암치료 단독과 항암방사선치료의 예후를 분석한 연구로, 2개 기관에서 후향적으로 분석함. 국소진행된 자궁경부암에서 수술후 보조적 항암치료는 일반적으로 시행하고 있으나, 항암치료와 함께 방사선치료를 시행하는 것은 치료 효과 측면에서는 여전히 논란의 여지가 있는 상황으로, 본 연구에서는 방사선치료 추가가 구역임파절(골반 및 대동맥주위임파절) 재발 가능성을 줄이는 데 효과가 있으나, 전체생존율 향상이라는 측면에서는 통계적 유의성을 보여주지 못했다고 보고했고, 이는 기존의 다른 연구에서도 이미 잘 알려진 내용임. 다만 방사선치료 추가가 원격전이 억제 효과의 가능성을 보임으로써 잠재적 장점이 있을 것으로 주장하는 것이 흥미로운 부분이라 생각됨.
2024-03-28 11:08:06