中晚期子宮內膜癌術后放療效果的系統評價_《中國循證醫學雜志》

作者：

魏冬梅 ¹ , 梅玲 ¹ ,  方芳 ¹ , 吳泰相 ² , 劉關鍵 ²

1. 四川大學華西附屬二院婦科（成都 610041）2. 四川大學華西醫院循證醫學與臨床流行病學中心（成都 610041）;

關鍵詞：

輔助性放療子宮內膜癌系統評價隨機對照試驗 Meta分析

DOI：

10.7507/1672-2531.20080054

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目的　系統評價術后放療在中晚期子宮內膜癌的治療效果、安全性及成本效果。
方法　電子檢索Cochrane圖書館、The Cochrane Central Register of Controlled Trials（CENTRAL）、The National Research Register、Health technology assessment database（HTA）、MEDLINE、 EMbase、CancerLit、CBMdisc、VIP、萬方學位論文數據庫、CNKI并輔以手工檢索。檢索時間截至2007年3月，收集子宮內膜癌（EC）術后放療與術后非放療比較的隨機對照試驗（RCT）。由兩名研究者按Cochrane系統評價方法，獨立選擇試驗，提取資料、評價納入研究的方法學質量，提取有效數據進行Meta分析。
結果　共納入符合標準的RCT 3個，患者1126例， 3個RCT均是術后盆腔放療與術后化療的比較，其中2個RCT為放療與CAP化療方案比較，包括730例患者；1個RCT為放療與AP化療方案比較，包括396例患者。Meta分析結果顯示：對子宮內膜癌Ic、II、III期患者，其5、7年總體生存率、疾病無進展存活率及5年局部復發率、遠處復發率、總復發率，在放療組與化療組的差異無統計學意義；對子宮內膜癌III、IV期患者，其5年總體生存率、疾病無進展存活率，化療組優于放療組；在3/4級消化系統及泌尿生殖系毒性反應方面，化療組與放療組的差異無統計學意義；而3/4級血液學毒性反應方面，化療組高于放療組。
結論　對子宮內膜癌Ic、II、III期患者，術后盆腔放療的效果和化療相似；但對子宮內膜癌III、IV期患者，放療的效果比化療差；放療的骨髓抑制作用比化療小，在胃腸道和泌尿生殖系3/4級毒性反應，兩者差異無統計學意義。

引用本文： 魏冬梅,梅玲,方芳,吳泰相,劉關鍵. 中晚期子宮內膜癌術后放療效果的系統評價. 中國循證醫學雜志, 2008, 08(4): 244-251. doi: 10.7507/1672-2531.20080054 復制

1.	?9 Abeler VM, Kjorstad KE. Endometrial squamous cell carcinoma: Report of three cases and review of the literature. Gynecol Oncol, 1990, 36(2): 21.
2.	Eitan R, Saenz CC, Venkatraman ES, et al. Pilot study prospectively evaluating the use of the measurement of preoperative sonographic endometrial thickness postmenopausal patients with endometrial cancer. Menopause, 2005, 12(1): 27-30.
3.	Purdie DM, Green AC. Epidemiology of endometrial cancer: best practice and research. Clin Obstet Gynaecol, 2001, 15(1): 341-354.
4.	Jeffrey JF, Krepart GV, Lotocki RJ. Papillary serous adenocarcinoma of the endometrium. Obstet Gynecol, 1986, 67(5): 670-674.
5.	Dunton CJ, Balsara G, Mcfarland M, et al. Uterine papillary serous carcinoma: A review. Obstet Gynecol Surv, 1991, 46(8): 97-102.
6.	吳鳴, 郎景和. 子宮內膜癌的特殊類型--子宮乳頭狀漿液性癌. 中華婦產科雜志, 1996, 31(1): 3-7.
7.	Sherman AL. Progesterone caproate in the treatment of endometnal cancer. Obstet Gynecal, 1992, 28(6): 309.
8.	吳鳴, 沈鏗, 郎景和. 子宮內膜癌206 例臨床分析. 中華婦產科雜志. 2002, 37(5): 620.
9.	Abeler VM, Kjorstad KE. Clear cell carcinoma of the endometrium: A histo-pathological and clinical study of 97 cases. Gynecol Oncol, 1991, 40(6): 207.
10.	Creasman WT, Odicino F, Maisonneuve P, et al. Carcinoma of the corpus uteri. Int J Gynaecol Obstet, 2003, 83(Suppl 1): 79-118.
11.	Martinez AA, Stitt JA, Speiser BL, et al. Clinical applications of brachytherapy II: high2dose2rate. In: Perez CA, Brady LW, eds.Principles and practice of radiation oncology. 3rd ed. Philadelphia Lippincott-Raven, 1998. 5732576.
12.	中華醫學會婦產科學會, 中華婦產科雜志編輯委員會. 婦科常見惡性腫瘤診斷治療規范(草案). 中華婦產科雜志, 1998, 33(4): 701-704.
13.	Ball HG, Elkadry EA. Endometrial cancer: current concepts and management. Surg Oncol Clin N Am, 1998, 7(1): 271-284.
14.	Creasman WT, Morrow CP, Bundy BN, et al. Surgical pathologic spread patterns of endometrial cancer, A Gynecologic Oncology Group Study. Cancer, 1987, 60(suppl.8): 2035-2041.
15.	Morrow CP, Bundy BN, Kurman RJ, et al. Relationship between surgical-pathological risk factors and outcome in clinical stage 1 and II carcinoma of the endometrium: a Gynecologic Oncology Group study. Gynecol Oncol, 1991, 40(8): 55-65.
16.	Kadar N, Malfetano JH, Homesley HD. Determinants of survival of surgically staged patients with endometrial carcinoma histologically confined to the uterus: implications for therapy. Obstel Gynecol, 1992, 80(6): 655-659.
17.	Randall ME, Wilder J, Greven K, et al. Role of intracavitary cuff boost after adjuvant external irradiation in early endometrial carcinoma. Int J Radiat Oncol Biol Phys, 1990, 19(7): 49-54.
18.	Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions 4.2.4 [updated March 2005]. In: The Cochrane Library, Issue 2, 2005.
19.	Maggi R, Lissoni A, Spina F, et al. Adjuvant chemotherapy vs radiotherapy in high-risk endometrial carcinoma: results of a randomised trial. J British of cancer, 2006, 95(9): 266-271.
20.	Randall ME, Filiaci VL, Muss H, et al. A randomized phase III trial of whole abdominal irradiation versus doxorubicin-cisplatin chemotherapy in advanced endometrial carcinoma: A Gynecologic Oncology Group study. J Clin Oncol, 2006, 24(8): 36-44.
21.	Sagae S, Udagawa Y, Susumu N, et al. Randomized phase III trial of whole pelvic radiotherapy versus cisplatin-based combined chemotherapy in patients with inertmediate risk endometrial carcinoma (slide).
22.	Fanning J, Hoffman ML, Andrews SJ, et al. Cost-effectiveness analysis Of the treatment for intermediate risk endometrial cancer: postoperativebrachy therapy versus observation. Gynecol Oncol, 2004, 93(6): 632-636.
23.	Laupacis A, Feeny D, Detsky AS, et al. How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluation. Can Med Assoc J, 1992, 146(11): 473-481.

1. ?9 Abeler VM, Kjorstad KE. Endometrial squamous cell carcinoma: Report of three cases and review of the literature. Gynecol Oncol, 1990, 36(2): 21.
2. Eitan R, Saenz CC, Venkatraman ES, et al. Pilot study prospectively evaluating the use of the measurement of preoperative sonographic endometrial thickness postmenopausal patients with endometrial cancer. Menopause, 2005, 12(1): 27-30.
3. Purdie DM, Green AC. Epidemiology of endometrial cancer: best practice and research. Clin Obstet Gynaecol, 2001, 15(1): 341-354.
4. Jeffrey JF, Krepart GV, Lotocki RJ. Papillary serous adenocarcinoma of the endometrium. Obstet Gynecol, 1986, 67(5): 670-674.
5. Dunton CJ, Balsara G, Mcfarland M, et al. Uterine papillary serous carcinoma: A review. Obstet Gynecol Surv, 1991, 46(8): 97-102.
6. 吳鳴, 郎景和. 子宮內膜癌的特殊類型--子宮乳頭狀漿液性癌. 中華婦產科雜志, 1996, 31(1): 3-7.
7. Sherman AL. Progesterone caproate in the treatment of endometnal cancer. Obstet Gynecal, 1992, 28(6): 309.
8. 吳鳴, 沈鏗, 郎景和. 子宮內膜癌206 例臨床分析. 中華婦產科雜志. 2002, 37(5): 620.
9. Abeler VM, Kjorstad KE. Clear cell carcinoma of the endometrium: A histo-pathological and clinical study of 97 cases. Gynecol Oncol, 1991, 40(6): 207.
10. Creasman WT, Odicino F, Maisonneuve P, et al. Carcinoma of the corpus uteri. Int J Gynaecol Obstet, 2003, 83(Suppl 1): 79-118.
11. Martinez AA, Stitt JA, Speiser BL, et al. Clinical applications of brachytherapy II: high2dose2rate. In: Perez CA, Brady LW, eds.Principles and practice of radiation oncology. 3rd ed. Philadelphia Lippincott-Raven, 1998. 5732576.
12. 中華醫學會婦產科學會, 中華婦產科雜志編輯委員會. 婦科常見惡性腫瘤診斷治療規范(草案). 中華婦產科雜志, 1998, 33(4): 701-704.
13. Ball HG, Elkadry EA. Endometrial cancer: current concepts and management. Surg Oncol Clin N Am, 1998, 7(1): 271-284.
14. Creasman WT, Morrow CP, Bundy BN, et al. Surgical pathologic spread patterns of endometrial cancer, A Gynecologic Oncology Group Study. Cancer, 1987, 60(suppl.8): 2035-2041.
15. Morrow CP, Bundy BN, Kurman RJ, et al. Relationship between surgical-pathological risk factors and outcome in clinical stage 1 and II carcinoma of the endometrium: a Gynecologic Oncology Group study. Gynecol Oncol, 1991, 40(8): 55-65.
16. Kadar N, Malfetano JH, Homesley HD. Determinants of survival of surgically staged patients with endometrial carcinoma histologically confined to the uterus: implications for therapy. Obstel Gynecol, 1992, 80(6): 655-659.
17. Randall ME, Wilder J, Greven K, et al. Role of intracavitary cuff boost after adjuvant external irradiation in early endometrial carcinoma. Int J Radiat Oncol Biol Phys, 1990, 19(7): 49-54.
18. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions 4.2.4 [updated March 2005]. In: The Cochrane Library, Issue 2, 2005.
19. Maggi R, Lissoni A, Spina F, et al. Adjuvant chemotherapy vs radiotherapy in high-risk endometrial carcinoma: results of a randomised trial. J British of cancer, 2006, 95(9): 266-271.
20. Randall ME, Filiaci VL, Muss H, et al. A randomized phase III trial of whole abdominal irradiation versus doxorubicin-cisplatin chemotherapy in advanced endometrial carcinoma: A Gynecologic Oncology Group study. J Clin Oncol, 2006, 24(8): 36-44.
21. Sagae S, Udagawa Y, Susumu N, et al. Randomized phase III trial of whole pelvic radiotherapy versus cisplatin-based combined chemotherapy in patients with inertmediate risk endometrial carcinoma (slide).
22. Fanning J, Hoffman ML, Andrews SJ, et al. Cost-effectiveness analysis Of the treatment for intermediate risk endometrial cancer: postoperativebrachy therapy versus observation. Gynecol Oncol, 2004, 93(6): 632-636.
23. Laupacis A, Feeny D, Detsky AS, et al. How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluation. Can Med Assoc J, 1992, 146(11): 473-481.

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中晚期子宮內膜癌術后放療效果的系統評價

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《中國循證醫學雜志》

中晚期子宮內膜癌術后放療效果的系統評價

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