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2007 | 5 | 3 | 151-158
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Analiza wyników samodzielnej radioterapii chorych na raka endometrium

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Radiotherapy as sole treatment of endometrial cancer. Analysis of treatment outcome
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Radiotherapy was used as a stand-alone therapeutic modality in 155 patients with endometrial cancer, treated at the Cracow Branch of the Center of Oncology since 1988 thru 1999. In these patients surgical excision was impossible due to far-advanced cancer (clinical stages III and IV) (n=50), severe comorbidity and poor performance status (n=105). In this patient population, 50 persons in clinical stage I received intracavitary brachytherapy, while the remaining 105 patients in clinical stages II, III and IVA received external beam irradiation followed by intracavitary brachytherapy. In the entire group (n=155), cumulative symptom-free 5 year survival rate was 51% (n=79). In relation to tumour grade, 5 year symptom- free survival rate was 70.3% in patients with well differentiated tumour, 43.5% in those with intermediate- grade tumour and only 20% in persons with poorly differentiated cancer. In patients with stage I endometrial cancer, symptom-free 5 year survival rate was 82% (n=41/50); in clinical stage II – 54.5% (30/55), in clinical stages III and IVA – 16% (8/50). Multivariate Cox analysis revealed that independent prognostic factors were clinical stage and tumour grade. Cure rates were 82%, 54.4% and 16% in clinical stages I, II and III/IVA, respectively. Symptom-free 5-year survival rates were 70.3%, 43.5% and 20% in well-differentiated, intermediate- and poorly-differentiated tumours, respectively. Severe late complications of radiotherapy (3rd and 4th degree) developed in 3.5% of patients.
W latach 1988-1999 w krakowskim Oddziale Centrum Onkologii (COOK) leczono pierwotnie napromienianiem 155 chorych na raka endometrium (RE), u których niemożliwe było wykonanie zabiegu operacyjnego z powodu zbyt dużego zaawansowania raka (stopnie III i IV) (50 chorych), ciężkich chorób towarzyszących i złego stanu sprawności (105 chorych). U 50 chorych na RE w I stopniu zaawansowania zastosowano wyłącznie brachyterapię dojamową, u pozostałych 105 (stopnie II, III i IVA) brachyterapię dojamową skojarzono z uprzednią teleradioterapią. Spośród 155 chorych badanej grupy 79 pacjentek (51%) przeżyło 5 lat bez objawów nowotworu. Pięć lat bez objawów nowotworu przeżyło 70,3% chorych na wysoko zróżnicowanego, 43,5% na średnio zróżnicowanego i 20% na nisko zróżnicowanego raka. Spośród 50 chorych na raka w I stopniu zaawansowania 5 lat bez objawów choroby przeżyło 41 (82%) pacjentów, spośród 55 chorych na raka w II stopniu zaawansowania - 30 (54,5%), a spośród 50 chorych na raka w stopniach III i IVA - tylko 8 (16%). W wielocechowej analizie Coksa niezależnymi czynnikami prognostycznymi były zaawansowanie kliniczne i stopień zróżnicowania raka. Wyleczono 82% chorych na RE w I stopniu zaawansowania, 54,5% w II stopniu i tylko 16% w stopniach III i IVA. Pięć lat bez objawów nowotworu przeżyło odpowiednio 70,3%, 43,5% i 20% chorych na wysoko, średnio i nisko zróżnicowanego raka. Odległe, ciężkie powikłania (stopnie 3. i 4.) radioterapii wystąpiły jedynie u 3,5% chorych.
Physical description
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