Background/Purpose: Analyse the outcomes of stages I–III inoperable endometrial cancer (IEC) patients treated with external-beam-irradiation (EBRT) and 3D-image-guided-brachytherapy (IGBT). Material and Methods: Medical records of IEC patients receiving EBRT + IGBT in eight European and one Canadian centres (2004–2019) were examined, including: pelvic ± para-aortic EBRT and lymph node boost; anaesthetic procedure, applicators, BT-planning imaging, clinical target volume (CTV), brachytherapy schedule, and EQD2 to the CTV(α/β=4.5Gy)and D2 cm3(α/β=3Gy)for organs at risk. Complications are evaluated using CTCAEv4 scores. The 2- and 5-year survival probability according to stages was estimated (cancer-specific survival (CSS), disease-free survival (DFS), local relapse-free survival (LRFS), loco-regional relapse-free survival (LRRFS), and distant metastasis-free survival (DMFS)). Statistics: descriptive analysis and the Kaplan–Meier method. Results: 103 patients (stages: I-44, II-14, III-44) were included. Median follow-up: 28 months (7–170). All patients received pelvic ± para-aortic EBRT. Median D90-EQD2(α/β=4.5)to the CTV:73.3 Gy (44.6–132.7), 69.9 Gy (44.7–87.9 and 75.2 Gy (55.1–97) in stages I, II, and III, respectively. Thirty patients presented relapse (stages: 10-I, 3-II, 17-III): 24 uterine (stages: 7-I, 3-II, 14-III), 15 nodal (stages: 4-I, 1-II, 10-III), and 23 distant (stages: 6-I, 2-II, 15-III). Five year CSS was 71.2% (stages: 82%-I-II and 56%-III) and DFS, LRFS, LRRFS, and DMFS were 55.5%, 59%, 72%, and 67.2%, respectively. Late G3-G4 complications (crude): 1.3% small bowel, 2.5% rectum, and 5% bladder. Conclusion: In stages I–III of the IEC, EBRT + IGBT offer good 2- and 5-year CSS of 88.7% and 71.2%, respectively, with the best outcomes in stages I–II. Prospective studies are needed to determine how better outcomes can be achieved.
背景/目的：分析接受外照射放疗（EBRT）联合三维图像引导近距离放疗（IGBT）治疗的I-III期不可手术子宫内膜癌（IEC）患者的临床结局。材料与方法：回顾性分析欧洲八家中心及加拿大一家中心（2004-2019年）接受EBRT+IGBT治疗的IEC患者病历资料，包括：盆腔±腹主动脉旁EBRT及淋巴结增量照射；麻醉方式、施源器、近距离放疗计划影像、临床靶区（CTV）、近距离放疗方案，以及基于线性二次模型（CTV的α/β=4.5Gy，危及器官的α/β=3Gy）计算的CTV等效生物剂量（EQD2）和危及器官D2 cm3剂量。并发症采用CTCAEv4标准评估。按分期估算2年及5年生存率（癌症特异性生存率（CSS）、无病生存率（DFS）、局部无复发生存率（LRFS）、区域无复发生存率（LRRFS）及无远处转移生存率（DMFS））。统计学方法：描述性分析与Kaplan-Meier法。结果：共纳入103例患者（分期：I期44例，II期14例，III期44例）。中位随访时间28个月（7-170个月）。所有患者均接受盆腔±腹主动脉旁EBRT。CTV中位D90-EQD2(α/β=4.5)剂量：I、II、III期分别为73.3 Gy（44.6-132.7）、69.9 Gy（44.7-87.9）和75.2 Gy（55.1-97）。30例患者出现复发（分期：I期10例，II期3例，III期17例）：子宫复发24例（分期：I期7例，II期3例，III期14例），淋巴结复发15例（分期：I期4例，II期1例，III期10例），远处转移23例（分期：I期6例，II期2例，III期15例）。5年CSS为71.2%（分期：I-II期82%，III期56%），DFS、LRFS、LRRFS和DMFS分别为55.5%、59%、72%和67.2%。晚期G3-G4并发症（粗发生率）：小肠1.3%，直肠2.5%，膀胱5%。结论：对于I-III期IEC患者，EBRT+IGBT治疗方案可获得良好的2年及5年CSS（分别为88.7%和71.2%），其中I-II期患者疗效最佳。未来需开展前瞻性研究以探索更优的治疗策略。
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