放射加化療不能改善子宮內膜癌無復發生存率 Radiation plus chemotherapy doesn’t improve endometrial cancer recurrence-free survival

評論:該報告似乎表明單獨化療作為放療和化療是有效的。 但是,我們不確定化療是否有效且足夠安全。 如果化療有效,為什麼要使用放療和化療相結合? 這可能意味著僅化療並不是那麼有效。

用於治療子宮內膜癌的化療藥物包括紫杉醇(紫杉醇),卡鉑,多柔比星(阿黴素)或脂質體多柔比星(Doxil)。 這些藥物可促進癌症轉移。

新聞稿12-Jun-2019

放射加化療不能改善子宮內膜癌無復發生存率

科學家們驚訝地發現,這可能會改變當地晚期的子宮內膜癌護理

西北大學

對於局部晚期子宮內膜癌,護理標準是放射和化療
化療與聯合治療同樣有效
輻射會導致負面影響,阻止一些女性完成治療
子宮內膜癌,正在上升,是最常見的婦科癌症,可能與肥胖流行有關

芝加哥—手術後III / IVA期子宮內膜癌患者的護理標準是化療和放療,以防止複發。但在一項令人驚訝的新發現中,輻射聯合化療並未增加這些女性的無復發生存率,美國國家癌症研究所贊助的婦科腫瘤學小組研究由西北醫學科學家/醫師領導。

這是第一項將聯合方案與單獨化療相比較的研究。它將於6月12日在新英格蘭醫學雜誌上發表。

“該試驗應該是一項陽性試驗,證明聯合治療方案優於單獨使用化療,”西北大學費因伯格醫學院醫學教授,西北醫學婦科腫瘤學家Daniela Matei博士說。 “我們的研究結果表明,放療和化療的聯合治療方案並未導致無復發生存率的提高,單獨的化療仍然是III期子宮癌的標準治療方案。”

Matei還是西北大學Robert H. Lurie綜合癌症中心實體腫瘤翻譯研究項目的聯合負責人。

從子宮開始的子宮內膜癌是最常見的婦科癌症,大多數病例發生在55歲以後的女性中。今年將診斷出約62,000例新病例。 Matei說,子宮內膜癌的發生率和死亡率正在上升,這可能與肥胖流行有關。

通常子宮內膜癌伴有絕經後不規則出血。 Matei說,沒有篩查,但絕經後的任何出血都應該引發醫生的就診和檢查。大多數病例在早期診斷,僅通過手術治愈。

3期試驗將736名符合條件的患者隨機分配到兩個可能的治療組之一。一組346人在21週內接受了化療和放療的綜合治療,第二組361名女性在17週內接受了化療。

隨機3期試驗後6個月的中位隨訪顯示,試驗的兩組無復發生存期非常相似:化療和放療組為59%,單純化療組為58%。

同時接受化療和放療的患者骨盆復發較少,但這並沒有轉化為無復發生存率提高,因為在放射野外有復發。

“對於局部復發風險高的患者,可能偶爾需要放射治療以防止骨盆復發,”Matei說。

輻射可引起影響治療患者生活質量的即時和慢性副作用。這些包括腹瀉,低血細胞計數,泌尿系統症狀等。

“一個重要的考慮因素是同時進行化療和放療會導致治療耐受性降低和化療不完全傳遞,”Matei說。 “在這項研究中,超過25%被分配到聯合治療組的患者無法完成化療。”

在認識到化療在子宮內膜癌的治療中起作用之前,歷史上首先使用輻射。在化學治療中加入治療後,繼續使用輻射作為標準方法。

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聽聽Matei博士關於這項研究的禁播播客:https://oembed.libsyn.com/embed?item_id = 10078850

該研究得到美國國立衛生研究院國家癌症研究所的資助CA 27469,CA 37517,1 U10 CA180822,U10CA180868和UG1 CA189867的支持。

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Comment: The report seems to indicate that chemotherapy alone is as effective as radiation and chemotherapy. However, we are not certain how effective and safe chemotherapy is? If chemotherapy is effective, why should a combination of radiation and chemotherapy is used? This could possibly mean that chemotherapy alone is not so effective.

Chemotherapy drugs indicated to treat endometrial cancer include Paclitaxel (Taxol), Carboplatin, Doxorubicin (Adriamycin) or liposomal doxorubicin (Doxil). These drugs promote cancer metastasis.

News Release 12-Jun-2019

Radiation plus chemotherapy doesn’t improve endometrial cancer recurrence-free survival

Surprised by finding, scientists say this may change locally advanced endometrial cancer care

Northwestern University

Standard of care has been radiation and chemo for locally advanced endometrial cancer

Chemotherapy was as effective as combined therapy

Radiation causes negative side effects that prevent some women from completing therapy

Endometrial cancer, on the rise, is most common gynecologic cancer, could be tied to obesity epidemic

CHICAGO — The standard of care for women with stage III/IVA endometrial cancer following surgery has been chemotherapy and radiation to prevent recurrence. But in a surprising new finding, radiation combined with chemotherapy did not increase recurrence-free survival in these women, reports a National Cancer Institute-sponsored Gynecology Oncology Group study led by a Northwestern Medicine scientist/physician.

This is the first study comparing the combined regimen to chemotherapy alone. It will be published June 12 in the New England Journal of Medicine.

“The trial was supposed to be a positive trial demonstrating that the combined regimen was superior to chemotherapy given alone,” said lead investigator Dr. Daniela Matei, a professor of medicine at Northwestern University Feinberg School of Medicine and a Northwestern Medicine gynecological oncologist. “Our results indicate the combined regimen of radiation and chemotherapy did not result in an improvement in recurrence-free survival, and that chemotherapy alone remains the standard of care for stage III uterine cancer.”

Matei also is the co-leader of the Translational Research in Solid Tumors Program at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

Endometrial cancer, which begins in the uterus, is the most common gynecologic cancer with most cases occurring in women after age 55. About 62,000 new cases will be diagnosed this year. Occurrence of and mortality from endometrial cancer is rising, which may be tied to the obesity epidemic, Matei said.

Usually endometrial cancer presents with post-menopausal irregular bleeding. There is no screening, but any bleeding after menopause should trigger a doctor’s visit and examination, Matei said. Most cases are diagnosed at an early stage and are cured with surgery alone.

The phase 3 trial randomly assigned 736 eligible patients to one of two possible treatment arms. A group of 346 received a combined treatment consisting of chemotherapy and radiation over 21 weeks, a second group of 361 women received chemotherapy alone over 17 weeks.

A median follow-up of six months after the randomized phase 3 trial showed the recurrence-free survival for the two arms of the trial were very similar: 59 percent for the group that got chemotherapy and radiation and 58 percent for chemotherapy alone.

Patients who received both chemo and radiotherapy had fewer recurrences in the pelvis, however this did not translate into improved recurrence-free survival, because there were relapses outside of the radiation field.

“For patients at high risk of a local relapse, radiation may be occasionally necessary to prevent pelvic recurrences,” Matei said.

Radiation can cause immediate as well as chronic side effects that impact the quality of life of treated patients. These include diarrhea, low blood counts, urinary symptoms and others.

“An important consideration is the fact that concomitant delivery of chemo and radiotherapy can result in decreased tolerance of the treatment and incomplete delivery of chemotherapy,” Matei said. “More than 25 percent of patients assigned to the combined arm were not able to complete chemotherapy on this study.”

Radiation was historically used first, before it was recognized that chemotherapy has a role in the treatment of endometrial cancer. After chemotherapy was added to the treatment, radiation continued to be used as a standard approach.

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Listen to an embargoed podcast about the study with Dr. Matei: https://oembed.libsyn.com/embed?item_id=10078850

This study was supported by grants CA 27469, CA 37517, 1 U10 CA180822, U10CA180868 and UG1 CA189867 from National Cancer Institute of the National Institutes of Health.

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