Lokálisan és lokoregionálisan előrehaladott, magas kockázatú endometriumtumorok műtét előtti szisztémás előkezelése = Preoperative systemic treatment of locally and locoregionally advanced high-risk endometrial cancer

Absztrakt: Bevezetés: A méhtestrák a fejlett országokban a leggyakoribb invazív nőgyógyászati daganat. A legjobb túlélési eredmények a tumor műtéti eltávolítása után várhatók, ezért a komplex ellátás célja a lokálisan és lokoregionálisan előrehaladott betegség reszekábilissé tétele. Célkitűzés: A jelen közleményben azt vizsgáljuk, hogy a neoadjuváns kemoterápiával kezelt és műtéten átesett betegek teljes túlélése jobb-e a csak sugárkezelést kapott páciensekéhez képest. Módszer: 2015. január és 2018. december között 28, lokálisan, illetve lokoregionálisan előrehaladott, primeren irreszekábilis, magas kockázatú méhtesttumoros betegnél végeztünk neoadjuváns szisztémás kezelést paklitaxel-karboplatin alkalmazásával. Ezt követően radikális hysterectomia, kétoldali petefészek-eltávolítás történt lymphadenectomiával. Eredmények: A 6 ciklus kemoterápia után készült kontroll-MR-vizsgálat minden esetben méretbeli csökkenést igazolt. Minden betegnél véghez vihető volt a teljes tumoreltávolítás. A szövettani leletek alapján 4 páciens esetében igazolódott maradék tumor az eltávolított nyirokcsomókban. A 2 éves túlélési arány 65,5%, a 2 éves progressziómentesség 66,1% volt. A medián teljes túlélés 16,5 hónap volt. Mindegyik érték jobbnak bizonyult a csak sugárkezelést kapó csoportnál. Következtetés: A neoadjuváns kezelés hatékony módja lehet a reszekabilitás feltételeinek megteremtésében, ami túlélésbeli előnnyel járhat. A komplex ellátás ellenére a betegek túlélése továbbra is szerény. Orv Hetil. 2020; 161(11): 425–433. | Abstract: Introduction: Endometrial cancer is the most common invasive gynecologic malignancy in developed countries. The best survival rates are expected after surgical removal, thus the aim of a complex treatment is to achieve resecability in locally and locoregionally advanced disease. Aim: The primary purpose of this study was to evaluate if the neoadjuvant systemic treatment leads to better overall survival compared to irradiation solely. Method: From January 2015 to December 2018, we enrolled 28 patients diagnosed with irresecable, locally and locoregionally advanced high-risk endometrial carcinoma. Patients were treated by neoadjuvant paclitaxel–carboplatin, then radical hysterectomy, bilateral oophorectomy and lymphadenectomy were performed. Results: After administration of 6 cycles of carboplatin–paclitaxel, the control MR test showed tumor shrinkage in all patients. Complete resection was achieved in the case of every patient. Tumor residuum in lymph nodes was verified in 4 cases by pathological evaluation. The 2-year survival and the 2-year progression-free survival rates were 65,1% and 66,1%, respectively. The median overall survival was 16,5 months. Conclusion: Neoadjuvant treatment can be an effective approach in providing the conditions for complete tumor resection, which may result in survival advantage. Despite multimodal treatment, prognosis is poor. Orv Hetil. 2020; 161(11): 425–433

3-D conformal photon boost in the treatment of early stage breast cancer: four year follow up results.

peer reviewedIn the treatment of early stage breast cancer, breast conserving surgery (BCS) followed by whole breast irradiation (WBI) is the standard treatment. The impact of the tumor bed boost following WBI is well-defined, but there are various delivery methods. In this study we demonstrate our 4 year experience with the 3-D conformal boost technique. Between January 2004 and June 2005, 77 early stage (Stage I-II) breast cancer patients were treated in our institute with whole breast irradiation (WBI, 50.4 Gy in 28 fractions) after breast conserving surgery. Following WBI, 3-D conformal photon boost was delivered (10-16 Gy in five to eight fractions) for all patients. The clinical outcome was retrospectively recorded in terms of survival and local control. The side effect profile (fibrosis, fat necrosis and cosmetic outcome) was also recorded and studied. In our patient group the mean follow up time was 46.8 months (median: 52, range: 17-71, SD: 14.4) The 4-year probability of local tumor control was 96% (crude rate: 74/77-96.1%), the 4-year probability of overall survival was 96% (crude rate: 74/77-96.1%) in this patient group. In case of the distant metastasis free survival the probability was 89, 5% (crude rate: 70/77-90, 1%). Probability of disease specific survival was 98% (crude rate: 76/77-98. 7%). Local relapse occurred in three cases (3.9%). In ten cases (12.9%) asymptomatic grade I-II breast fibrosis, in eight cases (10.4%) asymptomatic breast fat necrosis were registered. For 14 patients (18.2%) asymptomatic lung fibrosis was recorded on the control CT scans. In term of the relapse free survival, the close resection margin and the nodal positivity resulted in significant difference in favor of the clear resection margin group and the node negative group. In this study the 3-D conformal photon boost resulted in good local control and side effect profile. The presence of tumor bed clips resulted in significantly lower boost PTV volumes, but no correlation was found between the irradiated boost volume and the breast fibrosis. In the relapse free survival analysis, nodal negativity and clear margin status resulted in significantly better RFS