Clinical Analysis Of Postoperative Radiotherapy For Stage ? And ? Endometrial Carcinoma

Objective:Endometrial carcinoma is one of the three major malignant tumors in the female genital tract,the incidence of endometrial carcinoma has increased rapidly in recent years due to the changes of diet and metabolic diseases.More than 80% of the histologic types are endometrial adenocarcinoma,most of them can be diagnosed early,and have good response to adjuvant radiotherapy and chemotherapy after operation.Special types of endometrial cancer account for about 20%,such as serous endometrial carcinoma and clear cell carcinoma of endometrium with high malignancy and poor prognosis.The most common manifestation of endometrial carcinoma is irregular vaginal bleeding,which is prone to local infiltration and lymph node metastasis.Surgery is the preferred treatment for early endometrial cancer.Postoperative radiotherapy or chemotherapy should be combined according to high risk factors,including of histological grade,depth of muscular invasion,lymph node involvement.In recent years,the radiotherapy methods of pelvic external irradiation and vaginal internal irradiation have been widely used in the radiotherapy of endometrial cancer.In this study,vaginal irradiation was added in different treatment stages of pelvic external irradiation to observe the difference in efficacy and adverse reactions.Methods:Select ?,? postoperative endometrial carcinoma patients who with high risk factors from the first affiliated hospital of zhengzhou university radiotherapy department,90 patients of all.Divided them randomly into observation group(45 cases)and control group(45 cases).Both groups were treated with Intensity Modulated Radiation Therapy(IMRT)combined with vaginal brachytherapy(VBT).External pelvic radiation 1.8 Gy /d,5d/week,total dose of 45 Gy;Vaginal radiation 6Gy/ time,3 times in total,once a week.Observation group: vaginal irradiation was added in the first week of pelvic external irradiation treatment;Control group: vaginal irradiation was added after 2 weeks of external pelvic irradiation.External pelvic irradiation is not available on the day of vaginal irradiation therapy.During the treatment,symptomatic treatment was performed for the adverse reactions such as bone marrow suppression and gastrointestinal injury,patients were followed up after treatment to monitor the incidence of short-term and long-term adverse reactions and long-term survival rate.Results:All patients completed the treatment successfully.There was no significant difference in the incidence of acute radioactive cystitis and bone marrow suppression between the two groups(P > 0.05).Acute radiation proctitis observation group vs control group(93.3%vs77.8%),the difference was statistically significant(P < 0.05).After 2 years of follow-up,the incidence of adverse reactions was lower than grade 3.The survival rate of the observation group and the control group(86.7%vs93.3%),chronic radioactive cystitis(10.26%vs9.52%),the difference was not statistically significant(P > 0.05).Chronic radiation proctitis(23.08%vs7.14%),the difference was statistically significant(P < 0.05).Conclusions:?,?stage postoperative endometrial cancer patients who accompany with high risk factors,their 2-year survival rate was nearly 90% after the treatment of EBRT combined with VBT,the therapeutic effect was satisfactory.Add vaginal brachytherapy after 10 times external irradiation can effectively reduce the incidence of short-term and long-term radiation intestinal injury in patients and improve the quality of life.