结节阳性子宫内膜癌的治疗:化疗,放射治疗,免疫治疗和向治疗
Elizabeth A Tubridy1, Neil K Taunk2, Emily M Ko3,4,5
1Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA. Elizabeth.tubridy@pennmedicine.upenn.edu.
Current treatment options in oncology
|January 25, 2024
概括
对于IIIC期子宫内膜癌,不断发展的治疗方法结合了化疗,免疫疗法和辐射. 目前的策略为早期疾病提供辅助疗法,为晚期或复发病例提供化疗免疫疗法,以优化结果.
科学领域:
- 妇科瘤学 妇科瘤学
- 辐射瘤学 辐射瘤学
- 医学瘤学 医学瘤学
背景情况:
- 结节阳性子宫内膜癌 (FIGO IIIC阶段) 管理正在发展,超出了传统的放射治疗 (RT).
- 系统化疗,向疗法和分子瘤特征的进步正在重塑治疗范式.
- 寻求化学疗法,免疫疗法,向药物和RT的最佳组合,以最大限度地获得益处并最大限度地减少毒性.
研究的目的:
- 为IIIC期子宫内膜癌的最佳管理策略提供意见.
- 在正在进行的临床试验和不断变化的治疗选择的背景下指导临床决策.
主要方法:
- 文献综述和当前证据的综合.
- 根据疾病状况 (术后可测量与不可测量疾病) 和复发模式制定治疗建议.
- 考虑辅助疗法,化疗免疫疗法和辐射技术 (IMRT,支臂疗法).
主要成果:
- 用IMRT (强度调节辐射疗法) 和卡博普拉丁/帕克利塔塞尔,+/- pembrolizumab/dostarlimab进行辅助化疗,建议在没有可测量疾病的IIIC阶段患者进行术后治疗.
- 化学免疫疗法适用于患有可测量疾病,高风险组织学或第四阶段疾病的患者.
- 对于患有阴道复发的子宫风险因素的患者,增加了阴道支架疗法.
- 对于治疗后6个月以上的复发,IMRT和支臂疗法 (没有化疗) 是为盆腔节点和阴道复发提供.
- 对于可测量的复发而言,化学免疫疗法是首选的,这种复发不能仅仅接受盆腔辐射.
结论:
- 目前治疗IIIC期子宫内膜癌的方法是综合多模式治疗,包括化疗,免疫疗法和放射治疗.
- 治疗决策应根据疾病程度,组织学,分子特征和复发模式来个性化.
- 关于免疫疗法/RT组合和基于分子的管理的持续研究将进一步完善治疗策略.
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