tumorsMalignant tumoursMalignant tumours2224-50572587-6813Rosoncoweb10.18027/2224-5057-2014-3-68-71tumors-69Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL REPORTSАДЪЮВАНТНАЯ ЛУЧЕВАЯ ТЕРАПИЯ РАКА ЭНДОМЕТРИЯ НИЗКОГО И УМЕРЕННОГО РИСКА: АРГУМЕНТЫ ЗАADJUVANT RADIOTHERAPY FOR LOW AND MODERATE RISK ENDOMETRIAL CANCER: PRO AND CONTRAШарабураТ. М.SharaburaTatiana M.

Шарабура Татьяна Михайловна – кандидат медицинских наук, зав. отд. радиотерапии ГБУЗ «ЧОКОД» Тел: 89049777313. E-mail: tatyana1612@yandex.ru

tatyana1612@yandex.ruЖаровА. В.ZharovAleksandr V.

Жаров Александр Владимирович – доктор медицинских наук,  профессор кафедры онкологии ГБОУ ВПО «ЮУГМУ» Тел: +73512327877

E-mail: zharov1966@yandex.ru

zharov1966@yandex.ruВаженинА. В.VazheninAndrej V.

Важенин Андрей Владимирович – член-корреспондент РАМН, д.м.н.,  профессор, главный врач  ГБУЗ «ЧОКОД», зав. кафедрой онкологии, лучевой диагностики и лучевой терапии ГБОУ ВПО «ЮУГМУ» Тел: +73512327877. E-mail: roc_chel@mаil.ru

zharov1966@yandex.ruВасильеваТ. А.VasiljevaTamara A.

Васильева Тамара  Александровна – зав. отд. радиотерапии ГБУЗ «ЧОКОД» Тел: 89048064458

zharov1966@yandex.ruЧелябинский Областной Клинический Онкологический ДиспансерRussian FederationЮжно-Уральский государственный медицинский университет, ЧелябинскRussian FederationЧелябинский Областной Клинический Онкологический Диспансер; Южно-Уральский государственный медицинский университет, ЧелябинскRussian Federation201420052015036871Copyright © Шарабура Т.М., Жаров А.В., Важенин А.В., Васильева Т.А., 20152015Шарабура Т.М., Жаров А.В., Важенин А.В., Васильева Т.А.Sharabura T.M., Zharov A.V., Vazhenin A.V., Vasiljeva T.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.malignanttumors.org/jour/article/view/69

Большинство больных раком эндометрия  (РЭ) имеют I стадию заболевания,  основным методом лечения которой является тотальная гистерэктомия с двухсторонней сальпингоовариоэктомией с или без тазовой лимфаденэктомии. Отношение к адъювантной лучевой терапии при раннем раке эндометрия неоднозначно и определяется  риском рецидива. В соответствие с глубиной инвазии миометрия, гистологическим типом и степенью дифференцировки РЭ I ст классифицируется  на низкий, промежуточный и высокий риск поражения лимфатических узлов и отдаленного метастазирования.  В рандомизированных исследованиях доказано достоверное улучшение локального контроля после облучения малого таза и/ или внутриполостного облучения влагалища без улучшения общей выживаемости среди пациенток высокого и промежуточного риска. При этом больше всего разногласий связано с назначением адъювантной лучевой терапии при РЭ промежуточного риска в связи с неоднородностью данной группы, что потребовало выделение подгруппы высокого промежуточного риска с учетом дополнительных факторов: лимфоваскулярная  инвазия  и возраст.  В подгруппе высокого промежуточного риска локо-регионарный эффект  адъювантной лучевой терапии оказался  более  значимым. С учетом неоднородности пациенток ранним РЭ, сложностью оценки прогноза в случае невыполнения регионарной лимфаденэктомии и риска поздних лучевых осложнений предпринимаются  попытки оптимизировать показания, объем и способ адъювантной лучевой терапии в соответствие с факторами риска.

Most patients with endometrial cancer (EC) have stage I disease, the treatment of choice is a total hysterectomy with bilateral salpingo-oophorectomy with or without pelvic lymphadenectomy. Concerning adjuvant radiotherapy for early endometrial cancer is unclear and determined by the risk of recurrence. In accordance with the depth of invasion of the myometrium, histological type and degree of differentiation stage I endometrial cancer is classified into low, intermediate and high risk of lymph node and distant metastasizing. Randomized studies have shown significant improvement in local control after radiation of pelvis and/or intracavitary radiation of the vagina without improving overall survival among patients of high and intermediate risk. At the same time the most controversy associated with the using of adjuvant radiation therapy in intermediate risk EC due to the heterogeneity of the group, which required selection of a subgroup of high intermediate risk, taking into account additional factors: lymphovascular invasion and age. In a subgroup of high-intermediate risk loco-regional effect of adjuvant radiotherapy was more significant. Taking into account the heterogeneity of patients with early EC, the complexity of the assessment of prognosis in case of not provided regional lymphadenectomy and the risk of late radiation complications attempts to optimize the indications, the volume and method of adjuvant radiation therapy in accordance with the risk factors.

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The authors declare that there are no conflicts of interest present.