子宫内膜癌

对可治愈的患者，手术是最重要的治疗措施。

标准手术包括全子宫及双侧附件切除以及淋巴结清扫术。[71]Amant F, Moerman P, Neven P, et al. Endometrial cancer. Lancet. 2005;366:491-505.http://www.ncbi.nlm.nih.gov/pubmed/16084259?tool=bestpractice.com

初次手术可采用经腹、经典腹腔镜或机器人辅助的腹腔镜手术三种途径，这三种方式手术结局相当，后两种方式减少并发症。[148]Lin F, Zhang QJ, Zheng FY, et al. Laparoscopically assisted versus open surgery for endometrial cancer - a meta-analysis of randomized controlled trials. Int J Gynecol Cancer. 2008;18:1315-1325.http://www.ncbi.nlm.nih.gov/pubmed/18217968?tool=bestpractice.com[149]Palomba S, Falbo A, Mocciaro R, et al. Laparoscopic treatment for endometrial cancer: a meta-analysis of randomized controlled trials (RCTs). Gynecol Oncol. 2009;112:415-421.http://www.ncbi.nlm.nih.gov/pubmed/18973934?tool=bestpractice.com[150]de la Orden SG, Reza MM, Blasco JA, et al. Laparoscopic hysterectomy in the treatment of endometrial cancer: a systematic review. J Minim Invasive Gynecol. 2008;15:395-401.http://www.ncbi.nlm.nih.gov/pubmed/18602044?tool=bestpractice.com[151]Ju W, Myung SK, Kim Y, et al. Comparison of laparoscopy and laparotomy for management of endometrial carcinoma: a meta-analysis. Int J Gynecol Cancer. 2009;19:400-406.http://www.ncbi.nlm.nih.gov/pubmed/19407567?tool=bestpractice.com

关于常规行盆腔淋巴结清扫术的有效性的争议越来越多。从未有研究显示出常规淋巴结切除术治疗子宫内膜癌的获益，而一些较新的数据则质疑，增加此手术操作并联合子宫切除术和 BSO 作为所有子宫内膜癌病例的主要手术治疗方法是否有益。[152]Kitchener H, Swart AM, Qian Q, et al. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet. 2009;373:125-136.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2646126/?tool=pubmedhttp://www.ncbi.nlm.nih.gov/pubmed/19070889?tool=bestpractice.com前瞻性研究将女性患者随机分配至淋巴结切除术组和未接受淋巴结切除术组，结果并未显示接受淋巴结切除术的女性比未接受此术的女性有更多的获益。[152]Kitchener H, Swart AM, Qian Q, et al. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet. 2009;373:125-136.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2646126/?tool=pubmedhttp://www.ncbi.nlm.nih.gov/pubmed/19070889?tool=bestpractice.com[153]Benedetti Panici P, Basile S, Maneschi F, et al. Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst. 2008;100:1707-16.http://www.ncbi.nlm.nih.gov/pubmed/19033573?tool=bestpractice.com前哨淋巴结活检是一种前景广阔的新型分期技术，可指导辅助治疗，使发病率更低。[95]Frost JA, Webster KE, Bryant A, et al. Lymphadenectomy for the management of endometrial cancer. Cochrane Database Syst Rev. 2015;(9):CD007585.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007585.pub3/fullhttp://www.ncbi.nlm.nih.gov/pubmed/26387863?tool=bestpractice.com

肥胖以及伴随疾病使内膜癌患者更易发生围术期风险及并发症。[101]Badger C, Preston N, Seers K, et al. Physical therapies for reducing and controlling lymphoedema of the limbs. Cochrane Database Syst Rev. 2004;(4):CD003141.http://www.ncbi.nlm.nih.gov/pubmed/15495042?tool=bestpractice.com

对于具有特定危险因素（例如，年龄＞60 岁，存在淋巴血管间隙浸润 [LVI] 或患有 3 级肿瘤）的 IA 期疾病患者，如果为高危或中危，则可采用辅助放射疗法进行治疗。[104]Nout RA, Smit VT, Putter H, et al. Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): an open-label, non-inferiority, randomised trial. Lancet. 2010;375:816-823.http://www.ncbi.nlm.nih.gov/pubmed/20206777?tool=bestpractice.com[117]Nout RA, Putter H, Jürgenliemk-Schulz IM, et al. Five-year quality of life of endometrial cancer patients treated in the randomised Post Operative Radiation Therapy in Endometrial Cancer (PORTEC-2) trial and comparison with norm data. Eur J Cancer. 2012;48:1638-1648.http://www.ncbi.nlm.nih.gov/pubmed/22176868?tool=bestpractice.com

越来越多的证据表明阴道内放治疗可有效降低阴道复发且毒性较小。有证据表明，与外放射疗法 (EBRT) 相比，阴道短距离放疗导致的肠道毒性较少，可使患者的生活质量更佳，但是性功能障碍除外，性功能障碍是一个较为复杂的问题，这两种疗法对性功能的影响相似。目前中危患者应行阴道内放治疗而非外放治疗。[104]Nout RA, Smit VT, Putter H, et al. Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): an open-label, non-inferiority, randomised trial. Lancet. 2010;375:816-823.http://www.ncbi.nlm.nih.gov/pubmed/20206777?tool=bestpractice.com[117]Nout RA, Putter H, Jürgenliemk-Schulz IM, et al. Five-year quality of life of endometrial cancer patients treated in the randomised Post Operative Radiation Therapy in Endometrial Cancer (PORTEC-2) trial and comparison with norm data. Eur J Cancer. 2012;48:1638-1648.http://www.ncbi.nlm.nih.gov/pubmed/22176868?tool=bestpractice.com证据 A生存期：有高质量的证据表明对于疾病低危且手术病率较低的患者，外放治疗不能明确延长生存期。阴道内放治疗可预防阴道复发。阴道内放治疗后患者的生活质量较外放治疗后更高（PORTEC-2临床试验）[108]Nout RA, Putter H, Jurgenliemk-Schulz IM, et al. Vaginal brachytherapy versus external beam pelvic radiotherapy for high-intermediate risk endometrial cancer: results of the randomized PORTEC-2 trial. J Clin Oncol. 2008;26:LBA5503.系统评价或者受试者＞200名的随机对照临床试验（RCT）。对于年轻的中危患者（<60岁），盆腔外放治疗可增加继发肿瘤风险，而应谨慎选择。[116]Onsrud M, Cvancarova M, Hellebust TP, et al. Long-term outcomes after pelvic radiation for early-stage endometrial cancer. J Clin Oncol. 2013;31:3951-3956.http://jco.ascopubs.org/content/31/31/3951.longhttp://www.ncbi.nlm.nih.gov/pubmed/24019546?tool=bestpractice.com

内膜癌有时可发生于仍有生育要求的年轻患者中。对这类患者手术仍为标准治疗。然而，经详细咨询后，患者仍选择保留生育功能，可行孕激素治疗，最常用的为小剂量甲地孕酮。孕激素治疗2年以上的安全性研究证据较少。应进行有创性监测包括每3-6个月行宫腔镜内膜活检一次，强烈建议患者完成生育功能后切除子宫。[136]Gunderson CC, Fader AN, Carson KA, et al. Oncologic and reproductive outcomes with progestin therapy in women with endometrial hyperplasia and grade 1 adenocarcinoma: a systematic review. Gynecol Oncol. 2012;125:477-482.http://www.ncbi.nlm.nih.gov/pubmed/22245711?tool=bestpractice.com[137]Baker JO. Efficacy of oral or intrauterine device-delivered progestin in patients with complex endometrial hyperplasia with atypia or early endometrial adenocarcinoma: a meta-analysis and systematic review of the literature. Gynecol Oncol. 2012;125:263-270.http://www.ncbi.nlm.nih.gov/pubmed/22196499?tool=bestpractice.com

参考当地专科医生治疗方案作为剂量指导。

对可治愈的患者，手术是最重要的治疗措施。

标准手术包括全子宫及双侧附件切除以及淋巴结清扫术。[71]Amant F, Moerman P, Neven P, et al. Endometrial cancer. Lancet. 2005;366:491-505.http://www.ncbi.nlm.nih.gov/pubmed/16084259?tool=bestpractice.com

初次手术可经开腹、腹腔镜或机器人辅助的腹腔镜三种途径进行。三种途径的手术结局相当，后两种病死率降低。[148]Lin F, Zhang QJ, Zheng FY, et al. Laparoscopically assisted versus open surgery for endometrial cancer - a meta-analysis of randomized controlled trials. Int J Gynecol Cancer. 2008;18:1315-1325.http://www.ncbi.nlm.nih.gov/pubmed/18217968?tool=bestpractice.com[149]Palomba S, Falbo A, Mocciaro R, et al. Laparoscopic treatment for endometrial cancer: a meta-analysis of randomized controlled trials (RCTs). Gynecol Oncol. 2009;112:415-421.http://www.ncbi.nlm.nih.gov/pubmed/18973934?tool=bestpractice.com[150]de la Orden SG, Reza MM, Blasco JA, et al. Laparoscopic hysterectomy in the treatment of endometrial cancer: a systematic review. J Minim Invasive Gynecol. 2008;15:395-401.http://www.ncbi.nlm.nih.gov/pubmed/18602044?tool=bestpractice.com[151]Ju W, Myung SK, Kim Y, et al. Comparison of laparoscopy and laparotomy for management of endometrial carcinoma: a meta-analysis. Int J Gynecol Cancer. 2009;19:400-406.http://www.ncbi.nlm.nih.gov/pubmed/19407567?tool=bestpractice.com

关于全面的盆腔淋巴结清扫术的争议越来越多。从未有研究显示出常规淋巴结切除术治疗子宫内膜癌的获益，而一些较新的数据则质疑，增加此手术操作并联合子宫切除术和 BSO 作为所有子宫内膜癌病例的主要手术治疗方法是否有益。[152]Kitchener H, Swart AM, Qian Q, et al. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet. 2009;373:125-136.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2646126/?tool=pubmedhttp://www.ncbi.nlm.nih.gov/pubmed/19070889?tool=bestpractice.com前瞻性研究将女性患者随机分配至淋巴结切除术组和未接受淋巴结切除术组，结果并未显示接受淋巴结切除术的女性比未接受此术的女性有更多的获益。[152]Kitchener H, Swart AM, Qian Q, et al. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet. 2009;373:125-136.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2646126/?tool=pubmedhttp://www.ncbi.nlm.nih.gov/pubmed/19070889?tool=bestpractice.com[153]Benedetti Panici P, Basile S, Maneschi F, et al. Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst. 2008;100:1707-16.http://www.ncbi.nlm.nih.gov/pubmed/19033573?tool=bestpractice.com前哨淋巴结活检是一种前景广阔的新型分期技术，可指导辅助治疗，使发病率更低。[95]Frost JA, Webster KE, Bryant A, et al. Lymphadenectomy for the management of endometrial cancer. Cochrane Database Syst Rev. 2015;(9):CD007585.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007585.pub3/fullhttp://www.ncbi.nlm.nih.gov/pubmed/26387863?tool=bestpractice.com

肥胖以及伴随疾病使内膜癌患者更易发生围术期风险及并发症。[101]Badger C, Preston N, Seers K, et al. Physical therapies for reducing and controlling lymphoedema of the limbs. Cochrane Database Syst Rev. 2004;(4):CD003141.http://www.ncbi.nlm.nih.gov/pubmed/15495042?tool=bestpractice.com

IB 至 II 期（高-中等风险）常推荐盆腔放射，但并未证实有生存优势。此外还推荐用于部分并不符合“中危”严格定义的患者。包括患有 3 级肿瘤且肌层浸润≥50% 的患者，或患有 II 期疾病的患者。[73]Keys HM, Roberts JA, Brunetto VL, et al. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2004;92:744-751.http://www.ncbi.nlm.nih.gov/pubmed/14984936?tool=bestpractice.com[102]Einhorn N, Trope C, Ridderheim M, et al. A systematic overview of radiation therapy effects in uterine cancer (corpus uteri). Acta Oncol. 2003;42:557-561.http://www.ncbi.nlm.nih.gov/pubmed/14596513?tool=bestpractice.com[119]Lanciano RM, Curran WJ, Jr., Greven KM, et al. Influence of grade, histologic subtype, and timing of radiotherapy on outcome among patients with stage II carcinoma of the endometrium. Gynecol Oncol. 1990;39:368-373.http://www.ncbi.nlm.nih.gov/pubmed/2258085?tool=bestpractice.com[154]Blake P, Swart AM, Orton J, et al. Adjuvant external beam radiotherapy in the treatment of endometrial cancer (MRC ASTEC and NCIC CTG EN.5 randomised trials): pooled trial results, systematic review, and meta-analysis. Lancet. 2009;373:137-146.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2646125/http://www.ncbi.nlm.nih.gov/pubmed/19070891?tool=bestpractice.com[155]Kong A, Simera I, Collingwood M, et al. Adjuvant radiotherapy for stage I endometrial cancer: systematic review and meta-analysis. Ann Oncol. 2007;18:1595-1604.http://annonc.oxfordjournals.org/cgi/content/full/18/10/1595http://www.ncbi.nlm.nih.gov/pubmed/17347128?tool=bestpractice.com证据 A复发：有高质量证据表明，对早期（I 期）中危子宫内膜癌症患者实施辅助术后盆腔放射疗法可降低复发风险（相比未进行额外治疗的患者），但是该疗法应限于危险因素符合高危或中危定义（妇科肿瘤协作组 [GOG] 第 99 号试验）的患者。[73]Keys HM, Roberts JA, Brunetto VL, et al. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2004;92:744-751.http://www.ncbi.nlm.nih.gov/pubmed/14984936?tool=bestpractice.com系统评价或者受试者＞200名的随机对照临床试验（RCT）。

针对经选择患者组全部患者的治疗推荐

早期高危疾病患者的辅助化疗效果仍有争议。化疗方案多样。[124]Fleming GF, Brunetto VL, Cella D, et al. Phase III trial of doxorubicin plus cisplatin with or without paclitaxel plus filgrastim in advanced endometrial carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol. 2004;22:2159-2166.http://jco.ascopubs.org/cgi/content/full/22/11/2159http://www.ncbi.nlm.nih.gov/pubmed/15169803?tool=bestpractice.com相比紫杉醇、多柔比星和顺铂的联合疗法，优先选择紫杉醇和卡铂，因为其具有相同的有效性，并且毒副作用更小。

参考当地专科医生治疗方案作为剂量指导。

越来越多的证据表明阴道内放治疗可有效降低阴道复发且毒性较小。有证据表明，与外放射疗法 (EBRT) 相比，阴道短距离放疗导致的肠道毒性较少，可使患者的生活质量更佳，但是性功能障碍除外，性功能障碍是一个较为复杂的问题，这两种疗法对性功能的影响相似。目前中危患者应行阴道内放治疗而非外放治疗。[104]Nout RA, Smit VT, Putter H, et al. Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): an open-label, non-inferiority, randomised trial. Lancet. 2010;375:816-823.http://www.ncbi.nlm.nih.gov/pubmed/20206777?tool=bestpractice.com[117]Nout RA, Putter H, Jürgenliemk-Schulz IM, et al. Five-year quality of life of endometrial cancer patients treated in the randomised Post Operative Radiation Therapy in Endometrial Cancer (PORTEC-2) trial and comparison with norm data. Eur J Cancer. 2012;48:1638-1648.http://www.ncbi.nlm.nih.gov/pubmed/22176868?tool=bestpractice.com证据 A生存期：有高质量的证据表明对于疾病低危且手术病率较低的患者，外放治疗不能明确延长生存期。阴道内放治疗可预防阴道复发。阴道内放治疗后患者的生活质量较外放治疗后更高（PORTEC-2临床试验）[108]Nout RA, Putter H, Jurgenliemk-Schulz IM, et al. Vaginal brachytherapy versus external beam pelvic radiotherapy for high-intermediate risk endometrial cancer: results of the randomized PORTEC-2 trial. J Clin Oncol. 2008;26:LBA5503.系统评价或者受试者＞200名的随机对照临床试验（RCT）。对于年轻的中危患者（<60岁），盆腔外放治疗可增加继发肿瘤风险，而应谨慎选择。[116]Onsrud M, Cvancarova M, Hellebust TP, et al. Long-term outcomes after pelvic radiation for early-stage endometrial cancer. J Clin Oncol. 2013;31:3951-3956.http://jco.ascopubs.org/content/31/31/3951.longhttp://www.ncbi.nlm.nih.gov/pubmed/24019546?tool=bestpractice.com

这类患者的治疗为综合治疗，但各类治疗的先后顺序及时间没有最好的方案。

最常见的治疗方法包括手术，之后给予化疗、证据 A生存期：有高质量的证据表明对于III期或IV期内摸样腺癌患者及术后有残余病灶者，多柔比星或顺铂化疗方案可延长无进展生存期。与全腹部放疗相比，化疗能明显延长无进展生存期及总体生存期。[112]Randall ME, Filiaci VL, Muss H, et al. Randomized phase III trial of whole-abdominal irradiation versus doxorubicin and cisplatin chemotherapy in advanced endometrial carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol. 2006;24:36-44.http://jco.ascopubs.org/cgi/content/full/24/1/36http://www.ncbi.nlm.nih.gov/pubmed/16330675?tool=bestpractice.com系统评价或者受试者＞200名的随机对照临床试验（RCT）。和受累野放射疗法。[112]Randall ME, Filiaci VL, Muss H, et al. Randomized phase III trial of whole-abdominal irradiation versus doxorubicin and cisplatin chemotherapy in advanced endometrial carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol. 2006;24:36-44.http://jco.ascopubs.org/cgi/content/full/24/1/36http://www.ncbi.nlm.nih.gov/pubmed/16330675?tool=bestpractice.com[139]Creutzberg CL, van Putten WL, Koper PC, et al. Survival after relapse in patients with endometrial cancer: results from a randomized trial. Gynecol Oncol. 2003;89:201-209.http://www.ncbi.nlm.nih.gov/pubmed/12713981?tool=bestpractice.com[142]Homesley HD, Filiaci V, Gibbons SK, et al. A randomized phase III trial in advanced endometrial carcinoma of surgery and volume directed radiation followed by cisplatin and doxorubicin with or without paclitaxel: a Gynecologic Oncology Group study. Gynecol Oncol. 2009;112:543-552.http://www.ncbi.nlm.nih.gov/pubmed/19108877?tool=bestpractice.com[143]Carey MS, Gawlik C, Fung-Kee-Fung M, et al. Systematic review of systemic therapy for advanced or recurrent endometrial cancer. Gynecol Oncol. 2006;101:158-167.http://www.ncbi.nlm.nih.gov/pubmed/16434086?tool=bestpractice.com证据 A生存期：有高质量证据表明，对于出现阴道疾病复发且此前未接受过放疗的患者群体而言，盆腔放射疗法是有效的挽救治疗方法，其 5 年生存率为 40% 至 70%。[139]Creutzberg CL, van Putten WL, Koper PC, et al. Survival after relapse in patients with endometrial cancer: results from a randomized trial. Gynecol Oncol. 2003;89:201-209.http://www.ncbi.nlm.nih.gov/pubmed/12713981?tool=bestpractice.com[140]Jhingran A, Burke TW, Eifel PJ. Definitive radiotherapy for patients with isolated vaginal recurrence of endometrial carcinoma after hysterectomy. Int J Radiat Oncol Biol Phys. 2003;56:1366-1372.http://www.ncbi.nlm.nih.gov/pubmed/12873682?tool=bestpractice.com系统评价或者受试者＞200名的随机对照临床试验（RCT）。

3 期前瞻性临床试验正在评估同期放化疗之后进行化疗的效果。化疗方案多样。[156]Miller D, Filiaci V, Gelming G, et al. Late-breaking abstract 1: randomized phase III noninfoeriority trial of first line chemotherapy for metastatic or recurrent endometrial carcinoma: a Gynecologic Oncology Group Study. Gynecol Oncol. 2012;125:771-773.相比紫杉醇、多柔比星和顺铂的联合疗法，优先选择紫杉醇和卡铂，因为其具有相同的有效性，并且毒副作用更小。

参考当地专科医生治疗方案作为剂量指导。

化疗结束后，一些患者行盆腔放射治疗，放疗通常在最后一期化疗后35天内开始。

对 IIIA 至 IIIC 期患者以及仅局限于腹部的 IV 期疾病患者进行体外放射治疗 (EBRT)。EBRT 治疗应由实施治疗的放射肿瘤专科医生制定，覆盖盆腔，涵盖或不涵盖主动脉旁淋巴结。对于晚期疾病，尚未对阴道短距离放疗单用或作为盆腔放射疗法后的巩固进行前瞻性的评估。[157]Duska LR, Berkowitz R, Matulonis U, et al. A pilot trial of TAC (paclitaxel, doxorubicin, and carboplatin) chemotherapy with filgastrim (r-metHuG-CSF) support followed by radiotherapy in patients with "high-risk" endometrial cancer. Gynecol Oncol. 2005;96:198-203.http://www.ncbi.nlm.nih.gov/pubmed/15589601?tool=bestpractice.com

对于组织学为浆液性和透明细胞的患者，可考虑使用放射疗法（EBRT 或阴道短距离放疗），但尚不明确此类疗法对生存期的影响。

支持治疗包括机体、心理、社会及精神各个方面的治疗。

常见的医学挑战包括疼痛、恶心和呕吐、淋巴水肿、出血、梗阻（泌尿生殖和胃肠道）和瘘管。[144]Penson RT, Wenzel LB, Vergote I, et al. Quality of life considerations in gynecologic cancer: FIGO 6th annual report on the results of treatment in gynecological cancer. Int J Gynaecol Obstet. 2006;95(suppl 1):S247-S257.http://www.ncbi.nlm.nih.gov/pubmed/17161164?tool=bestpractice.com

对孤立且有症状的复发，可考虑采用放射疗法和/或外科切除术。

针对经选择患者组全部患者的治疗推荐

以下患者推荐行姑息性化疗证据 A生存期：有高质量的证据表明对于III期或IV期内摸样腺癌患者及术后有残余病灶者，多柔比星或顺铂化疗方案可延长无进展生存期。与全腹部放疗相比，化疗能明显延长无进展生存期及总体生存期。[112]Randall ME, Filiaci VL, Muss H, et al. Randomized phase III trial of whole-abdominal irradiation versus doxorubicin and cisplatin chemotherapy in advanced endometrial carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol. 2006;24:36-44.http://jco.ascopubs.org/cgi/content/full/24/1/36http://www.ncbi.nlm.nih.gov/pubmed/16330675?tool=bestpractice.com系统评价或者受试者＞200名的随机对照临床试验（RCT）。

[124]Fleming GF, Brunetto VL, Cella D, et al. Phase III trial of doxorubicin plus cisplatin with or without paclitaxel plus filgrastim in advanced endometrial carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol. 2004;22:2159-2166.http://jco.ascopubs.org/cgi/content/full/22/11/2159http://www.ncbi.nlm.nih.gov/pubmed/15169803?tool=bestpractice.com相比紫杉醇、多柔比星和顺铂的联合疗法，优先选择紫杉醇和卡铂，因为其具有相同的有效性，并且毒副作用更小。

参考当地专科医生治疗方案作为剂量指导。

针对经选择患者组全部患者的治疗推荐

对于不可手术或复发患者孕激素治疗的临床有效率各文献报道一致，大约为1/3（15%-34%），该有效率与其他药物如他莫西芬有效率相当。[127]Thigpen T, Brady MF, Homesley HD, et al. Tamoxifen in the treatment of advanced or recurrent endometrial carcinoma: a Gynecologic Oncology Group study. J Clin Oncol. 2001;19:364-367.http://www.ncbi.nlm.nih.gov/pubmed/11208827?tool=bestpractice.com[130]Decruze SB, Green JA. Hormone therapy in advanced and recurrent endometrial cancer: a systematic review. Int J Gynecol Cancer. 2007;17:964-978.http://www.ncbi.nlm.nih.gov/pubmed/17442022?tool=bestpractice.com

GnRH-a及口服甲羟孕酮的有效率与文献中报道的他莫西芬与甲地孕酮交替使用的最高有效率相当（32%）。[128]Thigpen JT, Brady MF, Alvarez RD, et al. Oral medroxyprogesterone acetate in the treatment of advanced or recurrent endometrial carcinoma: a dose-response study by the Gynecologic Oncology Group. J Clin Oncol. 1999;17:1736-1744.http://www.ncbi.nlm.nih.gov/pubmed/10561210?tool=bestpractice.com[129]Fiorica JV, Brunetto VL, Hanjani P, et al. Phase II trial of alternating courses of megestrol acetate and tamoxifen in advanced endometrial carcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2004;92:10-14.http://www.ncbi.nlm.nih.gov/pubmed/14751131?tool=bestpractice.com[131]Polyzos NP, Pavlidis N, Paraskevaidis E, et al. Randomized evidence on chemotherapy and hormonal therapy regimens for advanced endometrial cancer: an overview of survival data. Eur J Cancer. 2006;42:319-326.http://www.ncbi.nlm.nih.gov/pubmed/16376072?tool=bestpractice.com

芳香化酶抑制剂如来曲唑日益被视为有效的治疗措施，且根据乳腺癌的相关文献研究其不良反应更小。[147]Sjoquist KM, Martyn J, Edmondson RJ, et al. The role of hormonal therapy in gynecological cancers-current status and future directions. Int J Gynecol Cancer. 2011;21:1328-1333.http://www.ncbi.nlm.nih.gov/pubmed/21720258?tool=bestpractice.com

参考当地专科医生治疗方案作为剂量指导。