PELVIC CONTROL FOLLOWING EXTERNAL-BEAM RADIATION FOR SURGICAL STAGE-IENDOMETRIAL ADENOCARCINOMA

Purpose: To determine if postoperative external pelvic radiation (EBRT ), without vaginal brachytherapy, is sufficient to prevent vaginal cuf f and pelvic recurrences in patients with surgical Stage I endometrial adenocarcinoma (ACA). Methods and Materials: The records of 122 patie nts with surgical Stage I endometrial cancer were reviewed. There were 87 patients with ACA who received EBRT alone and are the subject of t his study. Their radiation records were reviewed. All patients underwe nt exploration, total abdominal hysterectomy, and bilateral salpingo-o ophorectomy (TAH BSO), and pelvic and paraaortic lymph node sampling. They were staged according to the FIGO 1988 surgical staging system re commendations. Postoperatively, pelvic EBRT was administered by megavo ltage equipment using four fields, to a total dose of 45 to 50.4 Gy. A ctuarial survival and disease free survival were calculated according to Kaplan-Meier Method. Results: Twenty-seven patients with Stage IA G rade 1 or 2 ACA with less than one-third myometrial invasion, who did not receive EBRT, and eight patients with histology other than adenoca rcinoma (i.e., serous papillary, mucinous, etc.) were not included in the study. For the remaining 87 patients who are in the study group, t he median follow-up was 52 months (range: 12-82 months). The 5-year ov erall survival for these 87 patients was 92%, with a disease-free surv ival of 83%. There were no tumor recurrences in the upper vagina or in the pelvis. Two patients developed small bowel obstruction (no surger y required), and one patient developed chronic enteritis. Conclusion: Adjuvant external pelvic radiation, without vaginal brachytherapy, pre vents pelvic and vaginal cuff recurrences in surgical Stage I endometr ial ACA.