MEDICALLY INOPERABLE STAGE-I ENDOMETRIAL CARCINOMA - A FEW DILEMMAS IN RADIOTHERAPEUTIC MANAGEMENT

Purpose: The aggressiveness of radiation therapy for patients with med ically inoperable endometrial carcinoma is controversial. Patients may die of their underlining medical disease before succumbing to cancer. We try to identify certain subgroup of patients who might benefit mos t from an aggressive approach and also investigate the impact of resid ual tumor present in dilatation and curettage (D&C) specimen obtained in second intracavitary implant (ICI). Methods and Materials: From 196 5 to 1990, 101 patients were treated for clinical clinical Stage I end ometrial carcinoma with RT alone due to medical problems. Ages ranged from 39 to 94 years (median 71 years). There were 18 patients with cli nical Stage IA and 83 with clinical Stage IB disease. Histology includ ed 44 well-differentiated, 37 moderately differentiated, and 20 poorly differentiated tumors. Radiation therapy consisted of external beam o nly in 3 patients, ICI alone in 26, whole pelvis plus ICI in 10, and w hole pelvis plus split field plus ICI in 62. A second D&C was performe d on 26 patients at the time of the second ICI. Minimum follow-up was 2 years (median, 6.3 years). Results: The 5-year actuarial disease-fre e survival (DFS) for the studied cohort is comparable to the expected survival of an age-matched population. Pelvic control was 100% for Sta ge IA and 88% for Stage IB with 5-year disease-free survivals of 80 an d 84%, respectively. We also observed a greater disassociation of DFS and overall survial among patients older than 75 years (84 and 55%, re spectively) than in younger patients (84 and 78%, respectively). This is mainly because older patients succumbed to their medical illness. W ell-differentiated disease demonstrated the trend toward a better outc ome than moderately or poorly differentiated lesions in Stage IB patie nts (p = 0.05), but not in Stage IA patients. Aggressive radiation the rapy approach showed the trend toward a better result in Stage IB pati ents 75 years of age or younger. There were two failures among 19 pati ents with no tumor found in the D&C specimen at the time of second imp lant. In contrast, seven patients with residual tumor seen in the endo metrial sample at the time of second implant remain disease free. Conc lusions: Radiation therapy alone is an effective treatment modality fo r medically inoperable Stage I endometrial carcinoma. Disease-free sur vival can be translated into longer overall survival in the younger ag e group, but not in older patients. The latter tend to die of their un derlining medical illness. Tumor differentiation influenced the progno sis of Stage IB disease. No tumor seen in the endometrial sampling at the time of second implant did not correlate with a better disease con trol, and the treatment plan should not be modified on such informatio n.