ADJUVANT RADIATION-THERAPY IS NOT NECESSARY IN THE MANAGEMENT OF ENDOMETRIAL CARCINOMA STAGE-I, LOW-RISK CASES

In an attempt to create uniform nationwide guidelines for the manageme nt of all stages of endometrial carcinoma, and to limit the use of adj uvant radiation therapy in stage I disease to high-risk patients only, a protocol was developed by the Danish Endometrial Cancer group (DEMC A). From September 1986 through August 1988, 1214 women in Dennark wit h newly diagnosed carcinoma of the endometrium have been treated accor ding to this protocol. This figure represents all endometrial carcinom as diagnosed in Denmark during this 2-year period. The primary treatme nt was total abdominal hysterectomy and bilateral salpingo-oophorectom y and no preoperative radiation therapy was delivered. Ln 1039 cases n o macroscopic residual tumor and/or microscopic tumor tissue in the re section margins was found following surgery. Based on surgery and hist opathology, these patients were classified as: P-stage I low-risk (gra de 1 & 2 and less than or equal to 50% myometrial invasion), P-stage I high-risk (grade 1 & 2 and > 50% myometrial invasion, and grade 3), P -stage II and P-stage III (Group 1). Distribution was as follows: P-I low-risk 641 patients, P-I high-risk 235, P-II 105 and P-III (Group 1) 58 patients. No postoperative radiation therapy was given to P-I low- risk cases. P-I high-risk, P-II, and P-III (Group 1) cases received ex ternal radiation therapy. Recurrence rate at 68-92 months follow-up wa s 45/641 (7%) in P-I low-risk, 36/235 (15%) in P-I high-risk, 30/105 ( 29%) in P-II, and 27/58 (47%) in P-III (Group a) cases. Fifteen of 17 vaginal recurrences in P-I low-risk cases were salvaged (mean observat ion time 61 months).