THE PRACTICE OF SURGICAL STAGING AND ITS IMPACT ON ADJUVANT TREATMENTRECOMMENDATIONS IN PATIENTS WITH STAGE-I ENDOMETRIAL CARCINOMA

A survey of American gynecologic oncologists was undertaken to assess their compliance with current surgical staging criteria in patients wi th early endometrial carcinoma, One hundred forty-four members of the Society of Gynecologic Oncologists responded to the survey, Respondent s treated an average of 22 new cases annually. Tumor grade and intraop erative determination of depth of myometrial invasion were demonstrate d to influence the frequency of lymphatic dissection. In grade 1, 2, a nd 3 lesions, 76, 60, and 34% of responders, respectively, indicated t hat depth of invasion influenced their decision to perform lymphadenec tomy, In addition, depth of invasion was important in determining type and extent of lymphatic resection. Further, the impact of pathologic lymph node status on postoperative adjuvant radiation therapy recommen dations was evaluated for various stratifications of endometrial adeno carcinoma confined to the corpus, The greatest differences in treatmen t recommendations were noted in the 50-66% invasion category, For grad e 1 and 2 cancers, adjuvant therapy recommendations were reduced by 23 and 16% respectively when comparing pelvic and combined therapy versu s none and vaginal therapy. The effect of surgical staging data on cli nical decisions is clearly evident. The knowledge of pathologically ne gative lymph node status reduces the recommendation for postoperative adjuvant radiotherapy in patients with adenocarcinoma otherwise confin ed to the uterine corpus, (C) 1996 Academic Press, Inc.