PREOPERATIVE RADIOTHERAPY IN STAGE I II ENDOMETRIAL ADENOCARCINOMA/

From 1972 to 1993, 170 patients received preoperative radiotherapy fol lowed, 5-6 weeks later, by total extrafascial hysterectomy with bilate ral salpingo-oophorectomy without lymphadenectomy. Eighty-three :patie nts with good prognostic factors (low grade tumour and no cervical inv olvement) received low dose rate utero vaginal brachytherapy alone bef ore surgery (Group 1). Eighty-seven patients with poor prognostic fact ors (high grade tumors and/or cervical involvement) received external radiotherapy to 40 Gy and low dose rate brachytherapy before surgery ( Group 2). A single vaginal failure was observed (0.6%). The overall pe lvic failure rate was 2.3% (four patients) including two cases with pe lvic recurrence and metastases. Three of the four pelvic failures occu rred in Group 1. Using the 1971 FIGO clinical staging, 5-year disease- free survival was 82% in Stage Ia, 79% in Stage Ib, and 81% in Stage I I (P = 0.36). Five-year disease-free survival was 86% in Grade 1, 76% in Grade 2, and 83% in Grade 3 (P = 0.20). Five-year overall survival was 83% in Stage Ia, 79% in Stage Ib, and 83% in Stage II (P = 0.78). Five-year overall survival was 88% in Grade 1, 77% in Grade 2, 83% in Grade 3 (P = 0.27). Complications were recorded with the French-Italia n syllabus. Grade 2 complications occurred in 12 cases (7%), Grade 3 i n five cases (3%). The lack of correlation between classical risk fact ors (stage, grade) and disease outcome suggests that preoperative radi otherapy strategies should be preferred when such factors can be ident ified before surgery.