Pg. Rose et al., PRIMARY RADIATION-THERAPY FOR ENDOMETRIAL CARCINOMA - A CASE-CONTROLLED STUDY, International journal of radiation oncology, biology, physics, 27(3), 1993, pp. 585-590
Citations number
20
Categorie Soggetti
Oncology,"Radiology,Nuclear Medicine & Medical Imaging
Purpose: Primary radiation therapy is generally considered inferior to
a surgical approach for patients with endometrial carcinoma and is re
served for patients with a high operative risk. These patients are usu
ally elderly, have multiple medical problems and frequently die of int
ercurrent disease. To evaluate the efficacy of primary radiation thera
py a case controlled analysis comparing corrected survival of patients
treated with primary radiation to patients treated with surgical ther
apy with or without radiation therapy was performed. Methods and Mater
ials: Sixty-four patients treated with primary radiation therapy were
retrospectively studied. A Kaplan-Meier product limit survival analysi
s was used to estimate survival among patients treated with primary ra
diation therapy. A case control study matched by clinical stage, tumor
grade, and time of diagnosis was performed. The Mantel-Cox statistic
was used to evaluated the equality of the survival curves. Results: Pr
imary radiation therapy was used to treat 9.0% of the patients with en
dometrial carcinoma during the study period. Cardiovascular disease, d
iabetes, age greater than 80 and morbid obesity were the most common i
ndications. Ninety percent of patients had either Stage I or II diseas
e. Forty-eight of the 64 patients (75%) completed treatment which incl
uded both teletherapy and brachytherapy. Ten patients received brachyt
herapy only. Twelve complications, both acute and chronic, occurred in
eleven patients (17%). Intercurrent disease accounted for 13 of the 3
6 (36%) of the deaths. Clinical stage of disease and histologic grade
of the tumor were significant predictors of survival, p = 0.0001 and p
= 0.013, respectively. The case controlled study of Stage I and II pa
tients treated by primary radiation therapy matched to surgically trea
ted controls showed no statistical difference in survival. Dilatation
and curettage after the completion of radiation therapy was predictive
of local control, p 0.003. Conclusion: Although surgery followed by t
ailored radiation therapy has become widely accepted therapy for Stage
I and II endometrial carcinoma, even in patients who are a poor opera
tive risk, the survival with primary radiation therapy is not statisti
cally different.