STAGE-II ADENOCARCINOMA OF THE ENDOMETRIUM TREATED BY 2 STANDARD REGIMENS OF COMBINED PREOPERATIVE IRRADIATION AND SURGERY

We retrospectively analyzed 77 patients with stage 11 endometrial carc inoma treated with standard regimens of preoperative radiotherapy (RT) and surgery (S). The age range was 31-74 years with a median of 56.3 years. Thirty-three patients received 40 Gy whole pelvis RT followed b y either radical or modified radical hysterectomy. Forty-four patients received 50 Gy whole pelvis RT and sequential intrauterine and intrav aginal cesium-137 brachytherapy followed by a simple hysterectomy. Med ian follow-up was 111 months. No patient was lost to follow-up. The ov erall 5-year actuarial survival was 78%. There was no significant diff erence between the two treatment groups. Several prognostic variables were analyzed. Those with histologic grade I and 11 had 5-year surviva l of 89% and 83%, respectively, compared to 62% for grade III (P=0.045 ). The 5-year survival for microscopic cervical involvement was 87% co mpared to 59% for gross involvement (P=0.008). Patients with negative or microscopic residual tumor in the surgical specimen and those with negative lymph nodes had less risk of treatment failure. Local failure occurred in only 9%. Major complications (3%) were seen only in the r adical surgery group. Combined preoperative RT and S provide high cure rates with minimal complications for patients with stage II endometri al carcinoma. Patients with adverse prognostic factors are candidates for trials of more aggressive local and systemic therapy.