SURVIVAL IN PATIENTS WITH PARAAORTIC LYMPH-NODE METASTASES FROM ENDOMETRIAL ADENOCARCINOMA CLINICALLY LIMITED TO THE UTERUS

Purpose: The purpose of this study was (a) to evaluate the incidence o f paraaortic lymph node metastasis from adenocarcinoma of the endometr ium clinically limited to the uterus (1971 FIGO Stages I and II) and ( b) to report the 5 year disease-free survival of patients with histolo gically documented paraaortic lymph node metastasis from endometrial a denocarcinoma clinically limited to the uterus treated on two separate protocols. Methods and Materials: From June 1979 to June 1990, 109 pa tients underwent staging paraaortic lymphadenectomy or paraaortic lymp h node biopsy at the time of total abdominal hysterectomy and bilatera l salpingo-oophorectomy for adenocarcinoma of the endometrium clinical ly limited to the uterus. Patients with histologically documented para aortic lymph node metastasis were treated on two protocols: (a) pelvic radiation (5,040 cGy) plus progestins or (b) pelvic radiation therapy (5,040 cGy) plus paraaortic radiation (4,500 cGy). Results: Paraaorti c lymph node metastases was primarily associated with grade 3 tumors ( 34.4%) and deep myometrial invasion (42%) and was present in 17.4% (19 ) of 109 patients. None of the women treated with pelvic radiation the rapy and progestins survived five years disease-free. In contrast, the 5 year disease-free survival was 27% for patients treated by pelvic a nd paraaortic radiation. Conclusions: Since all patients with macrosco pic metastases to the paraaortic lymph nodes developed recurrent cance r and only a small percentage of those with microscopic metastases to the paraaortic lymph nodes survived disease-free at 5 years, improved survival for patients with paraaortic lymph node metastases will neces sitate the addition of effective cytotoxic chemotherapy to pelvic and paraaortic radiation.