SURGERY WITHOUT RADIOTHERAPY FOR PRIMARY-TREATMENT OF ENDOMETRIAL CANCER

Objective: To analyze the role of surgery alone, including pelvic and para-aortic lymphadenectomy, in patients with endometrial cancer who d id not receive radiotherapy. Methods: Between August 1987 and January 1997, 225 women with disease clinically confined to the uterus were st aged surgically by a standard protocol that included pelvic and para-a ortic lymphadenectomy in women with high risk factors. No radiation wa s administered before or after surgery. Results: The combination of pr eoperative endometrial biopsy grade and gross depth of myometrial inva sion identified 123 (55%) high-risk patients who had lymphadenectomy a nd 102 (45%) low-risk patients who did not. Eighteen (15%) high-risk p atients had lymph node metastases and received postoperative systemic therapy. Three low-risk, eight high-risk-node-negative, and no high-ri sk-node-positive patients were diagnosed with recurrent cancer, corres ponding to 5-year recurrence-free proportions of 0.95, 0.89, and 1.00, respectively. Although sample sizes and limited follow-up limit concl usions, the experience to date suggests a high rate of survival in all three groups. Conclusion: Our preliminary experience indicates that e ven high-risk patients have an excellent prognosis when treated with s urgery, including pelvic and para-aortic lymphadenectomy, without radi otherapy. (C) 1998 by The American College of Obstetricians and Gyneco logists.