AN ANALYSIS OF APPROACHES TO THE MANAGEMENT OF ENDOMETRIAL CANCER IN NORTH-AMERICA - A CTF STUDY

Objective. The aim of this study was to define the clinical-therapeuti cal approach to endometrial cancer now being followed in some of the m ost important centers of reference for gynecological cancer in North A merica by means of a questionnaire. Study design. The questionnaire fo cused on four principal areas: (1) surgical staging and therapy; (2) a djuvant treatment; (3) treatment modifications; and (4) management of advanced stages (FIGO III-IV). Results. There mere 48 evaluable respon ses (77%) received by the end of December 1994 which were considered f or this analysis. Lymphadenectomy is utilized routinely in 26/38 cente rs (54.2%) and in selective clinical-pathological conditions in anothe r 21/48 centers (43.5%). In the majority of centers (31/48; 64.6%) rad ical surgery is utilized for selected indications such as cervical inv olvement. Only 3/48 (6.2%) centers consider the vaginal approach total ly inappropriate. The great majority (40/48; 83.3%) of the centers con sidered postsurgical adjuvant therapy to be necessary in FIGO Stage Ic . Brachytherapy is routinely performed in 3 centers (6.2%) in postsurg ical management of Stage I endometrial cancer, while the majority of t he centers (31/48; 63.6%) perform brachytherapy of the vaginal vault i n certain clinical-pathological conditions. A nide variety of treatmen ts are used for advanced stages (FIGO III-IV). Conclusions. It emerges that some controversial aspects exist on endometrial cancer treatment , and these conflicting data need a large-scale multicenter randomized clinical trial. (C) 1998 Academic Press.