PREOPERATIVE RADIOTHERAPY AND SURGERY FOR ENDOMETRIAL CARCINOMA - PROGNOSTIC-SIGNIFICANCE OF THE STERILIZATION OF THE SPECIMEN

Introduction: We report a retrospective study on the analysis of the o perative specimen after preoperative radiotherapy for FIGO (1971) stag e I or II endometrial carcinoma. Methods and Materials: From 1976 to 1 996, 221 patients were treated with external radiotherapy (XRT) and/or low-dose-rate brachytherapy (BT) followed by surgery (S). Patients wi th cervical involvement (89 patients) or with high-grade tumors (49 pa tients) received XRT and BT. Patients stage FIGO Ia (89 patients) or w ith low-grade tumors (57 patients) received BT alone. Surgery was perf ormed 5 to 6 weeks after irradiation. Results: The mean follow-up is 7 8 months (12-216). The 5-year survival was 90% for FIGO Ia, 80% for FI GO Ib, and 84% for FIGO II (p = 0.51). According to the differentiatio n, 5-year survival was 87% for grade 1, 84% for grade 2, 84% for grade 3 (p = 0.10). Grade 3 complications were registered in 2% (no grade 4 ). The tumors were sterilized in 37 patients (17%), sterilized but wit h dystrophic glands in 34 patients (16%), only modified and altered in 21 patients (95%), with viable cells in 56 patients (26%). After preo perative radiotherapy, 37/148 specimens mere sterilized (25%), 14/74 a fter brachytherapy and surgery (19%), 23/74 after external radiotherap y-brachytherapy and surgery (31%). According to the response of the sp ecimen, 5-year survival,vas 87% when the tumor was sterilized, 96% whe n altered glands were present, 85% when modified, and 76% if residual tumor with viable cells was identified (p = 0.043). Conclusion: Preope rative radiotherapy followed by surgery is a safe and effective treatm ent of PICO stage I or II endometrial carcinomas. BT with two uterine tubes seems to be of interest in the contribution of the treatment of the uterus to sterilize the specimen. The analysis of this new prognos tic factor remains important to select a population with worst prognos is. (C) 1998 Elsevier Science Inc.