Surgery and postoperative radiation therapy in stage II endometrial carcinoma

The traditional approach to patients with stage II endometrial carcinoma is preoperative radiation therapy (RT) followed by surgery. Currently, many p atients are treated with primary surgery and postoperative RT. We retrospec tively reviewed the outcome of 44 stage II (32 IIA, 12 IIB) patients who un derwent surgery and postoperative RT. Nine (20%) had microscopic cervical i nvolvement noted before surgery, and 35 (80%) had occult involvement noted postoperatively. Postoperative RT consisted of whole pelvic RT (WPRT) (50%) , vaginal brachy-therapy (VB) (18%), or both (32%). At a median follow-up o f 40 months, the 5-year actuarial disease-free survival was 72.4%. Two pati ents (4%) had recurrence in the pelvis tone vagina, one lateral pelvis). Ei ghteen stage IIA patients treated with WPRT alone and eight stage IIA patie nts, without deep myometrial invasion (MI), were treated with VB alone, and remained controlled in the pelvis. Extrapelvic recurrences occurred in 12 patients (25%), primarily in those with deep MI and/or grade 2-3 disease. O ur results suggest that patients with stage II endometrial carcinoma with m icroscopic or occult cervical involvement treated with surgery and postoper ative RT have a favorable outcome. A high rate of pelvic control is achieve d with RT tailored to the pathologic findings.