Surgery followed by radiotherapy in endometrial cancer: analysis of survival and patterns of failure

We performed a retrospective evaluation of survival and patterns of failure in 317 consecutive endometrial cancer patients treated between 1974 and 19 91 with surgery and adjuvant radiotherapy. Two hundred and forty seven pati ents (78%) had FIGO stage I disease, 30 (9%) - stage II, 35 (11%) - stage I II and 5 (2%) - stage IV. Both low dose rate brachytherapy (BRT) and extern al beam radiation (EBRT) were applied in 247 patients (78%), only BRT in 49 (15%), and only EBRT in 21 (7%). Median follow-up was 7.3 years. Five-year overall survival was 75%, and five-year disease free survival was 81%. Bot h overall and disease free survival rates were correlated with stage (P = 0 .001 and P = 0.000, respectively). Recurrence occurred in 70 patients (22%) : 11 (3.5%) in the pelvis, 51 (16%) outside the pelvis and 6 (2%) both in- and outside the pelvis. Independent risk factors for local recurrence inclu ded older age (P = 0.03) and variant histologic subtypes (P = 0.039), where as independent risk factors for distant spread were stage (P = 0.000) and o lder age (P = 0.011). Normalized Total Dose (the sum of EBRT and BRT doses, based on linear-quadratic equation), type of radiotherapy regimen, overall radiotherapy time and surgery-to-radiotherapy interval did not correlate w ith the risk of relapse. Severe early and late radiotherapy complications w ere observed in 21 (7%) and 35 patients (11%), respectively. In view of the relatively low risk of exclusive pelvic recurrences and the high rate of s evere late radiotherapy complications, indications for postoperative radiot herapy and its scheme should be verified. A relatively high rate of extrape lvic recurrences calls for effective systemic adjuvants to surgery. Further definition of high risk patients is warranted in order to tailor postopera tive therapy to the prognostic factors and to increase the therapeutic inde x of management of endometrial cancer.