TREATMENT OF NODE-POSITIVE ENDOMETRIAL CANCER WITH COMPLETE NODE DISSECTION, CHEMOTHERAPY AND RADIATION-THERAPY

We assessed the therapeutic significance of systematic aortic and pelv ic lymphadenectomy followed by adjuvant therapy in node-positive endom etrial carcinoma. Among 173 stage I-III patients, 30 (17%) had positiv e nodes: ten in the pelvic region alone (group P) and 20 in the aortic region alone or in both regions (group A). The adjuvant therapy was a dministered as follows: subjects in group P received 50 Gy pelvic radi ation, including three post-surgical T3 (pT3) patients who received ei ther one or three cycles of cisplatin-based chemotherapy before radiat ion. Subjects in group A were given three cycles of chemotherapy follo wed by 50 Gy pelvic and 50 Gy extended field periaortic radiation usin g a four-field or conformational technique. Five-year survival was 95% for 143 patients with negative nodes and 84% for 30 patients with pos itive nodes (100% for group P and 75% for group A). In group A, 5-year survival was 38% for eight patients with both pT3 and histology other than endometrioid type G1, and 91% for the remaining 12 patients. Eit her way, both group P and group A patients had a better prognosis than previously reported. In summary, aortic and pelvic lymphadenectomy an d subsequent chemotherapy and radiation therapy based on node status s eem to improve the survival of endometrial cancer patients with positi ve nodes.