Recurrent endometrial cancer after surgery alone: Results of salvage radiotherapy

Purpose: Postoperative irradiation of endometrial cancer patients decreases the risk of local recurrence but is associated with a number of long-term sequelae, In a proportion of patients, no immediate postoperative radiother apy is applied and this treatment is introduced only at relapse. The aim of our study was to assess the long-term results of salvage radiotherapy in p reviously nonirradiated endometrial cancer patients who developed local rec urrence, and to evaluate the impact of patient- and treatment-related facto rs on treatment efficacy. Methods and Materials: We performed a detailed retrospective analysis of 73 endometrial cancer patients given radiotherapy for local recurrence after the initial surgery only. The mean age at diagnosis of the recurrence was 6 3 years (range, 39-78 years), Median time to recurrence was 11 months (rang e, 1-19 months). All recurrences were staged with the use of Perez modifica tion of the International Federation of Gynecology and Obstetrics (FIGO) st aging system for primary vaginal carcinoma. There were five (7%) Stage I pa tients, 43 (59%) Stage II patients, and 25 (34%) Stage III patients. Forty- four patients (60%) received both external beam irradiation (EBRT) and endo vaginal brachytherapy (BRT), 17 (23%) received only BRT, and 12 (17%) recei ved only EBRT, The mean total physical radiation dose was 75.9 Gy (range, 8 -130 Gy), and the mean normalized total dose (NTD) calculated on the base o f the linear-quadratic model was 86.6 Gy (range, 8.5-171.9 Gy), Median foll ow-up for alive patients was 8.8 years (range, 3-21 years). The impact of p atient-, tumor-, and therapy-related factors on the treatment outcome was e valuated with the use of uni- and multivariate analyses. Results: Three- and 5-year overall survival rates were 33% and 25%, respect ively. In the univariate analysis, lower stage of recurrent disease (p < 0. 0005), combined EBRT and BRT (p = 0.027), higher total radiation dose (p = 0.031), and higher NTD (p = 0.006) were significantly correlated with bette r survival. In the multivariate analysis, only stage of recurrent disease ( p < 0.005) and high total dose (p = 0.047) were independently correlated wi th better survival. Lower FIGO stage of recurrence (p = 0.023) and higher t otal dose (p = 0.005) were also independently correlated with longer time t o progression, whereas higher radiotherapy dose was the only factor correla ted with better local control (p = 0.029). Conclusions: The efficacy of salvage radiotherapy in endometrial cancer pat ients with local failure after previous surgery is limited. Factors determi ning treatment outcome include advancement of the tumor at relapse and radi otherapy dose. (C) 2000 Elsevier Science Inc.