The role of preoperative brachytherapy as an adjunct to surgery and postoperative radiotherapy in the treatment of stage I endometrial carcinoma

Purpose: Between 1978 and 1993, 817 cases of endometrial carcinoma were tre ated with simple hysterectomy with bilateral salpingo-oophorectomy. Five hu ndred and twenty-six cases had preoperative brachytherapy (Preo), and 291 c ases underwent surgery without preoperative radiotherapy (Nopre). The aim o f the study was to compare disease-free survival of the two groups. Methods and materials: Survival comparison of the two groups was controlled for po stoperative treatment type, according to stage, histological type, degree o f differentiation, depth of myometrial invasion and age. The life-table met hod was used for survival analysis. Cumulative disease-free survival probab ilities were calculated as a function of the proportion of normal remaining life elapsed from the time of diagnosis. Results: Five-year disease-free s urvival of patients with and without preoperative brachytherapy in stage IA , IB and IC was 93 and 93.6%, 93 and 94%, and 80 and 65%, respectively. In well differentiated tumors and poorly differentiated tumors, there was no d ifference in disease-free survival between patients with and without preope rative brachytherapy. Patients with moderately differentiated tumor treated with preoperative brachytherapy had significantly better disease-free surv ival than those without preoperative radiotherapy, however, this was confou nded by uneven distribution of invasion depth: Conclusion: Preoperative bra chytherapy plays a limited role in the treatment of early stage endometrial carcinoma. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.