Adenocarcinoma of the endometrium treated with combined irradiation and surgery: Study of 437 patients

Purpose: To identify prognostic factors and treatment toxicity in a series of operable endometrial adenocarcinomas, Methods and Materials: Between November 1971 and October 1992, 437 patients (pts) with endometrial carcinoma, staged according to the 1988 FIGO stagin g system (225 Stage TB, 107 Stage IC, 4 Stage TIA, 35 Stage LLB, 30 Stage I IIA, 6 Stage IIIB, and 30 Stage IIIC), underwent total abdominal hysterecto my and bilateral salpingo-oophorectomy without (n = 140) or with (n = 297) pelvic lymph node dissection, The chronology of adjuvant RT was not randomi zed and depended on the usual practices of the surgical teams. Seventy-nine pts (Group I) received preoperative low-dose-rate uterovaginal brachythera py (mean dose [MD]: 57 Gy), Three hundred fifty-eight pts (Group II) receiv ed postoperative RT, One hundred ninety-six pts received low-dose-rate vagi nal brachytherapy alone (MD: 50 Gy), One hundred fifty-eight pts had extern al beam pelvic RT (MD: 46 Gy) followed by low-dose-rate vaginal brachythera py (MD: 17 Gy), Four pts had external beam pelvic RT alone (MD: 47 Gy), The mean follow-up from the beginning of treatment was 128 months. Results: The 10-year disease-free survival fate was 86%. From 57 recurrence s, only 12 were isolated locoregional recurrences, The independent factors decreasing the probability of disease-free survival were as follows: histol ogic type (clear-cell carcinoma,p = 0.038), largest histologic tumor diamet er >3 cm (p = 0.015), histologic grade (p = 0.008), myometrial invasion > 1 /2 (p = 0.005), and 1988 FIGO staging system (p = 9.10(-8)). In Group II, t he addition of external beam pelvic RT did not seem to independently improv e vaginal or pelvic control. The postoperative complication rate was 7%, Th e independent factors increasing the risk of postoperative complications we re stage FIGO (p = 0.02) and pelvic lymph node dissection (p = 0.011). The 10-year rate for Grade 3 and 4 late radiation complications according to th e LENT-SOMA scoring system was 3.1%. External beam pelvic RT independently increased the rate for Grade 3 and 4 late complication (RR: 5.6, p = 0.0096 ), Conclusion: Postoperative external beam pelvic RT increases the risk of lat e radiation complications. After surgical and histopathologic staging with pelvic lymph node dissection, in subgroup of "intermediate-risk" patients ( Stage IA Grade 3, IB-C and II), postoperative vaginal brachytherapy alone i s probably sufficient to obtain a good therapeutic index. Results for patie nts with Stage III tumor are not satisfactory. (C) 2001 Elsevier Science In c.