Significant pelvic recurrence in high-risk pathologic stage I-IV endometrial carcinoma patients after adjuvant chemotherapy alone: Implications for adjuvant radiation therapy

Objective: To evaluate the risk of pelvic recurrence (PVR) in high-risk pat hologic Stage I-IV endometrial carcinoma patients after adjuvant chemothera py alone. Methods: Between 1992 and 1998, 43 high-risk endometrial cancer patients re ceived adjuvant chemotherapy. All patients underwent primary surgery consis ting of total abdominal hysterectomy and bilateral salpingo-oophorectomy. N o patients received preoperative radiation therapy (AT). Regional lymph nod es and peritoneal cytology were sampled in 62.8% and 83.7% of cases, respec tively. Most patients had Stage III-IV disease (83.7%) or unfavorable histo logy tumors (74.4%). None had evidence of extra-abdominal disease. All pati ents received 4-6 cycles of chemotherapy as the sole adjuvant therapy, cons isting primarily of cisplatin and doxorubicin. Recurrent disease sites were divided into pelvic (vaginal, nonvaginal) and extrapelvic (para-aortic, up per abdomen, liver, and extra-abdominal). Median follow-up was 27 months (r ange, 2-96 months). Results: Twenty-nine women (67.4%) relapsed. Seventeen (39.5%) recurred in the pelvis and 23 (55.5%) in extrapelvic sites. The 3-year actuarial PVR ra te was 46.5%. The most significant factors correlated with PVR were cervica l involvement (CI) (p = 0.01) and adnexal (p = 0.05) involvement. Of the 17 women who developed a PVR, 8 relapsed in the vagina, 3 in the nonvaginal p elvis, and 6 in both. The 3-year vaginal and nonvaginal PVR rates were 37.8 % and 26%, respectively. The most significant factor correlated with vagina l PVR was CI (p = 0.0007). Deep myometrial invasion (p = 0.02) and lymph no dal involvement (p = 0.03) were both correlated with nonvaginal PVR. Nine o f the 29 relapsed patients (31%) developed PVR as their only (6) ar first s ite (3) of recurrence. Factors associated with a higher rate of PVR (as the first or only site) were CI and Stage I-II disease. Conclusions: PVR is common in high-risk pathologic Stage I-IV endometrial c ancer patients after adjuvant chemotherapy alone. These results support the continued use of locoregional RT in patients undergoing adjuvant chemother apy. Further studies are needed to test the addition of chemotherapy to loc oregional RT. (C) 2001 Elsevier Science Inc.