WHICH PROGNOSTIC FACTORS INFLUENCE THE OUTCOME OF PATIENTS WITH SURGICALLY STAGED ENDOMETRIAL CANCER TREATED WITH ADJUVANT RADIATION

Purpose: Despite the fact that retrospective reviews have documented p elvic failure rates ranging from 15-20% in patients with high-risk ute rine-confined endometrial cancer who have received no or ''inadequate' ' RT, the role of RT has been questioned. We sought to analyze pelvic control and disease-free survival for a large data base of women with corpus cancers managed with initial surgery followed by adjuvant irrad iation. Methods and Materials: Between 1983 and 1993, 294 patients rec eived adjuvant postoperative RT from one of three academic radiation p ractices. RT consisted of vaginal brachytherapy alone in 28 patients, pelvic RT in 173 patients, pelvic RT with vaginal brachytherapy in 97 patients, and whole abdominal RT in 2 patients. Lymph nodes were evalu ated in 49%. The median number of pelvic and periaortic LN in the path ology specimen were 6 and 4, respectively. Median follow up was 63 mon ths. Results: 5-year disease-free survival (DFS) rate and pelvic contr ol rates were 86 and 95%, respectively. Patient-related, treatment-rel ated, and tumor-related characteristics were assessed for the effect o n time to relapse. Unfavorable histology, older age, and capillary spa ce invasion were univariately associated with decreased DFS and pelvic control. Pathologic Stage II patients had significantly worse DFS tha n Stage I patients. Multivariate analysis revealed that age, capillary space invasion, and histology were jointly predictive of disease free survival. Conclusion: The excellent pelvic control and disease-free s urvival of patients with uterine-confined disease in this series sugge st that adjuvant RT should continue for patients with high risk diseas e. This analysis of a large group of postoperatively treated patients will provide a basis for determining alternative treatment strategies for patients who have an increased risk of disease recurrence despite RT. (C) 1997 Elsevier Science Inc.