Health related quality of life and symptoms after pelvic lymphadenectomy or radiotherapy vs. no adjuvant regional treatment in early-stage endometrial carcinoma: A large population-based study

• Published in: Gynecologic oncology Vol. 127; no. 1; pp. 153 - 160
• Main Authors: van de Poll-Franse, Lonneke V, Pijnenborg, Johanna M.A, Boll, Dorry, Vos, M. Caroline, van den Berg, Hetty, Lybeert, Marnix L.M, de Winter, Karin, Kruitwagen, Roy F.P.M
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2012
• Subjects: Aged; Brachytherapy - adverse effects; Brachytherapy - methods; Endometrial cancer; Endometrial Neoplasms - pathology; Endometrial Neoplasms - radiotherapy; Endometrial Neoplasms - surgery; EORTC QLQ-EN24; Female; Health related quality of life; Hematology, Oncology and Palliative Medicine; Humans; Lymph Node Excision - adverse effects; Lymph Node Excision - methods; Middle Aged; Neoplasm Staging; Obstetrics and Gynecology; Pelvic lymphadenectomy; Pelvis - surgery; Quality of Life; Radiotherapy; Radiotherapy, Adjuvant - adverse effects; Radiotherapy, Adjuvant - methods; Risk Factors; Surveys and Questionnaires; Symptoms; Health related quality of life; EORTC QLQ-EN24; Pelvic lymphadenectomy; Endometrial cancer; Radiotherapy; Symptoms
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2012.06.007

Abstract Objectives Routine lymphadenectomy (LA) in early stage endometrial cancer does not improve survival. However, in the absence of lymph node metastasis, radiotherapy (RT) could be withheld and hence could result in less morbidity. Our aim was to evaluate health related quality of life (HRQL) in endometrial cancer survivors that received routine pelvic LA without RT compared to no LA, but RT in the presence of risk factors. Methods Stage I–II endometrial cancer survivors diagnosed between 1999 and 2007 were selected from the Eindhoven Cancer Registry. Survivors completed the SF-36 and the EORTC-QLQ-EN24. ANCOVA and multiple linear regression analyses were applied. Results 742 (77%) of the endometrial cancer survivors returned a completed questionnaire. 377 (51%) had received no LA nor RT (LA−RT−), 198 (27%) had received LA+RT−, 153 (21%) LA−RT+ and 14 patients (2%) had received both. LA+ women reported as higher lymphedema symptom scores (25 vs. 20, p = 0.04). Women who were treated with RT reported higher gastrointestinal symptom scores vs. those who did not (23 vs. 16, p = 0.04). HRQL scales were comparable between all four treatment groups. Conclusion Despite distinct symptom patterns among women who received LA or RT, no clinically relevant differences in HRQL were observed when compared to women not receiving adjuvant therapy. Using LA to tailor adjuvant pelvic radiotherapy and prevent over-treatment in low-risk patients cannot be recommended.