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

• Published in: International journal of radiation oncology, biology, physics Vol. 50; no. 1; pp. 81 - 97
• Main Authors: Touboul, Emmanuel, Belkacémi, Yazid, Buffat, Laurent, Deniaud-Alexandre, Elisabeth, Lefranc, Jean-Pierre, Lhuillier, Pierre, Uzan, Serge, Jannet, Denis, Uzan, Michele, Antoine, Martine, Huart, Judith, Ganansia, Valerie, Milliez, Jacques, Blondon, Jean, Housset, Martin, Schlienger, Michel
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.05.2001; Elsevier
• Subjects: Adenocarcinoma - pathology; Adenocarcinoma - radiotherapy; Adenocarcinoma - surgery; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Brachytherapy - adverse effects; Brachytherapy - methods; Complications; Disease-Free Survival; Endometrial carcinoma; Endometrial Neoplasms - pathology; Endometrial Neoplasms - radiotherapy; Endometrial Neoplasms - surgery; Female; Female genital diseases; Genital system. Mammary gland; Gynecology. Andrology. Obstetrics; Humans; Hysterectomy - adverse effects; Medical sciences; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Ovariectomy - adverse effects; Radiotherapy; Radiotherapy - adverse effects; Radiotherapy - methods; Radiotherapy, Adjuvant; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Risk factors; Surgery; Survival; Tumors; Radiotherapy; Complications; Endometrial carcinoma; Survival; Surgery; Risk factors; Adenocarcinoma; Human; Prognosis; Stage classification; Surgical resection; Malignant tumor; Female genital diseases; Cohort study; Uterine diseases; Complication; Female; Curietherapy; Treatment planning; Survival curve; Endometrium; Comparative study
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/S0360-3016(00)01571-6

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 staging system (225 Stage IB, 107 Stage IC, 4 Stage IIA, 35 Stage IIB, 30 Stage IIIA, 6 Stage IIIB, and 30 Stage IIIC), underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy without ( n = 140) or with ( n = 297) pelvic lymph node dissection. The chronology of adjuvant RT was not randomized and depended on the usual practices of the surgical teams. Seventy-nine pts (Group I) received preoperative low-dose-rate uterovaginal brachytherapy (mean dose [MD]: 57 Gy). Three hundred fifty-eight pts (Group II) received postoperative RT. One hundred ninety-six pts received low-dose-rate vaginal brachytherapy alone (MD: 50 Gy). One hundred fifty-eight pts had external beam pelvic RT (MD: 46 Gy) followed by low-dose-rate vaginal brachytherapy (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 rate was 86%. From 57 recurrences, only 12 were isolated locoregional recurrences. The independent factors decreasing the probability of disease-free survival were as follows: histologic type (clear-cell carcinoma, p = 0.038), largest histologic tumor diameter >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, the addition of external beam pelvic RT did not seem to independently improve vaginal or pelvic control. The postoperative complication rate was 7%. The independent factors increasing the risk of postoperative complications were 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 the 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 late 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 is probably sufficient to obtain a good therapeutic index. Results for patients with Stage III tumor are not satisfactory.