Endometrial carcinoma: Influence of prognostic factors on radiation management

Abstract

The earliest intracavitary radium treatment for uterine cancer was reported in 1908. Refinements reported during the next 20 years, using an intrauterine tube and colpostats or radium capsules, established a treatment philosophy of preoperatively irradiating uterine and parauterine tissues. Thus, preoperative intracavitary irradiation became entrenched as therapy for all endometrial cancers for the better part of four decades. In the 1950s and 1960s, the ability of external irradiation to eradicate cancer in regional lymphatic vessels prompted the use of pelvic field irradiation in Stage I1 and I11 and recurrent disease. The results of surgical exploratory studies in the 1970s established more refined criteria for preoperative or postoperative external pelvic irradiation in highgrade infiltrating Stage I cancers. In the 1980% it became apparent that, for tumors with lymphovascular invasion, clear cell, and serous papillary histologic types, the disease spread to the upper abdomen and the paraaortic nodes might benefit from extended field and/or whole abdominal irradiation, with or without systemic bolus or concomitant continuous-infusion chemotherapy. In the 1980s, a subset of patients was identified with high-grade lymphovascular invasion clear cell and papillary serous histologic types or with positive peritoneal cytologic findings who were at high risk of failing in the paraaortic nodes and/or the upper abdomen for whom extended field or whole abdominal irradiation have been advocated. Given the fraction and dose limitation for a large abdominal field, the addition of systemic concomitant bolus or continuous infusion of chemotherapy currently is proposed to improve the control of intraabdominal failure in these high-risk patients. Cancer 1993; 71:1471-9.

Proliferating Cell Nuclear Antigen in Endometrial Carcinoma: Pretreatment Identification of High-Risk Patients

“…6. Newbury, R., Scherch, C., Goodspeed, N., Fanning, J., Glidewell, O., As previously reported [2][3][4], myometrial invasion is a prog- Notwithstanding the small number of recurrences, in con-11. Poulsen, H. E., Taylor for appropriate management.…”

“…The primary prognostic indicators ascribed to locally ad-vical spread by ultrasounds and/or other instruments seems to be inadequate; the risk of general underestimation is high vanced endometrioid adenocarcinoma included surgical FIGO stage, histologic differentiation, and depth of myome- [13]. The determination of myometrial invasion and cervical spread may be also carried out intraoperatively, but it is a trial invasion [2][3][4]. These parameters are generally used to define the adjuvant therapeutic strategies, but new prognostic difficult procedure unless performed on frozen sections [14].…”

Prognostic impact of morphometric nuclear grade of endometrial carcinoma

“…3 The identification of high risk patients, especially among those with localized disease, is a major goal because adjuvant therapy may be important for this group. 9,10 The prognostic importance of standard variables such as histologic type is well established, with a poor outcome especially noted in patients with serous papillary and clear cell carcinomas. 34 -36 These aggressive histologic types also are associated with advanced disease stage at the time of diagnosis.…”

“…[1][2][3][4][5][6][7][8] The identification of high risk groups, especially among women with localized disease, would make it possible to avoid overtreatment of patients with a good prognosis and reserve the most extensive therapy for those with aggressive tumors. 9,10 To date stage of disease, histologic type, and histologic grade have been shown to influence survival significantly. 1,11 According to more recent studies, age and biologic markers such as ploidy, hormone receptors, HER-2/neu, nuclear p53 protein expression, and microvessel density may be im-portant prognostically, but the clinical implications of these findings are not yet clear.…”

Uterine Cancer (Corpus Uteri)

“…One argument was the opportunity to tailor subsequent radiotherapy according to the surgical findings (staging laparotomy). Several authors support these guidelines (20)(21)(22)(23).…”