Surgery followed by radiotherapy in endometrial cancer: analysis of survival and patterns of failure

Abstract

We performed a retrospective evaluation of survival and patterns of failure in 317 consecutive endometrial cancer patients treated between 1974 and 1991 with surgery and adjuvant radiotherapy. Two hundred and forty seven patients (78%) had FIGO stage I disease, 30 (9%) - stage II, 35 (11%) - stage III and 5 (2%) - stage IV. Both low dose rate brachytherapy (BRT) and external beam radiation (EBRT) were applied in 247 patients (78%), only BRT in 49 (15%), and only EBRT in 21 (7%). Median follow-up was 7.3 years. Five-year overall survival was 75%, and five-year disease free survival was 81%. Both overall and disease free survival rates were correlated with stage (P = 0.001 and P = 0.000, respectively). Recurrence occurred in 70 patients (22%): 11 (3.5%) in the pelvis, 51 (16%) outside the pelvis and 6 (2%) both in- and outside the pelvis. Independent risk factors for local recurrence included older age (P = 0.03) and variant histologic subtypes (P = 0.039), whereas independent risk factors for distant spread were stage (P = 0.000) and older age (P = 0.011). Normalized Total Dose (the sum of EBRT and BRT doses, based on linear-quadratic equation), type of radiotherapy regimen, overall radiotherapy time and surgery-to-radiotherapy interval did not correlate with the risk of relapse. Severe early and late radiotherapy complications were observed in 21 (7%) and 35 patients (11%), respectively. In view of the relatively low risk of exclusive pelvic recurrences and the high rate of severe late radiotherapy complications, indications for postoperative radiotherapy and its scheme should be verified. A relatively high rate of extrapelvic recurrences calls for effective systemic adjuvants to surgery. Further definition of high risk patients is warranted in order to tailor postoperative therapy to the prognostic factors and to increase the therapeutic index of management of endometrial cancer.

Prognostic significance and clinical importance of estrogen receptor α and β in human endometrioid adenocarcinomas

“…Although >50% of patients with endometrial carcinomas are diagnosed with FIGO stage I, as many as 20% die as a result of their disease (30). This unusual situation might reflect that the current used diagnostic technology is quite insufficient to identify endometrial cancer patients with poor prognosis.…”

Analysis of acute and late toxicity of adjuvant radiotherpy in women with cervical and endometrial cancer

“…Łączenie teleterapii z brachyterapią dopochwową zwiększa odsetek odczynów popromiennych zarówno wczesnych, jak i późnych [7,[11][12][13][14][15].…”

Inhibin-α subunit expression in uterine endometrioid adenocarcinomas and endometrial cancer cell lines: a potential prognostic factor

“…Uterine cancer has become the most frequent gynecologic malignancy in the Western world (1)(2)(3). Meanwhile, endometrial cancer has been classified in two different clinicopathological categories according to several biological and molecular characteristics (2,(4)(5)(6).…”

“…Meanwhile, endometrial cancer has been classified in two different clinicopathological categories according to several biological and molecular characteristics (2,(4)(5)(6). Type I endometrial cancers account for almost 80% of endometrial cancers, being mostly endometrioid adenocarcinomas with low histological differentiation and a more favorable outcome compared to Type II endometrial cancers (1)(2)(3)(4)(5)7). Although several prognostic factors have been established (1,2), it is assumed that approximately 20% of these patients die due to their disease (3).…”

“…Type I endometrial cancers account for almost 80% of endometrial cancers, being mostly endometrioid adenocarcinomas with low histological differentiation and a more favorable outcome compared to Type II endometrial cancers (1)(2)(3)(4)(5)7). Although several prognostic factors have been established (1,2), it is assumed that approximately 20% of these patients die due to their disease (3). This is actually an unusual situation for a solid tumor, especially since patients with endometrial cancer are diagnosed in an early stage.…”