Abstract
PurposeTo report the relapse and survival rates associated to treatment for patients with stage IC, grade 2 or grade 3 and IB grade 3 diseases considered high risk patients group for relapse.Materials and methodsFrom January 1993 to December 2003, 106 patients with endometrial cancer stage I were managed surgically in our institution. Based on data from the medical records, 106 patients with epithelial endometrial cancer met the following inclusion criteria: stage IC grade 2 or 3 and IB grade 3 with or without lymphovascular invasion. Staging was defined according to the FIGO surgical staging system. Postoperative adjuvant radiotherapy consisted of external beam pelvic radiation, vaginal brachytherapy alone or both. The median age was 65 years (range, 32–83 years), lymph node dissection was performed in 45 patients (42.5%) and 14 patients (13.2%) received vaginal brachytherapy only, and 92 (86.8%) received combined vaginal brachytherapy and external beam radiotherapy. The median dose of external beam radiotherapy administered to the pelvis was 4500 cGy (range 4000 – 5040). The median dose to vaginal surface was 2400 cGy (range 2000 – 3000). Predominant pathological stage and histological grade were IC (73.6%) and grade 3 (51.9%). The lymphovascular invasion was present in 33 patients (31.1%) and pathological stage IC grade 2 was most common (48. 1%) combination of risk factors in this group.ResultsWith a follow up median of 58.3 months (range 12.8 – 154), five year overall survival and event free survival were 78.5% and 72.4%, respectively. Locoregional control in five year was 92.4%. Prognostic factors related with survival in univariate analyses were: lymphadenectomy (p = 0.045), lymphovascular invasion (p = 0.047) and initial failure site (p < 0.0001). In multivariate analyses the initial failure in distant sites (p < 0.0001) was the only factor associated with poor survival. Acute and chronic gastrointestinal and genitourinary toxicity grades 3 were not observed.ConclusionIn conclusion, our results showed that the stage IC, grade 2, 3 and IB grade 3 endometrial cancer was associated with significantly increased risk of distant relapse and endometrial carcinoma-related death independently of salvage treatment modality.
Highlights
In conclusion, our results showed that the stage IC, grade 2, 3 and IB grade 3 endometrial cancer was associated with significantly increased risk of distant relapse and endometrial carcinoma-related death independently of salvage treatment modality
The Gynecological Oncology Group (GOG) staging study [9] showed the risk of microscopic pelvic node metastases for patients with clinical stage I endometrial carcinoma to be below 10%, except for those with outer 33% myometrial invasion, for whom the risk amounted to 18%
When designing the multicenter randomized Postoperative Radiation Therapy in Endometrial Carcinoma (PORTEC) trial for stage I endometrial carcinoma, [10] it was decided to exclude the subgroup of patients with grade 3 tumors with outer 50% myometrial invasion from random assignment in view of the reported higher relapse rates and because a survival benefit with pelvic RT had been suggested
Summary
Patients with stage I endometrial carcinoma, treated with total abdominal hysterectomy and bilateral salpingooophorectomy (TAH-BSO) and postoperative radiotherapy (RT) tailored to prognostic factors, have 5-year overall survival rates of 80% to 90%, 5-year cancer-specific survival of 90% to 95%, and locoregional recurrence rates of 4% to 8%. [1,2,3,4,5,6,7,8] the subgroup of patients with grade 3 tumors with deep (50% or more) myometrial invasion (stage IC, grade 3) has been reported to have a considerably higher risk of both locoregional and distant relapse. In the Aalders et al [1] study, a subgroup analysis in patients with deep myometrial invasion revealed that the rate of pelvic relapse was lower in the radiotherapy treated both grade 3 disease and deep invasion, a 10% decreased in the cancer death rate was seen with the addition of pelvic radiotherapy, and the pelvic relapse rate was lower, at 4.5% versus 20% This series was done to report the relapse and survival rates for patients with stage IC, grade 2 or grade 3 and IB grade 3 disease with endometrial cancer considered high risk patients group for relapse. The secondary objective was to analyze the impact in survival of initial failure sites
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