Abstract
BackgroundType II (papillary serous and clear cell) endometrial carcinoma (EC) is a rare subgroup and is considered to have an unfavorable prognosis. The purpose of this retrospective analysis was to elucidate the meaning of adjuvant radiotherapy (RT) for clinical outcome and to define prognostic factors in these patients (pts).MethodsFrom 2004-2012 forty-two pts with type II EC underwent surgery followed by adjuvant RT at our department. Median age was 72 years. The majority were early stage carcinomas (FIGO I n = 27 [64.3%], FIGO II n = 4 [9.5%], FIGO III n = 11 [26.2%]. Seven pts (16.7%) received adjuvant chemotherapy (ChT). Pts were treated with external beam radiotherapy (EBRT) and brachytherapy (IVB) boost.ResultsFive-year local recurrence free survival (LRFS), distant metastases free survival (DMFS) and overall survival (OS) were 85.4%, 78%, and 64.5% respectively. LRFS was better with lower pT stage, without lymphangiosis (L0), without haemangiosis (V0) and negative resection margins (R0). DMFS was prolonged in lymph node negatives (N0), L0, V0 and R0. OS was improved in younger pts, N0, L0, V0 and after lymphadenectomy (LNE). Multivariate analysis revealed haemangiosis (V1) as the only independent prognostic factor for OS (p = .014) and DMFS (p = .008). For LRFS pT stage remained as an independent prognostic factor (p = .028).ConclusionsAdjuvant RT with EBRT/IVB ensures adequate local control in type II EC, but control rates remain lower than in type I EC. A benefit of additional adjuvant ChT could not be demonstrated and a general omission of EBRT cannot be recommended at this point. Lymphovascular infiltration and pT stage might be the best predictive factors for a benefit from combined local and systemic treatment.
Highlights
Uterine carcinomas with clear cell or papillary serous histology exhibit different features than endometrioid carcinomas (EC) [1]
RT consisted of external beam radiotherapy (EBRT) in 1.8-2.0 Gy fractions to a cumulative dose of 40-54 Gy and/or HDR intravaginal brachytherapy (IVB) in 5.0 Gy fractions to a cumulative dose of 10-20 Gy
Pelvic lymph nodes were resected in 15 patients (35.7%) and in 17 (40.5%) paraaortic lymph nodes were resected
Summary
Uterine carcinomas with clear cell or papillary serous histology (type II) exhibit different features than endometrioid (type I) carcinomas (EC) [1] They account for only 10% of all endometrial cancers, but analysis from historical data showed a substantially worse prognosis with frequent recurrences outside the uterus [2,3,4]. Due to their comparatively low incidence randomized trials on therapy and outcome of patients with theses histologic subtypes are scarce [5] and the existing retrospective studies have reported varied results regarding the effect of adjuvant radio- and chemotherapy [6,7]. The purpose of this retrospective analysis was to elucidate the meaning of adjuvant radiotherapy (RT) for clinical outcome and to define prognostic factors in these patients (pts)
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