Adjuvant Radiotherapy In Patients Research Articles

Eye-Preserving Surgery Followed by Adjuvant Radiotherapy for Lacrimal Gland Carcinoma: Outcomes in 37 Patients.

To describe the clinical outcomes of eye-preserving surgery followed by adjuvant radiotherapy in patients with lacrimal gland carcinoma. Thirty-seven patients with lacrimal gland carcinoma who underwent eye-preserving surgery were studied. At last follow up, 32 patients were alive without disease, 3 patients were alive with disease with distant metastasis, 1 patient had died of disease, and 1 patient had died of other cause. The 5-year recurrence-free survival rate was worse in patients without than in patients with adjuvant radiotherapy (p = 0.001) and worse in patients with T3-T4 tumors than in patients with T1-T2 tumors (p = 0.027). At last follow up, 25 patients (68%) had visual acuity of 20/40 or better. In patients with lacrimal gland carcinoma, eye-preserving surgery and adjuvant radiotherapy is associated with reasonable local control rates and visual and ocular function. Postoperative adjuvant radiotherapy seems to enhance local control rates.

Impact of Postoperative Chemoradiation for HPV Positive Oropharyngeal Cancers with Extranodal Extension and/or Positive Margins

Level 1 evidence suggests an overall survival (OS) benefit with the addition of concurrent chemotherapy to adjuvant radiation in patients with head and neck squamous cell carcinoma (HNSCC) who have pathologic positive margins (+margin) or extra-nodal extension (ENE). It is uncertain whether this benefit persists in HPV positive oropharyngeal cancer patients with similar risk factors. We sought to analyze adjuvant patterns of care and their impact on OS in HPV positive oropharyngeal patients with high risk pathologic features. We used the National Cancer Database to select a population of surgically treated (>local excision), pathologically high risk (+margin or ENE) patients with non-metastatic, HPV positive, squamous cell carcinoma of the oropharynx who received either adjuvant radiation (aRT) or chemoradiation (aCRT). Univariable and multivariable logistic regression was used to assess predictors of the use of aCRT compared to aRT in this cohort. Univariable and multivariable Cox regression was then performed to evaluate the impact of adjuvant treatment type on OS. Age (<55, 55-64, ≥65), gender (male, female), race (White, Black, Other), Charlson-Deyo comorbidity score (0, 1, ≥2), AJCC 7th edition stage (I, II, III, IVA, IVB), facility type (non-academic, academic), high-risk feature (+margin, ENE, both), insurance (none, private, Medicaid, Medicare, other/unknown), and year of diagnosis (2010-2012, 2013-2014) were included as confounders. There were 1,638 patients who met inclusion criteria; 436 (26.6%) received aRT and 1,202 (73.4%) received aCRT. Median follow up was 42 months and median RT dose was 6600cGy. On multivariable logistic regression, stage IVA-IVB (OR 3.31-5.81, p=0.001), presence of ENE (OR 1.42, 95% CI 1.04-1.92, p=0.027) or both ENE and +margin (OR 1.69, 95% CI 1.12-2.56, p=0.013) were associated with increased likelihood of receiving aCRT. Treatment at an academic facility (OR 0.65, 95% CI 0.50-0.85, p=0.002) was associated with decreased likelihood of receiving aCRT. The 5-year survival was 87.3% with aRT and 89.9% with aCRT (p=0.469); on multivariable analysis, there were no OS difference comparing postoperative CRT to postoperative RT (HR 0.68, 95% CI 0.44-1.05, p=0.079). Although not significant, after adjustment for confounders, there was a trend towards improved OS with aCRT compared to aRT in surgically treated OPC patients with high risk features. De-escalation of adjuvant therapy in this group, especially those with multiple high risk features, should be undertaken with caution.

The Role of MR in Determining the Need for Adjuvant Radiation for Patients with Stage IB Cervical Cancer and Correlation with Pathologic Size

The Role of MR in Determining the Need for Adjuvant Radiation for Patients with Stage IB Cervical Cancer and Correlation with Pathologic Size

Disseminated Tumor Cells Predict Efficacy of Regional Nodal Irradiation in Early Stage Breast Cancer

Disseminated tumor cells (DTCs) collect in the bone marrow and indicate micrometastatic spread. We previously reported that DTCs could be a predictive factor for the efficacy of regional node irradiation (internal mammary nodes [IMNs]/supra- and infraclavicular nodes [SCNs]). In this article, we report the long-term results (>10years) on the impact of DTC status in early stage breast cancer. Patients with localized breast cancer were eligible for inclusion in this prospective cohort. DTCs were obtained from a medullary iliac crest sample performed before any primary therapy. DTC status was prospectively assessed by pathologists. Irradiation volumes were defined per standard of care. Cumulative incidence rates and hazard ratios were obtained using both Cox and Fine-Gray models. Interaction tests were performed to confirm the predictive value of DTC status in a multivariate analysis. Six hundred twenty patients with localized breast cancer were included. Overall, 94 patients (15.2%) were DTC-positive. After a median follow-up of 11.7years, 47 patients (7.6%) experienced locoregional relapse. DTC detection was associated with a higher risk of locoregional relapse in univariate and multivariate analyses (Cox hazard ratio, 3.26; 95% confidence interval, 1.6-5.7; P=.001). In the multivariate subgroup analysis, IMN/SCN irradiation significantly reduced locoregional relapse among DTC-positive patients compared with DTC-negative patients (interaction test: hazard ratio, 0.3; 95% confidence interval, 0.1-0.9; P=.02). IMN/SCN was the only irradiation volume with an impact on locoregional relapse in patients according to DTC status, and the predictive value of DTC status for the benefit of locoregional irradiation was independent of locoregional nodal status. This long-term analysis confirms the predictive impact of DTC status on the efficacy of regional radiation therapy for locoregional relapse in early breast cancer. After further studies, DTC status could be used as a decision tool to better tailor adjuvant radiation therapy in patients with early stage breast cancer.

Respuesta clínica en pacientes con tumores de mama tratadas con radioterapia conformacional postmastectomía en el Instituto Nacional de Cancerología, Colombia

IntroductionBreast cancer is the world's leading cause of cancer, with 1,671,149 new cases and 521,907 deaths each year. Adjuvant radiotherapy in patients with T3-T4 tumours or with positive lymph nodes improves locoregional control and overall survival. There is a gap regarding the oncological outcomes and the toxicity derived from the treatments with new radiotherapy techniques used in our Institution since 2010. MethodsA retrospective, descriptive, historical cohort study was conducted on 82 patients with a diagnosis of locally advanced breast cancer treated with post-mastectomy conformational radiotherapy in the Instituto Nacional de Cancerología, between 1 January 2010 and 31 December 2011. ResultsA total of 82 consecutive patients were included in the analysis. At 6 years of follow-up 87.8% (n=72) were still alive, with 3 losses in follow-up. There was a relapse in 30%, and of these 76% were systemic, 12% regional, and 12% regional and systemic. Complications related to radiotherapy were present in 16% of patients. ConclusionThe outcomes of multimodal management of locally advanced breast cancer are similar to those reported by clinical trials. In future studies it will be necessary to evaluate factors associated with regional relapse in this institution.

Impact of Delayed Adjuvant Radiotherapy in the Survival of Women with Breast Cancer.

ObjectiveOur objective was to determine whether a delay in adjuvant radiotherapy is related to a decrease in relapse-free survival and disease-specific survival of women with operable breast cancer.MethodsData on 1000 patients diagnosed with breast cancer were recorded. The cohort was divided into five groups according to the timing of radiotherapy: ≤30 days, 31 to 60 days, 61 to 90 days, 91 to 120 days, and >120 days. The relapse-free survival and disease-specific survival were also calculated in relation to the number of patients.ResultsThis study found no statistical difference for delays in adjuvant radiotherapy in patients with early breast cancer, but we noted a statistical decrease in disease-specific survival in patients with locally advanced breast cancer receiving radiotherapy after a delay of at least 60 days.ConclusionWaiting times for radiotherapy should be as short as reasonably achievable, given the specific risk factors in the individual patient.

Stage II Oral Tongue Cancer: Survival Impact of Adjuvant Radiation Based on Depth of Invasion.

To determine if adjuvant radiation therapy for patients with pT2N0 oral cavity tongue cancer affects overall survival. Retrospective cohort study. National Cancer Database. Cases diagnosed between 2004 and 2013 with pathologic stage pT2N0 oral cavity tongue cancer with negative surgical margins were extracted from the National Cancer Database. Data were stratified by treatment received, including surgery only and surgery + postoperative radiation therapy. Univariate analysis was performed with a 2-sample t test, chi-square test, or Fisher exact test and log-rank test, while multivariate analysis was performed with Cox regression models adjusted for individual variables as well as a propensity score. A total of 934 patients were included in the study, with 27.5% of patients receiving surgery with postoperative radiation therapy (n = 257). In univariate analysis, there was no significant difference in 3-year overall survival between the patient groups ( P = .473). In multivariate analysis, there was no significant difference in survival between the treatment groups, with adjuvant radiation therapy having a hazard ratio of 0.93 (95% CI, 0.60-1.44; P = .748). Regarding tumors with a depth of invasion >5 mm, there was no survival benefit for the patients who received postoperative radiation therapy as compared with those who received surgery alone (hazard ratio = 0.93; 95% CI, 0.57-1.53; P = .769). An overall survival benefit was not demonstrated for patients who received postoperative radiation therapy versus surgery alone for pT2N0 oral cavity tongue cancer, irrespective of depth of tumor invasion.

Radiotherapy in Osteosarcomas

Abstract Osteosarcoma represents a rare primary tumor of the bone, but it ranks 5th among children and adolescents. When diagnosed, many patients already have a disseminated disease at subclinical level. Current treatment includes surgery and chemotherapy. Radiotherapy is not commonly indicated, especially given the radioresistant characteristic of this type of cancer and it is usually administered for residual disease after surgery, inoperable tumors or in palliation, such as whole lung irradiation. The purpose of this paper was to identify the real contribution of radiotherapy in osteosarcomas, with solutions to improve local control and survival. We reviewed clinical studies, starting with the period before chemotherapy, in order to identify treatment techniques related criteria that may influence local control, survival, and secondary toxicity. Modern radiotherapy techniques are outlined with their dosimetric advantages. Following the 1990s, the combination between proper surgery and chemotherapy has eliminated the need for pre-operative radiotherapy. Most clinical studies have used adjuvant radiotherapy for patients with positive resection margins, with good results but hard to dissociate from those of the concurrently administered chemotherapy. Proton therapy is frequently indicated for these patients, due to the healthy tissue sparing characteristics. Studies have pointed out the correlation between radiotherapy response and tumor size, total administered dose, chemo sensitivity. Whole lung irradiation for patients with lung metastases is inferior to chemotherapy. Radiotherapy associated complications include joint fibrosis with reduced functional capabilities, bone fracture, allograft loss and carcinogenic risk. Currently, radiotherapy is not the first choice when treating osteosarcomas, but new evidence is emerging for combining modern techniques, such as proton therapy with surgery and chemotherapy for patients with incomplete resections or inoperable tumors.

Objective assessment of flap volume changes and aesthetic results after adjuvant radiation therapy in patients undergoing immediate autologous breast reconstruction.

BackgroundThe use of immediate breast reconstruction and adjuvant radiation therapy is increasing in breast cancer patients. This study aimed to analyze the aesthetic outcome and changes in flap volume in patients with breast cancer undergoing radiation therapy of the surgical site after immediate autologous tissue reconstruction.MethodsImmediate abdominal free flap breast reconstruction following unilateral mastectomy was performed in 42 patients; 21 patients received adjuvant radiation (study group) and 21 patients did not (control group). To compare flap volume, three-dimensional computed tomography (CT) was performed before and after radiation. Also, aesthetic analysis was performed in both groups to evaluate shape changes.ResultsThere was a 12.3% flap volume reduction after the completion of radiation in the experimental group that was significantly greater than the 2.6% volume reduction observed in the non-radiation group (P<0.01). There was no significant difference in the short- and long-term aesthetic results between the groups.ConclusionsWhen performing immediate autologous breast reconstruction, 14% volume overcorrection is recommended for patients in whom adjuvant radiation therapy is anticipated to improve aesthetic outcomes.

Adjuvant radiation therapy in patients with breast cancer and Li-Fraumeni syndrome: Oncologic results and incidence of second neoplasms.

e12589Background: Li-Fraumeni syndrome (LFS) is an autosomal dominant disease related to an increased risk of various types of cancer, including radio-induced neoplasms, due to the TP53 gene mutati...

Assessing the effectiveness of adjuvant radiation therapy in patients with rare breast cancers including metaplastic and phyllodes tumors.

e12564Background: Metaplastic (MBC) and phyllodes (PBC) breast cancers are rare histologies of breast neoplasms, each representing less than 1% of total breast cancers. Literature over the past dec...

The Role of Adjuvant Radiation Therapy in Locally Advanced Bladder Cancer.

Background:The standard of care for locally advanced bladder cancer (LABC) is neoadjuvant chemotherapy followed by cystectomy. However, the role of adjuvant therapy for locally advanced bladder cancer is unclear.Objective:The purpose of this study was to evaluate the outcomes of adjuvant radiation therapy (RT) for patients with LABC, and to determine which risk factors best predict for patients who may best benefit from adjuvant RT.Methods:The National Cancer Data Base (NCDB) was queried (2004– 2013) for patients with newly-diagnosed pT3-4N0-3M0 urothelial carcinoma of the bladder that received neoadjuvant chemotherapy and cystectomy. Patients were divided into two groups based on the adjuvant therapy they received: RT or observation. Statistics included multivariable logistic regression to determine factors predictive of receiving adjuvant RT, Kaplan-Meier analysis to evaluate overall survival (OS), and Cox proportional hazards modeling to determine variables associated with OS.Results:Altogether, 1,646 patients met inclusion criteria; 59 (3.6%) patients received adjuvant RT, while 1,587 (96.4%) were observed. Patients treated with adjuvant RT were more likely to be female, have positive surgical margins, and receive treatment at a non-academic facility. There was no difference in median overall survival (OS) between patients treated with RT when compared to patients observed (17.7 months vs. 23.5 months; p = 0.085). However, an improvement in median OS with the use of adjuvant RT was observed among patients with positive surgical margins (20.3 months vs. 13.1 months; p = 0.032). On multivariate analysis, advancing age, pT4 stage, positive N stage, positive margins, and lower socioeconomic status were associated with worse OS.Conclusions:In the largest study to date evaluating efficacy of adjuvant radiotherapy in patients with locally advanced bladder cancer, use of RT was not associated with OS in all patients, while RT was associated with improvemed OS among patients with positive surgical margins. Prospective studies are recommended to confirm these findings.

Clinical characteristics, risk factors, and outcomes after adjuvant radiotherapy for patients with thymoma in the United States: analysis of the Surveillance, Epidemiology, and End Results (SEER) Registry (1988–2013)

Purpose: The surgery with adjuvant radiation for the treatment of thymoma is still debated. The aim of this study was to examine the efficacy of postoperative radiotherapy (PORT) in a population-based registry of patients with thymoma.Materials and methods: We conducted a retrospective analysis of the Surveillance, Epidemiology, and End Results database to compare the outcomes of patients with thymoma who received surgery with or without PORT.Results: Among the 2234 patients of this study, the surgery with PORT group had a longer mean overall survival (OS) and cancer-specific survival (CSS) than did the surgery without PORT group (OS: 172.3 vs. 155.3 months, p = .005; CSS: 247.3 vs. 241.8 months, p = .04). PORT significantly improved OS and CSS of patients with stage III/IV disease, but decreased CSS for those with stage I/IIA disease. Although the surgery with PORT group had a higher rate of secondary cancers, the between-group difference in the disease-free interval was not significant.Conclusions: PORT provides a significant benefit for patients with thymoma, particularly those with advanced disease. However, it also increases the risk of a second malignancy. We suggest that treatment guidelines should adopt a more positive stance on the use of PORT.

The influence of xenon-therapy on tolerance of adjuvant radiotherapy in patients with single brain metastasis

Objective: to study the tolerance of radiotherapy by adding the boost and the xenon-therapy during the whole brain radiotherapy (WBRT) in patients with single brain metastasis. Materials and methods: the study involved 60 patients divided in the 3 equal groups (20 people in each group) where the treatment varied according the methods of the adjuvant radiotherapy. The patients in the first group were assigned to receive WBRT alone, in the second group — WBRT and the boost to tumor bed, in the third group — WBRT and the boost in combination with the xenon-oxygen inhalations. The quality of life, the toxic and adaptation reaction, the psychological status and the electrical activity of the brain during the treatment were also included in the research. Results: the increase of side-effects of the treatment and the quantity of stress-reactions occurred during WBRT in combination with the boost. But the use of xenon allowed to level all the negative reactions and even to improve some of physiological and psychological parameters. The xenon-oxygen inhalations led to the decrease of intensity of situational anxiety and depression. There was also a reduction in delta-activity level according to EEG and a return of the other rhythms to baseline levels which was lacking in the other groups. Conclusions: the use of the xenon-therapy in combination with WBRT by the developed methods allows to improve the quality of life in patients with radiation treatment, as well as to reduce the degree of the intensity of side and toxic reactions. The results of objective methods at the trial demonstrate the stresseless and radioprotective effects of xenon.

Adjuvant radiotherapy following pancreaticoduodenectomy for ampullary adenocarcinoma improves survival in node-positive patients: a propensity score analysis.

This study aimed to evaluate the impact of adjuvant radiotherapy in patients undergoing pancreaticoduodenectomy (PD) for ampullary adenocarcinoma. Using the Surveillance, Epidemiology, and End Results, patients with non-metastatic ampullary adenocarcinoma between 2004 and 2013 were identified. Cancer-specific survival and overall survival were estimated using Kaplan-Meier and Cox regression to obtain adjusted hazard ratio of survival. In this study, 1106 patients with ampullary adenocarcinoma were identified, of which 27% received adjuvant radiotherapy and the remaining 73% (803/1106) patients did not receive any adjuvant radiotherapy. In the matched cohort, there were still no significant difference in CSS (median 41 vs 35, p=0.28) and OS (median 32 vs 30, p=0.26) between patients receiving adjuvant radiotherapy and those under observation alone. However, in patients with N2 (Fig.4) disease, both CSS (median 27 vs 19months, p=0.0044) and OS (median 23 vs 17months, p=0.0091) were significantly longer for patients receiving adjuvant radiotherapy. In summary, adjuvant radiotherapy following PD for ampullary adenocarcinoma significantly improves survival in patients with N2 disease. Future studies defining "high-risk" groups using larger cohorts will enable reliable appraisal on the benefit of adjuvant radiotherapy to allow for a more personalized approach in treating patients.

Cancers of the Major Salivary Gland.

Salivary gland malignancies are rare tumors that comprise multiple histologic entities with diverse clinical behavior. Mucoepidermoid carcinoma is the most frequent primary salivary malignancy, followed by adenoid cystic and acinic cell carcinoma. Although most salivary malignancies are asymptomatic, presentation with a rapidly enlarging mass may be accompanied by pain, functional neurologic deficits, soft-tissue invasion, or nodal enlargement. Assessment of clinical behavior and physical exam greatly contributes to diagnostic workup. Preoperative imaging, to include ultrasound, computed tomography, or magnetic resonance imaging, may assist with surgical planning. Limitations of preoperative fine-needle aspiration cytology mean that, in some cases, definitive histologic diagnosis may not be established until therapeutic surgery is undertaken. Treatment strategies rely on oncologic resection of the primary site with negative margins as well as adjuvant radiotherapy in patients with high-risk features, such as high-grade histology, advanced T class, or perineural invasion. Regional lymphadenectomy is recommended for involved nodal basins. Patients with clinically node-negative disease at high risk for occult nodal metastases may be considered for elective lymphadenectomy or radiotherapy. Use of chemotherapy in the adjuvant setting, in combination with radiotherapy, remains controversial. The rate of objective response to palliative chemotherapy in recurrent or metastatic salivary gland malignancy remains low. In studies that include a significant proportion of adenoid cystic carcinomas, whether disease stability represents an indolent disease process or the true effect of a therapeutic drug may be difficult to discern. Recognition of genetic alterations and protein expression unique to salivary malignancies presents exciting new opportunities for molecularly targeted therapy, although the response to molecularly targeted therapy in studies has been modest thus far.

Retracted article: Adjuvant radiotherapy in patients with diffuse large B-cell lymphoma in advanced stage (III/IV) improves the outcome in the rituximab era

Statement of Retraction: Adjuvant radiotherapy in patients with diffuse large B-cell lymphoma in advanced stage (III/IV) improves the outcome in the rituximab eraWe, the Editor[s] and Publisher of Hematology, have retracted the following article:Avilès, A, Nambo, M-J, Calva, A, et al. Adjuvant radiotherapy in patients with diffuse large B-cell lymphoma in advanced stage (III/IV) improves the outcome in the rituximab era. Hematology. 2019;24:507–511; DOI:10.1080/10245332.2018.1423880The above article has been retracted as a result of concerns regarding the data upon which the presented research has been based. After re-examination and several independent expert reviews the consensus is that the data and results are not reliable and therefore the article must be retracted. The authors have agreed with this decision.We have been informed in our decision-making by our policy on publishing ethics and integrity and the COPE guidelines on retractions.The retracted article will remain online to maintain the scholarly record, but it will be digitally watermarked on each page as “Retracted”.

Does adjuvant radiation provide any survival benefit after an R1 resections for pancreatic cancer?

BackgroundThe benefit of adding external beam radiation to adjuvant chemotherapy in patients that have undergone a margin positive resection for early stage, pancreatic ductal adenocarcinoma has not been determined definitively. MethodsThe National Cancer Data Base was queried to evaluate the utility of adjuvant radiation in patients with pathologic stage I–II pancreatic ductal adenocarcinoma who underwent upfront pancreatoduodenectomy with a positive margin (margin positive resection) between 2004 and 2013. ResultsIn the study, 1,392 patients met inclusion criteria, of whom 263 (18.9%) were lymph node-negative (pathologic stages IA, IB, IIA) and 1,129 (81.1%) were node-positive (pathologic stage IIB); 938 (67.4%) patients received adjuvant radiation and chemotherapy, while 454 (32.6%) received adjuvant chemotherapy alone. Cox modeling stratified by nodal status demonstrated the benefit of radiation to be statistically significant only in node positive patients (hazard ratio 0.81, 95% confidence interval, 0.71–0.93). Node-positive patients receiving adjuvant radiation and chemotherapy had an adjusted median survival of 17.5 months vs 15.2 months for those receiving adjuvant chemotherapy alone (P = .003). In patients who had negative nodes, there was no difference in overall survival with radiation (22.5 vs 23.6 months, P = .511). ConclusionAddition of radiation to adjuvant chemotherapy after a margin positive resection confers a survival benefit albeit limited (about 2 months) in patients with node-positive pancreatic head cancer. (Surgery 2017;160:XXX-XXX.)

Can Interrogation of Tumour Characteristics Lead us to Safely Omit Adjuvant Radiotherapy in Patients with Early Breast Cancer?

Adjuvant radiotherapy after breast-conserving surgery has been an important component of the standard of care for early breast cancer. Improvements in breast cancer care have resulted in a substantial reduction in local relapse rates over recent decades. Although the proportional benefits of adjuvant radiotherapy are similar for different prognostic risk groups of patients, the absolute benefits depend on the risk of relapse and therefore vary considerably between prognostic groups. Radiotherapy is not without risk and for some patients at very low risk of relapse the risks of radiotherapy may outweigh the benefit, leading to potential overtreatment.Randomised controlled trial (RCT) evidence shows that omission of radiotherapy in low risk early breast cancer does not reduce overall survival or increase breast cancer mortality and local recurrences are salvageable. Despite this there has not been a change in practice regarding omission of radiotherapy. The reasons for this may include challenges in patient selection. Recent advances in immunohistochemistry and genomic profiling may improve risk stratification and the development of biomarkers to directed therapies. Several RCTs have quantified the benefit of radiotherapy in reducing local relapse. Where a treatment benefit is known but is considered to be so small not to be clinically relevant then alternatives to RCTs may be considered to answer the question of need. This is because we can assess risk against a fixed ‘absolute’ boundary rather than needing a randomised comparator. The prospective cohort study is an alternative to the RCT design to answer the question of need for radiotherapy. The feasibility of recruitment into biomarker-directed de-escalation studies will become apparent as more studies open. The challenge is to determine if we are able to accurately risk stratify patients and avoid unnecessary toxicity, thereby tailoring the need for adjuvant breast radiotherapy on an individual patient basis.

Therapeutic value of lymphadenectomy and adjuvant radiotherapy in uterine corpus confined endometrioid-type cancer

BackgroundTo determine the efficacy of lymphadenectomy and adjuvant radiotherapy in patients with endometrioid-type cancer confined to the uterine corpus. MethodsA total of 323 patients were evaluated. Patients were stratified according to depth of myometrial invasion (DMI) and tumor grade. ResultsLymphadenectomy was performed in 83% of the entire cohort. Age (<60 vs. ≥60) and DMI affected disease-free survival. Addition of lymphadenectomy improved the disease-specific survival. The improved effect of lymphadenectomy was only observed in DMI ≥½ and grade 2 tumor (78.5% vs. 95.4%). However, that effect in this group was determined in patients with more than 50 removed lymph nodes. Performing adjuvant radiotherapy and the type of the radiotherapy (vaginal brachytherapy vs. external beam radiotherapy) were not significant for disease-free and disease-specific survival. In the entire cohort, loco-regional recurrence occurred in 3.1% and 4.4% of patients with or without adjuvant radiotherapy, respectively. However, these rates were 2.6% and 13.6% for patients with DMI ≥½ and grade 2 who were older than 60 years, respectively. ConclusionLymphadenectomy should be performed in patients with DMI ≥½ and grade 2 to improve survival. Adjuvant vaginal brachytherapy may only be given to patients who are older than 60 years old with moderate differentiation and deep myometrial invasion to reduce loco-regional recurrence.