Hysterectomy and adjuvant irradiation for pathologic stage III adenocarcinoma of the endometrium (original) (raw)
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International Journal of Radiation Oncology Biology Physics, 1986
Three hundred and four evaluahle patients with FIG0 Stage I adenocarcinoma of the endometrium were treated with hysterectomy and irradiation. Irradiation was preoperative in 250 and postoperative in 44 patients. Ten patients had a preoperative implant and postoperative external irradiation. The 5 year actuarial survival was 94%, 80% and 76% for grades 1, 2 and 3, respectively. Within each grade and for all patients there was no difference in survival for Stage IA versus IB. The initial failure rate was 26/304 (9%) with 2% of patients having only a pelvic failure, 2% pelvic and distal failure and 4% a distal failure only. There were four distal vaginal failures and no isolated cuff recurrences. The upper abdomen was the most frequent site of extra-pelvic failure for grade 3, while the periaortic nodes and lung constituted the most common sites of distal failure for grades 1 and 2 tumors. Timing of the hysterectomy following the irradiation was of importance when evaluating the prognostic significance of residual disease or depth of myometrial invasion. The presence of residual disease or greater than l/3 myometrial invasion had a significantly worse prognosis only among patients who received no preoperative irradiation or who underwent their hysterectomy immediately following a preoperative implant. There was no difference in survival among patients with an initial local failure only as compared to those with an initial distal metastases, as the majority of patients with an initial local failure subsequently developed distant metastases.
Cancer, 1984
Eighty-three patients treated with total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO) and adjuvant irradiation for Stage I, grade 111 adenocarcinoma of the endometrium were reviewed. At 5 years, the overall survival was 71 %, and the disease-free survival (excluding patients dying of intercurrent disease) was 79%. The failure rates for pelvis alone, pelvis plus distant, and distant alone were 4.8%, 4.8%, and 10.896, respectively. The most common site of failure was the upper abdomen; 12% of all patients had a failure at this site, either alone or in conjunction with failure at another site. The 24% rate of failure in 50 patients receiving a preoperative implant and external irradiation was not significantly different from the 15% failure rate in 33 patients whose adjuvant irradiation consisted of a preoperative implant only. For the patients who had both an implant and external irradiation, the dose of external irradiation had no correlation with the rate of failure. In contrast, the number of milligramhours delivered to the uterus by the preoperative implant had a strong inverse correlation with the rate of failure, both for patients receiving an implant only and for those receiving an implant plus external irradiation. The data suggest the following: (1) a high-intensity preoperative uterine implant may be an important adjunct to surgery; and (2) external pelvic irradiation in addition to the implant does not seem to be any more beneficial than an implant alone. Cancer 54:40-47, 1984.
The role of postoperative irradiation in the management of stage I adenocarcinoma of the endometrium
American Journal of Roentgenology, 1976
A comparison of treatment protocols for endometrial carcinoma is presented. Valid conclusions regarding optimum approach are virtually precluded because of variability of such factors as clinical staging, incidence of vaginal metastases, patient selection, and histologic grade. While hysterectomy is the established definitive treatment, the superiority of adjuvant irradiation can be demonstrated only by randomized, prospective studies. The management of endometrial carcinoma remains controversial after more than 25 years of experience accumulated by radiation therapists and pelvic surgeons in Europe and North America. No sense of urgency has appeared to critically evaluate the treatment of this disease, apparently because most cases are diagnosed "early" and the degree
Radiation therapy alone for medically inoperable patients with adenocarcinoma of the endometrium
International Journal of Radiation Oncology*Biology*Physics, 1988
Surgery with adjuvant radiation is the definitive method for treating patients with Stage I and II FIG0 endometrial carcinoma. However, radiation therapy alone becomes the only curative alternative for patients who presented with severe, acute, and chronic medical illnesses which prevented surgical management. We report on 104 such patients treated at Centre Alexis Vautrin in Nancy (FRANCE) between 1975 and 1984. The minimum follow-up was 2 years, the maximum was 11 years. Fifty-two patients were treated by association of external irradiation (RT) and curietherapy (CUR), and 52 by curietherapy alone. The median age of the patients was 68.8 years with a minimum of 43 and maximum of 89 years old. Ninety-six patients (92.3%) were obese. Forty-nine (47.1%) were hypertensive. Forty-one (39.4%) had cardiovascular diseases, 25 (24%) had diabetes mellitus, and 13 (12.5%) had history of phlebitis. Seventy-nine patients (75.9%) were Stage I FIGO, 15 (14.4%) were Stage II, 4 patients (3.8%) were Stage III, and 6 patients (5.7%) were Stage IV. The 5-and lo-year overall absolute survival was 51.6% and 35.9% respectively. The 5-and lo-year determinate survival was 65.9% and 58.6% respectively. The 5-and loyear absolute survival of patients treated by combination RT + CUR was 59.6 and 49.8% respectively. The 5-and IO-year survival of patients treated by CUR alone was 42.3% and 27% significantly worse (p = 0.025). The 5-and IO-year determinate survival for Stage Ia was 82.1%, 71.4% and for Stage Ib 64.6% and 64.6% respectively. The difference was not significant (p = 0.18). While the 5-and IO-year determinate survival for Stage II was 56.2% and 56.3%, significantly worse than Stage I patients (p = 0.043). Tumor differentiation (G) was found to be a significant prognostic factor in survival (p < 0.05). Local failure was seen in 9 patients (8.6%) 5 in association with distant metastasis (DM). The 5-and lo-year actuarial local control were 87.6% and 85.1% respectively. Severe complications occurred in 18 patients (17.3%). Five of these patients are still alive with a mean follow-up of 8.8 years (minimum 6 years and maximum 11 years). The rate of complications had considerably diminished after 1980, as techniques improved and computerized dosimetry was used. Adenocarcinoma of endometrium, Inoperable patients, Radiation therapy alone.
Long-term results of adjuvant radiotherapy in stage I endometrial cancer
2011
Two hundred sixty-three patients with stage I endometrial adenocarcinoma, who were treated with postoperative radiotherapy between 1978 and 1998, were analyzed retrospectively. According to the 1988-FIGO staging system, the disease was stage IA in 19, stage IB in 128, and stage IC in 116 patients. One hundred and ninety-seven patients were treated with external and intracavitary irradiation, 45 patients with external radiotherapy and 21 patients with vaginal brachytherapy.
Cancer, 1988
Since one third of the patients with Stage I1 endometrial carcinoma have occult extrauterine pelvic metastases at diagnosis, adequate treatment must include the pelvic lymph nodes and parametria. Eighty-three patients with Stage I1 endometrial carcinoma were treated between January 1964 and December 1983. Sixty-nine patients (83%) received combined whole-pelvic irradiation and surgery, five (6%) had surgery alone and nine (11%) had radiotherapy alone. Five-year actuarial survival rates were 67%, 60%, and 38%, respectively. No pelvic recurrence occurred in the 69 patients who received the combined therapy, and there was no vaginal recurrence in the 80 patients treated with intracavity radium. There was a significantly lower incidence of pelvic lymph node metastases (P = 0.03) in patients treated with preoperative irradiation. The median time to recurrence was 17 months, with 67% of the recurrences diagnosed before 2 years, and 88% within 5 years. Ten patients (12%) incurred severe complications and three died as a result. Whole-pelvic irradiation, intracavity radium, and hysterectomy are effective treatment for occult pelvic and vaginal disease. Cancer 6 1 :1528-1534,1988. EYMAN ET AL., first reported significance of cervi-H cal involvement by endometrial carcinoma.' The International Federation of Gynecology and Obstetrics (FIGO) acknowledged this by designating these "corpus et colli" tumors as Stage I1 in their 1963 and 1971 staging system^.^,^ The importance of cervical extension of disease is demonstrated by the 57% 5-year survival rate of patients with Stage I1 disease compared to 74% for patients with Stage I di~ease.~ This poorer prognosis has been attributed to the rich cervical lymphatics with a resulting 37% incidence of pelvic node metastases,' compared to 10% in Stage I disease.6
Low-dose preoperative radiation therapy for adenocarcinoma of the endometrium. A pilot study
Cancer, 1984
A pilot study using low-dose preoperative radiation therapy, i.e., 10 Gy in 3 to 4 days as an adjuvant preoperative procedure for grade 2 or 3 (FIGO classification) endometrial carcinoma, was done. The concept of low-dose preoperative radiation therapy is to administer treatment, either surgical or radiotherapeutic, postoperatively according to the surgical and pathologic findings, allowing identification of those patients with previously undiagnosed extensive metastatic disease outside the pelvis found at laparotomy in whom routine pelvic radiation therapy is futile, as well as those patients with relatively low risk of recurrence who may not require further radiotherapy. Forty-four patients with clinical Stage I, grade 2 or 3 with adenocarcinoma of the endometrium were entered into the pilot study. Following surgery, 68% remained Stage I by pathologic examination, and in the remaining patients the stages were changed to I1 in seven, I11 in three, and IV in four. Postoperative treatment was administered according to extent of the disease found at surgery. The 4-year actuarial probability of survival rate for the entire group of patients with clinical Stage I disease was 80%; corresponding disease-free rate was 77%. For the Stage I disease confirmed by pathologic examination, the corresponding rate was 96%. The rates for Stages I1 through IV, as shown by pathologic findings at laparotomy, were 53% and 42%, respectively.
Journal of the Turkish-German Gynecological Association, 2015
Medical records of patients diagnosed with endometrial endometrioid adenocarcinoma and treated in the gynecologic oncology department between August 2002 and January 2014 were reviewed retrospectively. The staging of patients Objective: The impact of adjuvant radiotherapy on the rates of survival and local recurrence was analyzed in patients diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage 1a grade 2 endometrial endometrioid adenocarcinoma. Material and Methods: Medical records of 82 patients diagnosed and treated for FIGO stage 1a grade 2 endometrial endometrioid adenocarcinoma were reviewed retrospectively. A group of 59 patients who received postoperative radiotherapy was compared with a control group of 23 subjects treated without adjuvant radiotherapy; the duration of survival as well as the local recurrence and metastasis rates were evaluated in both groups. Results: The analysis of patient data has revealed the rate of local recurrence as 4.3% vs. 1.7% (p=0.485), the rate of distant metastasis as 4.3% vs. 6.9% (p=1.000), and the mean survival time as 83.6±38.7 vs. 81.5±37.5 months (p=0.828) in the adjuvant radiotherapy and control groups, respectively. Conclusion: In the presented study, adjuvant radiotherapy failed to improve the overall survival of the patients in the low-risk group (stage 1a grade 2). With the addition of the significant risk of radiation toxicity, it is highly probable that these patients will not benefit from postoperative radiotherapy. Close observation should be performed following the primary surgery in this patient group. Nevertheless, it should also be considered that adjuvant radiotherapy is a very effective treatment modality for the recovery of patients with vaginal relapse.