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      Postoperative radiotherapy for endometrial cancer

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          Abstract

          Purpose

          To investigate the prognostic factors and effectiveness of postoperative radiotherapy alone for endometrial carcinoma.

          Materials and Methods

          Sixty four patients with stage I-III endometrial cancer (EC) treated with postoperative radiotherapy alone between January 1989 and December 2008 at the Keimyung University Dongsan Medical Center were chosen for the present study. Typically, total hysterectomy, salpingo-oophorectomy and lymphadenectomy were performed on the patient's pelvis. Total dose from 50.4 Gy to 63 Gy was irradiated at pelvis or extended field. Thirteen patients were treated with Co-60 or Ir-192 intracavitary radiotherapy. Follow-up periods were from 7 to 270 months, with a median of 56 months.

          Results

          Five year overall survival (OS) rate was 58.7%, respectively. Five year disease-free survival (DFS) rate was 59.2%, respectively. In univariate analysis for OS and DFS, stage, menopausal age, type of operation, serosal invasion, and lymph node involvement were found to be statistically significant. Histologic type was marginally significant. In multivariate analysis for OS and DFS, stage, types of operation, histologic type were also found to be statistically significant. Treatment failure occurred in 14 patients. The main pattern of failure was found to be distant metastasis. Time to distant metastasis was from 3 to 86 months (median, 12 months). There were no grade 3 or 4 complications.

          Conclusion

          Stage, types of operation, and histologic type could be the predictive prognostic factors in patients. We contemplated postoperative radiation as effective and safe treatment method for EC. Additional treatment would be needed to reduce distant metastasis.

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          Most cited references18

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          Source of estrogen production in postmenopausal women.

          J. L. Grodin, P Macdonald, P Siiteri (1973)
          Article 0 comments Cited 67 times – based on 0 reviews     Review now
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            Postoperative radiotherapy for Stage 1 endometrial carcinoma: long-term outcome of the randomized PORTEC trial with central pathology review.

            W L J van Putten, Peter van Lent, C C Wárlám-Rodenhuis … (2005)
            In 2000, the results of the multicenter Post Operative Radiation Therapy in Endometrial Carcinoma (PORTEC) trial were published. This trial included 714 Stage I endometrial carcinoma patients randomly assigned to postoperative pelvic radiotherapy (RT) or no further treatment, excluding those with Stage IC, Grade 3, or Stage IB, Grade 1 lesions. Radiotherapy significantly decreased the risk of locoregional recurrence (4% vs. 14%), without affecting overall survival. In this report the long-term outcome and results with central pathology review are presented. The slides of 569 patients (80%) could be obtained for pathology review. Median follow-up for patients alive was 97 months. Analysis was done according to the intention-to-treat principle. The primary study endpoints were locoregional recurrence and death. Ten-year locoregional relapse rates were 5% (RT) and 14% (controls; p < 0.0001), and 10-year overall survival was 66% and 73%, respectively (p = 0.09). Endometrial cancer related death rates were 11% (RT) and 9% (controls; p = 0.47). Pathology review showed a substantial shift from Grade 2 to Grade 1, but no significant difference for Grade 3. When cases diagnosed at review as Grade 1 with superficial myometrial invasion were excluded from the analysis, the results remained essentially the same, with 10-year locoregional recurrence rates of 5% (RT) and 17% (controls; p < 0.0001). In view of the significant locoregional control benefit, radiotherapy remains indicated in Stage I endometrial carcinoma patients with high-risk features for locoregional relapse.
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              Prognostic factors in endometrial carcinoma.

              Peter Uharcek (2008)
              Endometrial carcinoma is the most common malignancy of the female genital tract in industrialized countries, and occurs predominantly after the menopause. Although most endometrial carcinomas are detected at low stage, there is still a significant mortality from the disease. In postmenopausal women, prolonged life expectancy, changes in reproductive behavior and prevalence of overweight and obesity, as well as hormone replacement therapy use, may partially account for the observed increases of incidence rates in some countries. In order to improve treatment and follow-up of endometrial carcinoma patients, the importance of various prognostic factors has been extensively studied. The identification of high-risk groups would make it possible to avoid unnecessary adjuvant treatment among patients with a good prognosis. Over the past few decades, several studies have demonstrated the prognostic importance of different parameters including lymph node status, histological type of carcinoma (serous carcinoma and clear cell carcinomas are poor prognostic types), histological grade, stage of disease, depth of myometrial invasion, lymphovascular space involvement and cervical involvement. Other factors currently being investigated are estrogen and progesterone receptor status, p53 status, flow cytometric analysis for ploidy and S-phase fraction, and oncogenes such as HER-2/neu (c-erbB-2).
              Article 0 comments Cited 20 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Radiat Oncol J
                Journal ID (iso-abbrev): Radiat Oncol J
                Journal ID (publisher-id): ROJ
                Title: Radiation Oncology Journal
                Publisher: The Korean Society for Radiation Oncology
                ISSN (Print): 2234-1900
                ISSN (Electronic): 2234-3164
                Publication date (Print): September 2012
                Publication date (Electronic): 30 September 2012
                Volume: 30
                Issue: 3
                Pages: 108-116
                Affiliations
                [1 ]Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
                [2 ]Department of Gynecology and Obstetrics, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
                Author notes
                Correspondence: Jin Hee Kim, MD, Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, 56 Dalseong-ro, Jung-gu, Daegu 700-712, Korea. Tel: +82-53-250-7665, Fax: +82-53-250-7984, jhkim@ 123456dsmc.or.kr
                Article
                DOI: 10.3857/roj.2012.30.3.108
                PMC ID: 3496844
                PubMed ID: 23170289
                SO-VID: df6e7efa-08a3-4cdd-a5ab-f5eef24a0070
                Copyright © Copyright © 2012. The Korean Society for Radiation Oncology
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 25 June 2012
                Date revision received : 06 August 2012
                Date accepted : 11 September 2012
                Categories
                Subject: Original Article
                Subject: Clinical Investigation

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: adjuvant radiotherapy,endometrial neoplasm,menopause,prognosis,postoperative procedures
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: adjuvant radiotherapy, endometrial neoplasm, menopause, prognosis, postoperative procedures

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