Adjuvant radiation therapy is not necessary in the management of endometrial carcinoma stage I, low-risk cases

Abstract

In an attempt to create uniform nationwide guidelines for the management of all stages of endometrial carcinoma, and to limit the use of adjuvant radiation therapy in stage I disease to high‐risk patients only, a protocol was developed by the Danish Endometrial Cancer group (DEMCA). From September 1986 through August 1988, 1214 women in Denmark with newly diagnosed carcinoma of the endometrium have been treated according to this protocol. This figure represents all endometrial carcinomas diagnosed in Denmark during this 2‐year period. The primary treatment was total abdominal hysterectomy and bilateral salpingo‐oophorectomy and no preoperative radiation therapy was delivered. In 1039 cases no macroscopic residual tumor and/or microscopic tumor tissue in the resection margins was found following surgery. Based on surgery and histopathology, these patients were classified as: P‐stage I low‐risk (grade 1 & 2 and 50% myometrial invasion), P‐stage I high‐risk (grade 1 & 2 and> 50% myometrial invasion, and grade 3), P‐stage II and P‐stage III (Group 1). Distribution was as follows: P‐I low‐risk 641 patients, P‐I high‐risk 235, P‐II 105 and P‐III (Group 1) 58 patients. No postoperative radiation therapy was given to P‐I low‐risk cases. P‐I high‐risk, P‐II, and P‐III (Group 1) cases received external radiation therapy. Recurrence rate at 68–92 months follow‐up was 45/641 (7%) in P‐I low‐risk, 36/235 (15%) in P‐I high‐risk, 30/105 (29%) in P‐II, and 27/58 (47%) in P‐III (Group 1) cases. Fifteen of 17 vaginal recurrences in P‐I low‐risk cases were salvaged (mean observation time 61 months).

High frequency transvaginal ultrasonography in preoperative assessment of myometrial invasion in endometrial cancer.

“…7 Approximately 75% of the cases have stage I disease at diagnosis, and within this stage, tumor grade and myometrial invasion are consistent prognostic indicators of lymph node metastases and survival. 12 In our study 93 (77.4%) patients had FIGO stage I disease. If the myometrium is not invaded, nodal metastases are rare, irrespective of histologic grade.…”

Role of lymphadenectomy and pelvic radiotherapy in patients with clinical FIGO stage I endometrial adenocarcinoma: an analysis of 208 patients

“…The recurrence rate of our high-risk node-negative group (group B) was 15.7%, which is consistent with previous reports (20,29) . The recurrence rate observed by COSA-NZ-UK group was 14% in high-risk patients treated with formal surgical staging and brachytherapy (20) , while the Danish Endometrial Cancer Group demonstrated a 15% recurrence rate in the same group of patients who underwent hysterectomy and pelvic radiotherapy (29) .…”

“…The total recurrence rate in low-risk patients in our study was 8.1% (n ¼ 7) of which 5.8% recurred vaginal (n ¼ 5), and they were locally cured with salvage radiotherapy. Because of the 2.3% (2/7) low rate of fatal recurrence in this subset of patients, and because the deaths were due to distant metastases without pelvic relapse after salvage radiotherapy, and because of the high OS and disease-specific survival (93% and 97.5%, respectively), we agree with the previous reports that lowrisk patients are optimally treated by hysterectomy and bilateral salpingo-oophorectomy only (25,28,29) .…”

“…They concluded that this group of patients can be best treated by hysterectomy alone. However, the recurrence rate reported in low-risk patients treated with a surgery alone range from 4-7% (28,29) . The total recurrence rate in low-risk patients in our study was 8.1% (n ¼ 7) of which 5.8% recurred vaginal (n ¼ 5), and they were locally cured with salvage radiotherapy.…”

La lymphadénectomie dans les cancers de l’endomètre de stade I

“…Ces micrométastases sont la source des récidives ganglionnaires tardives couramment observées dans les centres de recours. Enfin, la documentation de l'absence d'atteinte ganglionnaire aide à renoncer à des irradiations externes systématiques [64].…”