Effect of Radiotherapy in Addition to Surgery in Early Stage Endometrial Cancer: A Population-Based Study

Abstract

Background: The role of radiotherapy in the management of early (FIGO I) endometrial cancer is controversial with limited availability of prospective data from randomized trials. Methods: German Epidemiologic Cancer Registries provided by the Robert Koch Institute. We considered FIGO I cases with recorded operative treatment (n = 12,718, 2000–2017). We computed hazard ratios (HR) from relative survival models in relation to the mortality of the general population with 95% confidence intervals (CI). Multivariate models were adjusted for age, stage (IA vs. IB), grading, and chemotherapy. Radiotherapy included external radiotherapy and brachytherapy. Results: Cases with a favorable risk profile (FIGO IA, G1/G2) had a slightly lower survival rate, relative to the general population (FIGO IA: 0.9, G1: 0.91). The proportion of FIGO IA cases was lower in the radiotherapy group (52.6%) vs. cases without radiotherapy (78.6%). Additional treatment with radiotherapy was beneficial in FIGO IB (HR = 0.74) and all histopathological grades, but not FIGO IA cases (HR = 0.93) cases. Compared to IA tumors, IB cases had a HR of 1.51 (95% CI: 1.34–1.7). Conclusions: Radiotherapy in addition to surgery is beneficial for patients in a FIGO IB stage. Further studies need to address the impact of new techniques and risk assessment.

Histopathological features of endometrial cancer. A cross sectional study

“…While these findings are consistent with previous studies, there is ongoing debate regarding the prognostic value of factors such as lympho-vascular invasion (LVSI), lymph node dissection, cervical invasion, and adjuvant treatment [18]. Adjuvant radiotherapy is recommended for early-stage endometrioid carcinoma with high-risk or highintermediate features [10].…”

“…Another noteworthy point is the presence of obesity as an important prognostic factor in most endometrial cancer cases, predisposing this population to higher mortality compared to the normal population, regardless of the underlying malignancy [10]. However, the present study did not align with this hypothesis.…”

Real-World Evaluation of Modern Adjuvant Radiotherapy in Women with Stage IB Endometrial Cancer

“…Endometrial cancer is the most common malignancy of the female genital tract, with a continuously increasing incidence rate [1]. The 2009 International Federation of Gynecology and Obstetrics (FIGO) staging system for endometrial carcinoma defined stage IB as a disease involving the invasion of more than half of the myometrium, which comprises a wide spectrum of risk according to pathologic and age-based risk factors, and the optimal 2 of 13 adjuvant management for these patients is not well-defined [2,3]. Several landmark clinical trials have attempted to identify women at risk for recurrence, so that the optimal treatment paradigm could be determined.…”