J Korean Soc Ther Radiol Oncol.
2000 Mar;18(1):40-45.
Postoperative Adjuvant Radiation Therapy in Endometrial Carcinoma
Abstract
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PURPOSE: To evaluate the histopathological prognostic factors, relapse pattern and survival in
patients with endometrial carcinoma who were treated with surgery and postoperative adjuvant radiotherapy (RT).
METHODS
AND MATERIALS: From September 1991 to December 1997, 27 patients with endometrial carcinoma treated
with surgery and postoperative adjuvant RT at Asan Medical Center were entered in this study. Surgery was
performed with total abdominal hysterectomy in six, total abdominal hysterectomy with pelvic lymph node
dissection in eight and radical hysterectomy in 13 patients. External RT of 50.4 Gy was done to all patients and
among these, additional high dose rate vaginal vault irradiation of 20-25 Gy with fractional dose of 4-5 Gy was
boosted in 16 patients. The patients were followed for 6-95 months (median 30).
RESULTS
The number of patients
according to FIGO stage were I 18 (67%), II 1 (4%) and III 7 (26%). Patients with poor histologic grade, deep
myometrial invasion, adnexal involvement, lymphovascular invasion showed more pelvic lymph node involvement,
but no statistical significance was indicated. The 5year overall and disease free survival were 100% and 76.8%,
respectively. Relapse sites were pelvic, para-aortic lymph node, and multiple metastases including lung, and no
vaginal relapse was developed. Factors that were associated with disease free survival were FIGO stage
(p=0.01), lymphovascular invasion (p=0.03), pelvic lymph node involvement (p=0.000 1). There was only one
Grade 1 rectal bleeding without moderate to severe complications.
CONCLUSION
Postoperative adjuvant RT is
considered to reduce the loco-regional failure, resulting the improvement of survival. The group of patients
with the risk of vaginal failure without vaginal vault irradiation should be investigated according to stage and
grade.