The effect of lymphadenectomy and radiotherapy on recurrence and survival in endometrial carcinoma. Experience in a population reference centre

Abstract

Aim

To evaluate the effect of lymphadenectomy and/or radiotherapy on recurrence and survival patterns in endometrial carcinoma (EC) in a radiotherapy reference centre population.

Material and Methods

A retrospective population-based review was conducted on 261 patients with stages I–III EC. Univariate and multivariate analyses were carried out. Both recurrence and survival were analysed according to patient age, FIGO stage, tumour size, myometrial invasion, tumour grade, lymphadenectomy, external beam irradiation (EBI), and brachytherapy (BT).

Results

Median age: 64.8 years. Median follow-up: 151 months. The following treatments were administered: surgery, 97.32%; lymph-node dissection, 54.4%; radiotherapy, 162 patients (62%) (EBI and BT: 64.1%, BT alone: 30.2%, EBI alone: 5.6%).

Twenty-six patients (9.96%) suffered loco-regional recurrence, whilst 27 (10.34%) suffered distant failure. The 5-year overall survival (OS) for all stages was 80.1%. The 5-year disease free survival (DFS) was 92.1% for all patients. The 10-year DFS was 89.9%.

The independent significant prognostic factors for a good outcome identified through the multivariate analysis were: age <75 years (p[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.001); tumour size ≤2[[ce:hsp sp="0.25"/]]cm (p[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.003); myometrial invasion ≤50% (p[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.011); lymphadenectomy (p[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.02); EBI (p[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.001); and BT (p[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.031).

Toxicity occurred in 114 of the 162 patients who received radiotherapy (70.5%). The toxicity was mainly acute, and late in only 28.3% (n[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]45) of cases. The majority experienced G1-2 toxicity, and only 3% of patients experienced G3 late toxicity (5/162).

Conclusions

Our results suggest that age <75 years, tumour size ≤2[[ce:hsp sp="0.25"/]]cm, myometrial invasion ≤50%, lymphadenectomy, EBI, and BT, are predictors of a good outcome in EC.