Evaluation of Treatment Outcomes of Early-Stage Endometrial Cancer Radiotherapy: A Single Center Experience

Background: Postoperative adjuvant radiotherapy (RT) in the management of early stage endometrial cancer(EC) is still controversial. Here we report our institutional experience with patients who received postoperativeRT for stage I-II EC over a period of 35 years and assess potential predictors of local recurrence (LR), distantmetastasis (DM), and overall survival (OS). Materials and
Methods: A total of 188 patients undergoingpostoperative RT for stage IA-II EC between 1977 and 2012 were evaluated. Some 96 received median 46 Gywhole pelvic radiotherapy (WPRT) (range: 40-60 Gy), 37 were given WPRT with vaginal cuff therapy (VCT), and55 received only VCT either with brachytherapy (BT) or stereotactic body radiotherapy (SBRT). Chemotherapywas given to 5 patients with uterine papillary serous carcinoma (UPSC). Logistic regression analysis was used toassess the effect of clinicopathological factors on LR, DM, and OS.
Results: Median follow-up time was 11 years(range: 1-35 years). At the time of analysis, 34 patients were not alive. Of the 15 patients with LR, 7 (46.7%)recurred in the vaginal stump, 5 (33.3%) in the pelvic region, and 3 (20%) in the paraaortic nodal region, while12 had distant metastasis. UPSC histology (p=0.027), sole VCT (p=0.041), high histologic grade (p=0.034), andage ≥ 71 (p=0.04) were poor prognostic factors on univariate analysis.
Conclusions: In our patients receivingradiotherapy for early-stage EC, grade III disease and age ≥ 71 were associated with shorter OS whereas UPSChistology was an independent predictor for both LR and DM.