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Postoperative Radiotherapy in Stage I/II Endometrial Cancer: Retrospective Analysis of 883 Patients Treated at the University of Florence

Scotti, Vieri MD*; Borghesi, Simona MD; Meattini, Icro MD*; Saieva, Calogero MD; Rossi, Francesca MD§; Petrucci, Alessia MD; Galardi, Alessandra MD*; Livi, Lorenzo MD*; Agresti, Benedetta MD*; Fambrini, Massimiliano MD; Marchionni, Mauro MD; Biti, Giampaolo MD*

International Journal of Gynecological Cancer: December 2010 - Volume 20 - Issue 9 - p 1540-1548
doi: 10.1111/IGC.0b013e3181f8fa26
Ovarian Cancer

Introduction: The efficacy of postoperative radiotherapy (RT) in the treatment of early-stage endometrial carcinoma (EC) is still under debate. This study was aimed to review the outcome and adverse effects in patients treated for EC with postoperative RT at a single center.

Methods: A total of 883 patients with pathological stages I to II EC were retrospectively analyzed. Surgery consisted of total abdominal hysterectomy and bilateral salpingo-oophorectomy, or vaginal hysteroannessiectomy in 532 patients (60.2%) with pelvic lymphadenectomy in 351 patients (39.8%). Seven hundred forty-seven patients (84.6%) underwent whole pelvic RT (WPRT) and 136 (15.4%) combined WPRT and vaginal brachytherapy (BT) boost.

Results: At a median follow-up of 9 years (range, 1.2-27.6 years), we observed 10.6% disease relapse. Forty-seven patients experienced local recurrence (LR), and 38 patients experienced distant metastases (DMs). At univariate analysis, age at diagnosis (P < 0.0001), stage (P < 0.04), and histological subtype (P < 0.0001) resulted in significant prognostic factors. At multivariate analysis, histotype emerged as an independent relapse predictor (P = 0.0001). Acute WPRT-related toxicity was mild; diarrhea was the most common adverse effect (19.8%). We recorded long-term adverse effects in 7.8% of the patients.

Conclusions: Our study showed that patients with early-stage EC have a good outcome in overall survival and disease-free survival. In our experience, standard surgery (including hysterectomy and bilateral salpingo-oophorectomy followed by WPRT with or without BT) showed an acceptable toxicity profile.

*Department of Radiation Oncology, University of Florence, Florence, Italy; †Radiotherapy Unit, S. Donato Hospital, Arezzo, Italy; ‡Molecular and Nutritional Epidemiology Unit, ISPO, Cancer Prevention and Research Institute, Florence, Italy; §Radiotherapy Unit, S.M. Annunziata Hospital, Florence, Italy; ∥Radiotherapy Unit, Pistoia Hospital, Pistoia, Italy; ¶Department of Gynaecology, Perinatology and Human Reproduction, University of Florence, Florence, Italy.

Received October 21, 2009, and in revised form August 20, 2010.

Accepted for publication August 24, 2010.

Address correspondence and reprint requests to Vieri Scotti, MD, Department of Radiation Oncology, University of Florence, Viale Morgagni No. 85, Florence, Italy. E-mail:

Copyright © 2010 by IGCS and ESGO