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Stage 1C Grade 3 Endometrial Cancer: The KK Hospital Gynaecological Oncology Group Experience

Siow, Tian Rui MRCP (UK)*; Yeo, Ming Chert Richard FRCR*; Khoo-Tan, Hoon Seng FRCR*; Yap, Swee Peng MRCP (UK), FRCR*; Soong, Yoke Lim FRCR, FFRRCSI*; Chua, Eu Jin DMRT*; Soh, Lay Tin FAMS, FRCP (Edin); Lim, Yong Kuei MRCOG (UK), FAMS; Chia, Yin Nin MRCOG (UK), DGO (RANZCOG), FAMS; Yam, Kwai Lam FRCOG, FAMS

International Journal of Gynecological Cancer: December 2010 - Volume 20 - Issue 9 - p 1557-1562
doi: 10.1111/IGC.0b013e3181fc4ff2
Ovarian Cancer

Objective: It is our standard of care to include pelvic lymph node dissection (PLND) in the staging of endometrial cancer, followed by adjuvant vaginal vault brachytherapy. We report our experience and outcome of patients with stage 1C grade 3 endometrial cancer from KK Hospital Singapore.

Methods: Records of patients with a diagnosis of stage 1C grade 3 endometrial cancer (based on the 1988 FIGO [International Federation of Gynecology and Obstetrics] staging system) from 1995 to 2008 were retrospectively reviewed. Details of surgery, chemotherapy, and radiotherapy were recorded, as were prognostic factors such as histological subtype and number of lymph nodes removed. Dates and sites of relapses were noted.

Results: A total of 31 cases were reviewed; 29 had sufficient records to be analyzed, of which one was excluded as she had a second primary cancer (breast). Median follow-up was 50.1 months (15.5-154 months). All cases underwent total hysterectomy and bilateral salpingo-oophorectomy; the majority (22 [76%]) had PLND as well. Those who did not undergo PLND received external beam radiotherapy instead. All but 1 case received postoperative vaginal vault brachytherapy. Eight of 10 patients with nonendometrioid adenocarcinoma (eg, clear cell) histology also received adjuvant chemotherapy. There were 5 systemic relapses (17.9%) and 1 pelvic recurrence (3.6%). The 5-year disease-free survival is 78.6%. No serious (grade 3 or 4) adverse effects were recorded.

Conclusion: Pelvic lymph node dissection and vaginal vault brachytherapy seem to be effective in preventing locoregional recurrences, with few associated adverse effects. However, the rate of systemic relapse is relatively high. Adjuvant chemotherapy should also be considered for cases with poor prognostic factors.

Departments of *Radiation Oncology and †Medical Oncology, National Cancer Centre Singapore; and ‡Gynaecological Oncology Unit, KK Hospital, Singapore.

Received June 13, 2010, and in revised form August 10, 2010.

Accepted for publication September 14, 2010.

Address correspondence and reprint requests to Tian Rui Siow, MRCP (UK), Department of Radiation Oncology, National Cancer Centre Singapore, Singapore. E-mail:

The authors have no conflicts of interest to declare.

Copyright © 2010 by IGCS and ESGO