Surgery and postoperative radiation therapy in FIGO Stage IIIC endometrial carcinoma

Mundt, Arno J; Murphy, Kevin T; Rotmensch, Jacob; Waggoner, Steven E; Yamada, S.Diane; Connell, Philip P

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Volume 50, Issue 5 , Pages 1154-1160, 1 August 2001

Surgery and postoperative radiation therapy in FIGO Stage IIIC endometrial carcinoma

Presented at the 42nd Annual Meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO), Boston, MA, October 22–26, 2000.

Arno J Mundt, M.D.
- Department of Radiation and Cellular Oncology, Section of Gynecologic Oncology, University of Chicago Hospitals, Chicago, IL, USA
- Reprint requests to: Dr. Arno J. Mundt, Department of Radiation and Cellular Oncology, University of Chicago Hospitals, MC 9006, 5758 S. Maryland Ave, Chicago, IL 60637
Kevin T Murphy, M.D.
- Department of Radiation and Cellular Oncology, Section of Gynecologic Oncology, University of Chicago Hospitals, Chicago, IL, USA
Jacob Rotmensch, M.D.
- Department of Radiation and Cellular Oncology, Section of Gynecologic Oncology, University of Chicago Hospitals, Chicago, IL, USA
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago Hospitals, Chicago, IL, USA
Steven E Waggoner, M.D.
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago Hospitals, Chicago, IL, USA
S.Diane Yamada, M.D.
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago Hospitals, Chicago, IL, USA
Philip P Connell, M.D.
- Department of Radiation and Cellular Oncology, Section of Gynecologic Oncology, University of Chicago Hospitals, Chicago, IL, USA

Received 21 November 2000; received in revised form 15 March 2001; accepted 21 March 2001.

Abstract

To determine the outcome, pattern(s) of failure, and optimal treatment volume in Stage IIIC endometrial carcinoma patients treated with surgery and postoperative radiation therapy (RT).

Between 1983 and 1998, 30 Stage IIIC endometrial carcinoma patients were treated with primary surgery and postoperative RT at the University of Chicago. All underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, sampling of pelvic lymph nodes (PLN), and peritoneal cytology. All were noted to have PLN involvement. Para-aortic lymph nodes (PALN) were sampled in 26 cases, and were positive in 14 cases (54%). Twenty women received whole-pelvic RT (WPRT) and 10 (WPRT), plus paraortic RT (extended-field RT, EFRT). One EFRT patient also underwent concomitant whole-abdominal RT (WART). Adjuvant vaginal brachytherapy (VB) was delivered in 10, chemotherapy in 5, and hormonal therapy in 7 patients.

At a median follow-up of 32 months, the actuarial 5-year disease-free and cause-specific survivals of the entire group were 33.9% and 55.8%, respectively. Overall, 16 women (53%) relapsed. Sites of failure included the pelvis (23%), abdomen (13%), PALN (13%), and distant (40%). Of the 7 pelvic failures, 4 were vaginal (3 vaginal only). Patients treated with VB had a trend to a lower vaginal recurrence rate (0/10 vs. 4/20, p = 0.12) than those not receiving VB. All 4 PALN failures were in women treated with WPRT (2 negative, 1 unsampled, and 1 positive PALN). None of the 10 EFRT patients (2 negative, 8 positive PALN) recurred in the PALN. No patient developed an isolated abdominal recurrence. Two patients developed significant RT sequelae: chronic diarrhea in 1 patient treated with WPRT and VB, and small bowel obstruction in 1 patient treated with EFRT.

FIGO Stage IIIC disease comprises a small percentage of endometrial carcinoma patients but carries a poor prognosis. Our failure pattern suggests that the optimal adjuvant RT volume is EFRT, even in women with negative PALN sampling. VB should also be administered to improve local control. The low rate of abdominal recurrence does not support the routine use of WART in these women. Given the predominance of failure in distant sites, attention should be focused on the development of systemic chemotherapy protocols.