title: Peritoneal fluid cytology in endometrial cancer: its significance and the role of chromic phosphate (32P) therapy.
abstract: Between 1978 and 1986, 243 patients (all stages) had peritoneal fluid cytology performed while undergoing total abdominal hysterectomy for endometrial carcinoma; 39 (16%) were found to be positive. At 3 years (median follow-up of 30 months) the disease-free survival (DFS) for the 165 negative cytology clinical Stage I patients was 91% compared to only 56% for the 25 positive cytology patients (p less than .001). Of the 25 Stage I positive cytology patients, 14 with greater than one-third myometrial invasion had a DFS of 30% at 3 years as compared to 87% for negative cytology patients with comparable depth of invasion (p less than .001). There was no difference in DFS between the negative and positive cytology Stage I patients who had one-third or less myometrial invasion. Stage I patients with histologic Grade 2 and 3 had a lower 3 year DFS when cytology positive, 49% and 22%, versus 92% and 79% when cytology negative (p less than .001 and p = .03 respectively). In clinical Stage II patients the 3-year DFS was 21% for those with a positive cytology and 59% with a negative cytology. Fourteen of the 25 clinical Stage I positive cytology patients received 15 mCi of intraperitoneal 32P. At 3 years they had a 68% DFS as compared to 27% for those not receiving 32P (p = 0.01). All 11 patients with superficial myometrial invasion (9 received 32P) remained disease-free. The 4 Stage I patients with deep invasion who received 32P therapy had an improvement in abdominal/pelvic control and DFS when compared to 9 similar patients who did not receive 32P (p = .02). For histologic Grade 2 and 3 patients, there was a 64% 3-year DFS in the 32P treated group and 16% for those not receiving 32P (p = 0.02). Although 32P therapy improved DFS in Stage I positive cytology patients its use along with pelvic radiation therapy can lead to complications. Of 9 Stage I patients receiving 32P as well as pelvic irradiation, 4 experienced serious bowel complications requiring surgery. None of the 5 patients receiving 32P only had a complication.
authors.affiliation: Department of Radiation Oncology, University of North Carolina, Chapel Hill 27514.
authors.forename: R
authors.initials: R
authors.lastname: Heath
authors.forename: J
authors.initials: J
authors.lastname: Rosenman
authors.forename: M
authors.initials: M
authors.lastname: Varia
authors.forename: L
authors.initials: L
authors.lastname: Walton
mesh_terms: D001202:Ascitic Fluid / Q000473:pathology*; D002857:Chromium / Q000008:administration & dosage; D017608:Chromium Compounds; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007274:Injections, Intraperitoneal; D010710:Phosphates / Q000008:administration & dosage; D010761:Phosphorus Radioisotopes / Q000008:administration & dosage / Q000627:therapeutic use*; D011379:Prognosis; D014594:Uterine Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery
chemical_list: D017608:Chromium Compounds; D010710:Phosphates; D010761:Phosphorus Radioisotopes; D002857:Chromium; C509369:chromic phosphate