title: Myometrial penetration of endometrial carcinoma as a prognostic factor for patients receiving pre- or postoperative radiation therapy.
abstract: From 1966-1980, 227 patients with Stage I endometrial carcinoma were treated by total abdominal hysterectomy, bilateral salpingo-oophorectomy, and either pre- or postoperative external beam pelvic irradiation. All therapy was delivered with megavoltage equipment. There was at least a 4-week interval between irradiation and surgery for 164 patients treated preoperatively. No significant differences were found in subsequent survival or local control at 5 years for those patients left with no residual tumor (81% survival/97% local control), disease confined to the mucosa (83% survival/93% local control), or invasion of the inner half of the myometrium (81% survival/93% local control). However, patients left with deeper myometrial penetration showed a significantly poorer survival rate of 57% (p = 0.02) and a local control rate of only 65% (p = 0.006). For 63 patients treated postoperatively, there was no significant difference in 5-year survival or local control for those patients with disease limited to the inner 1/2 of the myometrium (80% survival/93% local control) compared with more extensive myometrial invasion (75% survival/86% local control). As patients with deep myometrial penetration irradiated postoperatively showed survival rates comparable to patients with lesser extent of invasion, the adverse prognostic effect of deep penetration appears to have been attenuated by subsequent pelvic irradiation. By contrast, residual deep myometrial invasion remained a significant adverse prognostic indicator for patients treated preoperatively. For this group, further treatment seems necessary and postoperative vaginal brachytherapy and/or adjuvant chemotherapy should be considered.
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011182:Postoperative Care; D011300:Preoperative Care; D011379:Prognosis; D011882:Radiotherapy, High-Energy; D014594:Uterine Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery