title: Preoperative radiotherapy in stage I/II endometrial adenocarcinoma.
abstract: From 1972 to 1993, 170 patients received preoperative radiotherapy followed, 5-6 weeks later, by total extrafascial hysterectomy with bilateral salpingo-oophorectomy without lymphadenectomy. Eighty-three patients with good prognostic factors (low grade tumour and no cervical involvement) received low dose rate utero vaginal brachytherapy alone before surgery (Group 1). Eighty-seven patients with poor prognostic factors (high grade tumors and/or cervical involvement) received external radiotherapy to 40 Gy and low dose rate brachytherapy before surgery (Group 2). A single vaginal failure was observed (0.6%). The overall pelvic failure rate was 2.3% (four patients) including two cases with pelvic recurrence and metastases. Three of the four pelvic failures occurred in Group 1. Using the 1971 FIGO clinical staging, 5-year disease-free survival was 82% in Stage Ia, 79% in Stage Ib, and 81% in Stage II (P = 0.36). Five-year disease-free survival was 86% in Grade 1, 76% in Grade 2, and 83% in Grade 3 (P = 0.20). Five-year overall survival was 83% in Stage Ia, 79% in Stage Ib, and 83% in Stage II (P = 0.78). Five-year overall survival was 88% in Grade 1, 77% in Grade 2,83% in Grade 3 (P = 0.27). Complications were recorded with the French-Italian syllabus. Grade 2 complications occurred in 12 cases (7%), Grade 3 in five cases (3%). The lack of correlation between classical risk factors (stage, grade) and disease outcome suggests that preoperative radiotherapy strategies should be preferred when such factors can be identified before surgery.
authors.affiliation: Centre Georges-François-Leclerc, Dijon, France.
authors.forename: P
authors.initials: P
authors.lastname: Maingon
authors.forename: J C
authors.initials: JC
authors.lastname: Horiot
authors.forename: J
authors.initials: J
authors.lastname: Fraisse
authors.forename: S
authors.initials: S
authors.lastname: Salas
authors.forename: F
authors.initials: F
authors.lastname: Collin
authors.forename: M C
authors.initials: MC
authors.lastname: Bône-Lepinoy
authors.forename: I
authors.initials: I
authors.lastname: Barillot
authors.forename: S
authors.initials: S
authors.lastname: Douvier
authors.forename: M M
authors.initials: MM
authors.lastname: Padéano
authors.forename: J
authors.initials: J
authors.lastname: Cuisenier
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D018714:Radiotherapy, Adjuvant