Potential benefit of lymphadenectomy for the treatment of node-negative locally advanced uterine cancers.
OBJECTIVE
The aim of this study was to examine the outcomes in patients with high-risk Stage I endometrial cancers surgically staged by complete pelvic and para-aortic lymphadenectomy, with negative nodes, and treated with postoperative brachytherapy.


METHODS
From the database of patients treated for Stage I endometrial cancer, 23 patients were identified with either >50% myometrial invasion or grade 3 histology treated with total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic and para-aortic lymphadenectomy. All patients had no pathologic evidence of disease in the lymph nodes. These patients were then treated with brachytherapy and followed for treatment and cost outcomes. A comparison was made of the cost of treatment between brachytherapy and external beam radiation.


RESULTS
All 23 patients with either grade 3 tumor or greater than 50% myometrial invasion were treated with total abdominal hysterectomy with lymphadenectomy followed by brachytherapy for lesions that did not extend outside the uterine specimen. For all patients in this series, there were no recurrences in the follow-up period (median 25 months). This regimen is more cost efficient and spares the patient from possible complications related to whole pelvic radiation, at an average cost savings of $4100.


CONCLUSIONS
Women undergoing hysterectomy for endometrial adenocarcinoma with high-risk node-negative disease confined to the uterus can be safely treated with brachytherapy, at a substantial cost savings, without compromising survival.
Seago
D P
DP
Department of Gynecologic Oncology, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
Raman
A
A
Lele
S
S
D000230:Adenocarcinoma / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D003131:Combined Modality Therapy; D016889:Endometrial Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009215:Myometrium / Q000473:pathology; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011182:Postoperative Care; D016896:Treatment Outcome