title: The impact of complete surgical staging on adjuvant treatment decisions in endometrial cancer.
abstract: OBJECTIVE
  The aim of this study was to determine the impact of complete surgical staging on adjuvant treatment decisions in endometrial cancer.
  
  
  METHODS
  Two hundred ninety-one patients with endometrial cancer treated between 1996 and 2002 were identified through patient registry. Two hundred seventy-one (93%) of these women were completely surgically staged.
  
  
  RESULTS
  Average patient age: 64 years (23-92); average weight: 198 lb (99-350+); median follow-up: 12 months (0-77). Eighteen percent of tumors had surgical grade greater than preoperative grade. One hundred forty-nine patients had low-risk uterine factors, three with positive nodes (2%). One hundred forty-six out of 149 patients had negative nodes, received no adjuvant therapy, and four recurred (3%). Ninety-six patients had intermediate risk uterine factors, 16 with positive nodes (17%). Eighty out of 96 patients had negative nodes. Twenty-one out of 80 patients (26%) received whole pelvis radiation or chemotherapy. Three out of 21 patients (14%) had distant recurrences. Fifty out of 80 patients (63%) received no adjuvant therapy. Six out of 50 patients (12%) recurred, three distant and three distant and in the pelvis. The recurrence rate of patients with intermediate risk uterine factors that received adjuvant therapy was not statistically different than that of patients receiving no adjuvant therapy (P = 1.00, Fisher's exact test). Forty-six patients had high-risk uterine factors, 26 with positive nodes (55%). The recurrence rate for stage I disease was 5% (11/211), for stage II disease 14% (2/14), for stage III disease 21% (11/52), and for stage IV disease 50% (7/14).
  
  
  CONCLUSIONS
  Complete surgical staging adds important information that influences adjuvant treatment decisions. Patients with surgical stage I and II endometrial cancer do not benefit from whole pelvis radiation therapy.
authors.affiliation: Department of Obstetrics and Gynecology, Creighton University School of Medicine, Omaha, NE 68131, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Goudge
authors.forename: Shana
authors.initials: S
authors.lastname: Bernhard
authors.forename: Noelle G
authors.initials: NG
authors.lastname: Cloven
authors.forename: Peter
authors.initials: P
authors.lastname: Morris
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008197:Lymph Node Excision; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome