Utility and limitations of abdominal radiotherapy in the management of endometrial carcinomas.
OBJECTIVE
The present review analyzes long-term survival, recurrence sites, and toxicity in women with peritoneal spread of endometrial treated with abdominal radiotherapy, in order to provide therapeutic options as a function of disease spread and histology.


METHODS
Retrospective medical record review was performed of 86 patients receiving abdominal radiotherapy for endometrial carcinomas from 1975 to 1995 at the University of Minnesota.


RESULTS
FIGO stage distribution was 54 stage IIIA, 2 stage IIIB, 11 stage IIIC, and 19 stage IVB. Disease-free survivals were 55% at 5 years, 46% at 10 years, and 36% at 20 years. Recurrence rates were 16% for stage IIIA with one peritoneal site, 48% for stage IIIA with multiple peritoneal sites or stage IIIB or stage IIIC, and 72% for stage IVB. With univariate analysis, statistical significance was found for stage, gross peritoneal disease, nodal metastases, histology, concurrent chemotherapy, isolated adnexal spread, grade, angiolymphatic invasion, myometrial invasion, and age. Multivariate analysis found only stage, histology, and age to be significant. Most recurrences were pulmonary or peritoneal. Acute toxicity was acceptable. Six percent of patients required surgical intervention for small bowel obstructions.


CONCLUSIONS
Abdominal radiotherapy confers an excellent prognosis for women with stage IIIA cancers with one site of peritoneal involvement. Lack of randomized trials makes definitive treatment recommendations difficult to provide. Results are less optimal with multiple peritoneal sites of involvement, gross peritoneal spread, or papillary serous/clear cell pathology but a substantial number of such women can be cured as well.
Dusenbery
Kathryn E
KE
Department of Therapeutic Radiology-Radiation Oncology, 420 Delaware St. SE, Mayo Mail Code 494, Minneapolis, MN 55455, USA. dusen001@umn.edu
Potish
Roger A
RA
Gold
Douglas G
DG
Boente
Matthew P
MP
D018262:Adenocarcinoma, Clear Cell / Q000473:pathology / Q000532:radiotherapy / Q000556:secondary; D000231:Adenocarcinoma, Papillary / Q000473:pathology / Q000532:radiotherapy / Q000556:secondary; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018284:Cystadenocarcinoma, Serous / Q000473:pathology / Q000532:radiotherapy / Q000556:secondary; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000556:secondary; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000532:radiotherapy* / Q000556:secondary*; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies