title: Node-positive adenocarcinoma of the endometrium: outcome and patterns of recurrence with and without external beam irradiation.
abstract: OBJECTIVE
  To evaluate treatment outcomes and patterns of recurrence in patients with node-positive (International Federation of Obstetrics and Gynecology stage IIIC) adenocarcinoma of the uterus without serous or clear cell differentiation.
  
  
  METHODS
  The records of 71 women who were treated for stage IIIC endometrial adenocarcinoma at our institution between 1984 and 2005 were reviewed. All patients underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, and lymphadenectomy. Fifty patients received definitive pelvic or extended-field radiotherapy with or without systemic therapy (regional RT group). Eighteen received adjuvant systemic platinum-based chemotherapy or hormonal therapy without external beam RT. The median follow-up for patients not dying of disease was 67 months. Survival rates were calculated using the Kaplan-Meier method; differences were assessed using log-rank tests.
  
  
  RESULTS
  Thirty-nine percent (28/71) of patients had involved paraaortic lymph nodes while 61% (43/71) had only pelvic lymph nodes. Five- and 10-year disease-specific survival (DSS) rates were 63% and 54%, respectively; corresponding overall survival rates were 60% and 47%. Grade was strongly associated with DSS (76% vs 46% at 5 years for low-grade vs high-grade tumors, P=0.004). Cervical or adnexal involvement was associated with decreased DSS, but lymph-vascular space invasion, age, race, body mass index, and number and location of positive nodes were not. Five-year pelvic-relapse-free survival (98% vs 61%, P=0.001), DSS (78% vs 39%, P=0.01), and overall survival (73% vs 40%, P=0.03) were significantly better for the regional RT group than the systemic therapy group. In patients treated without regional RT, the most common site of relapse was the pelvis. DSS was not significantly correlated with number of nodes removed in the regional RT group but was in patients treated without regional RT (P=0.001).
  
  
  CONCLUSIONS
  Patients treated without regional RT had a high rate of locoregional recurrence. Patients with stage IIIC endometrial adenocarcinoma who underwent surgical staging followed by external beam irradiation had a high rate of cure. Relapses in patients treated with EBRT primarily occurred in patients with grade 3 cancer who may be most likely to benefit from combined-chemoradiation treatment.
authors.affiliation: Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA. Electronic address: AKlopp@mdanderson.org.
authors.forename: Ann H
authors.initials: AH
authors.lastname: Klopp
authors.affiliation: Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Anuja
authors.initials: A
authors.lastname: Jhingran
authors.affiliation: Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Lois
authors.initials: L
authors.lastname: Ramondetta
authors.affiliation: Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Lu
authors.affiliation: Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Gershenson
authors.affiliation: Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Eifel
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001918:Brachytherapy; D016190:Carboplatin / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D016889:Endometrial Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D010052:Ovariectomy; D017239:Paclitaxel / Q000008:administration & dosage; D018714:Radiotherapy, Adjuvant; D016896:Treatment Outcome
chemical_list: D016190:Carboplatin; D017239:Paclitaxel; D002945:Cisplatin