title: Stage I, grade 3 endometrioid adenocarcinoma of the endometrium: an analysis of clinical outcomes and patterns of recurrence.
abstract: OBJECTIVE
  To study patterns of recurrence and survival outcomes in patients with surgical stage I, grade 3 endometrioid adenocarcinoma of the endometrium (EA) treated with various treatment modalities.
  
  
  METHODS
  A retrospective multi-institutional study of surgical stage I, grade 3 EA patients diagnosed between 1988 and 2006 was performed. Demographic, clinicopathologic, treatment and outcome data were collected. After surgery, patients were treated with either observation or radiotherapy (vaginal brachytherapy, whole pelvic or both).
  
  
  RESULTS
  One hundred seventy-six patients were collected with a median age of 68 years. Twenty-six (15%) were stage IA, 96 (54%) IB and 54 (31%) IC. Sixty-one patients (35%) had lymphovascular space invasion (LVSI) and a mean of 18.9 lymph nodes (LNs) was removed. Seventy-eight patients (44%) were observed while 98 (56%) were treated with radiotherapy, the majority (n=51) receiving brachytherapy. After a median follow-up of 58 months, 20 recurrences (11%) were noted. Ninety percent of recurrences occurred in Stage IB/IC patients. The median time to recurrence was 22.5 months (5-74.5) and 80% of recurrences were extra-pelvic. There was no significant difference in recurrence based upon treatment modality or LVSI. Majority of recurrences were not salvaged as 75% (12/16) died of their disease with a median time of recurrence to death of 8 months.
  
  
  CONCLUSIONS
  Patients with stage IB/IC, grade 3 endometrioid adenocarcinoma have a significant risk for extra-pelvic recurrence. Most patients will not be salvaged and will succumb to their disease, suggesting that current loco-regional adjuvant treatment strategies are not optimal and evaluation of more systemic therapies is warranted.
authors.affiliation: Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA. rasooln@ccf.org
authors.forename: Nabila
authors.initials: N
authors.lastname: Rasool
authors.forename: Amanda Nickles
authors.initials: AN
authors.lastname: Fader
authors.forename: Leigh
authors.initials: L
authors.lastname: Seamon
authors.forename: Nikki L
authors.initials: NL
authors.lastname: Neubauer
authors.forename: Fadi Abu
authors.initials: FA
authors.lastname: Shahin
authors.forename: Heather A
authors.initials: HA
authors.lastname: Alexander
authors.forename: Kathleen
authors.initials: K
authors.lastname: Moore
authors.forename: Katherine
authors.initials: K
authors.lastname: Moxley
authors.forename: Angeles Alvarez
authors.initials: AA
authors.lastname: Secord
authors.forename: Charles
authors.initials: C
authors.lastname: Kunos
authors.forename: Peter G
authors.initials: PG
authors.lastname: Rose
authors.forename: David M
authors.initials: DM
authors.lastname: O'Malley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018269:Carcinoma, Endometrioid / Q000473:pathology* / Q000628:therapy*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D012189:Retrospective Studies; D016896:Treatment Outcome