Stage 1C grade 3 endometrial cancer: the KK Hospital gynaecological oncology group experience.
OBJECTIVE
It is our standard of care to include pelvic lymph node dissection (PLND) in the staging of endometrial cancer, followed by adjuvant vaginal vault brachytherapy. We report our experience and outcome of patients with stage 1C grade 3 endometrial cancer from KK Hospital Singapore.


METHODS
Records of patients with a diagnosis of stage 1C grade 3 endometrial cancer (based on the 1988 FIGO [International Federation of Gynecology and Obstetrics] staging system) from 1995 to 2008 were retrospectively reviewed. Details of surgery, chemotherapy, and radiotherapy were recorded, as were prognostic factors such as histological subtype and number of lymph nodes removed. Dates and sites of relapses were noted.


RESULTS
A total of 31 cases were reviewed; 29 had sufficient records to be analyzed, of which one was excluded as she had a second primary cancer (breast). Median follow-up was 50.1 months (15.5-154 months). All cases underwent total hysterectomy and bilateral salpingo-oophorectomy; the majority (22 [76%]) had PLND as well. Those who did not undergo PLND received external beam radiotherapy instead. All but 1 case received postoperative vaginal vault brachytherapy. Eight of 10 patients with nonendometrioid adenocarcinoma (eg, clear cell) histology also received adjuvant chemotherapy. There were 5 systemic relapses (17.9%) and 1 pelvic recurrence (3.6%). The 5-year disease-free survival is 78.6%. No serious (grade 3 or 4) adverse effects were recorded.


CONCLUSIONS
Pelvic lymph node dissection and vaginal vault brachytherapy seem to be effective in preventing locoregional recurrences, with few associated adverse effects. However, the rate of systemic relapse is relatively high. Adjuvant chemotherapy should also be considered for cases with poor prognostic factors.
Department of Radiation Oncology, National Cancer Centre Singapore, Singapore. siow.tian.rui@singhealth.com.sg
Tian Rui
TR
Siow
Ming Chert Richard
MC
Yeo
Hoon Seng
HS
Khoo-Tan
Swee Peng
SP
Yap
Yoke Lim
YL
Soong
Eu Jin
EJ
Chua
Lay Tin
LT
Soh
Yong Kuei
YK
Lim
Yin Nin
YN
Chia
Kwai Lam
KL
Yam
D000328:Adult; D000368:Aged; D000465:Algorithms; D001918:Brachytherapy; D018269:Carcinoma, Endometrioid / Q000175:diagnosis* / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D003131:Combined Modality Therapy; D016889:Endometrial Neoplasms / Q000175:diagnosis* / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D006176:Gynecology / Q000458:organization & administration; D006761:Hospitals; D006801:Humans; D007044:Hysterectomy; D008207:Lymphatic Metastasis; D008495:Medical Oncology / Q000458:organization & administration; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012846:Singapore; D012955:Societies, Medical; D016896:Treatment Outcome