title: Comprehensive staging surgery including complete pelvic and para-aortic lymphadenectomy followed by adjuvant vaginal brachytherapy improves survival rates for intermediate-risk endometrial cancer patients.
abstract: OBJECTIVE
  To investigate the survival of patients with intermediate-risk endometrial cancer treated with comprehensive staging surgery including complete pelvic and para-aortic lymphadenectomy and adjuvant vaginal brachytherapy (VBT).
  
  
  METHODS
  Between January 2000 and December 2009, we retrospectively reviewed the medical records of 156 patients who underwent comprehensive surgical staging consisting of total hysterectomy, adnexectomy, peritoneal cytology, and complete pelvic/para-aortic lymphadenectomy. There were 122 low-risk and 34 intermediate-risk patients, and intermediate-risk patients received adjuvant VBT.
  
  
  RESULTS
  During the follow-up period, 7 (4.5%) of the 156 patients developed recurrent disease: 3 (2.5%) of the 122 low-risk and 4 (11.8%) of the 34 intermediate-risk patients. Among the 7 patients with recurrent disease, only 1 intermediate-risk patient died of disease and 6 stayed alive for the rest of the follow-up period. Disease-free survival at 5 years was 95.7% in the low-risk patients and 81.6% in the intermediate-risk patients, and this difference was statistically significant (p = 0.009). There was no statistically significant difference in overall survival at 5 years between the two groups (100% in low-risk patients vs. 96.7% in intermediate-risk patients, p = 0.061). Overall, grade 3 toxicities were seen in 1 (2.9%) patient.
  
  
  CONCLUSIONS
  Comprehensive staging surgery including complete pelvic and para-aortic lymphadenectomy followed by adjuvant VBT improves survival rates for intermediate-risk endometrial cancer patients, which are comparable with those of low-risk patients.
authors.affiliation: Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Tae Wook
authors.initials: TW
authors.lastname: Kong
authors.forename: Jiheum
authors.initials: J
authors.lastname: Paek
authors.forename: Suk-Joon
authors.initials: SJ
authors.lastname: Chang
authors.forename: Mison
authors.initials: M
authors.lastname: Chun
authors.forename: Ki-Hong
authors.initials: KH
authors.lastname: Chang
authors.forename: Hee-Sug
authors.initials: HS
authors.lastname: Ryu
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery*; D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D016889:Endometrial Neoplasms / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods / Q000401:mortality; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery