title: Preoperative radiotherapy for inoperable stage II endometrial cancer: insights into improving treatment and outcomes.
abstract: OBJECTIVE
  To review recurrence patterns and survival outcomes of women receiving preoperative radiotherapy for clinical stage II endometrial cancer in British Columbia.
  
  
  METHODS
  We performed a retrospective population-based cohort study of all patients with clinical stage II endometrial cancer who were referred to the British Columbia Cancer Agency from 2000 to 2008, deemed ineligible for primary surgery, and therefore offered preoperative radiotherapy followed by surgery. Patient demographics, uterine risk factors, timing and details of treatments, and timing and sites of recurrence were obtained from patient records. Primary outcome measures were the sites and rates of recurrence and recurrence-free survival.
  
  
  RESULTS
  We identified 29 patients with a mean age of 61 years (range 41 to 83) and median follow-up of 3.1 years (range 0.3 to 5.3). Three-year overall survival was 79%, and median recurrence-free survival was 2.5 years. Eight patients had recurrence of disease (27.6%), with a median time to recurrence of 1.3 years, (range 0.4 to 2.7). Six of these eight women had two or more high-risk uterine factors (deep myometrial invasion, grade 3 tumour), ovarian involvement, or adverse histological type (carcinosarcoma), compared with only one of 21 patients without recurrence. Seven of eight women had recurrence outside the radiated volume of tissue. Median survival after recurrence was 1.0 years (range 0.4 to 2.2).
  
  
  CONCLUSIONS
  Women with clinical stage II endometrial cancer had a significant risk of recurrence when treated with preoperative radiotherapy followed by surgery. They were more likely to have distant recurrences, implying the need for an alternate treatment paradigm.
authors.affiliation: Division of Gynaecologic Oncology, University of British Columbia and BC Cancer Agency, Vancouver BC.
authors.forename: Marette H
authors.initials: MH
authors.lastname: Lee
authors.affiliation: Division of Gynaecologic Oncology, University of British Columbia and BC Cancer Agency, Vancouver BC.
authors.forename: Christina
authors.initials: C
authors.lastname: Aquino-Parsons
authors.affiliation: Division of Gynaecologic Oncology, University of British Columbia and BC Cancer Agency, Vancouver BC.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Hoskins
authors.affiliation: Division of Gynaecologic Oncology, University of British Columbia and BC Cancer Agency, Vancouver BC.
authors.forename: Peter
authors.initials: P
authors.lastname: Lim
authors.affiliation: Division of Gynaecologic Oncology, University of British Columbia and BC Cancer Agency, Vancouver BC.
authors.forename: Janice S
authors.initials: JS
authors.lastname: Kwon
mesh_terms: D002170:Canada / Q000453:epidemiology; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D009362:Neoplasm Metastasis / Q000517:prevention & control*; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care; D011300:Preoperative Care / Q000379:methods / Q000706:statistics & numerical data; D018714:Radiotherapy, Adjuvant / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data
keywords: endometrial carcinoma; preoperative radiotherapy; recurrence