Adjuvant treatment and analysis of failures in patients with high-risk FIGO Stage Ib-II endometrial cancer: an Italian multicenter retrospective study (CTF study).
OBJECTIVE
The purpose of this retrospective study was to assess the clinical outcome of patients with high-risk, early-stage endometrioid endometrial cancer (stage Ib or II with myometrial invasion >50%, grade 2-3).


METHODS
We assessed 192 patients who underwent hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy, had histologically negative pelvic nodes, and had negative CT findings for aortic node involvement.


RESULTS
Tumor relapsed in 36 patients after a median time of 21.2 months. The recurrence was vaginal in 7 (19.4%), distant in 16 (44.4%), aortic in 8 (22.2%), and involved multiple sites in 5 (13.9%). There was a trend to a lower vaginal recurrence rate in the 143 patients who received adjuvant radiotherapy (+chemotherapy) compared with the 46 who did not (2.1% versus 8.7%). Distant or aortic recurrences were lower in the 37 patients who received adjuvant chemotherapy (+radiotherapy) than in the 152 who did not (2.7% versus 18.4%, p=0.02). Of the 29 patients who received sequential adjuvant chemotherapy and radiotherapy, none developed local recurrence and only one had distant recurrence. There was a trend for a better 5-year progression-free survival and overall survival for the patients who received chemotherapy (+radiotherapy) compared with those who did not (86.0% versus 71.3%, and 92.3% versus 75.6%, respectively).


CONCLUSIONS
Our data appear to suggest that adjuvant chemotherapy reduces the risk of distant or aortic recurrences and that sequential adjuvant chemotherapy and radiotherapy achieve an excellent local and distant control of disease in these clinical settings.
Department of Experimental and Clinical Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy. Electronic address: a.gadducci@med.unipi.it.
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A
Gadducci
Department of Experimental and Clinical Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy.
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S
Cosio
Department of Gynecology, Cervical Cancer Center, European Institute of Oncology, Milan, Italy.
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F
Landoni
Unit of Gynecology and Obstetrics, Umberto I Hospital, Mestre, Venice, Italy.
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T
Maggino
Department of Surgical Science, University of Turin, Italy.
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P
Zola
Department of Gynecology and Obstetrics, University of Brescia, Brescia, Italy.
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B
Sostegni
Department of Gynecology and Obstetrics, University of Brescia, Brescia, Italy.
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A
Bellicini
Department of Surgical Science, University of Turin, Italy.
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L
Fuso
Department of Experimental and Clinical Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy.
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R
Cristofani
Department of Gynecology and Obstetrics, University of Brescia, Brescia, Italy.
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Sartori
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059186:Chemoradiotherapy, Adjuvant; D016889:Endometrial Neoplasms / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007558:Italy; D008197:Lymph Node Excision; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D010052:Ovariectomy; D012189:Retrospective Studies; D016896:Treatment Outcome
Chemotherapy; Endometrial cancer; Lymphadenectomy; Radiotherapy; Recurrence; Surgery