title: Survival of women with clear cell and papillary serous endometrial cancer after adjuvant radiotherapy.
abstract: BACKGROUND
  Type II (papillary serous and clear cell) endometrial carcinoma (EC) is a rare subgroup and is considered to have an unfavorable prognosis. The purpose of this retrospective analysis was to elucidate the meaning of adjuvant radiotherapy (RT) for clinical outcome and to define prognostic factors in these patients (pts).
  
  
  METHODS
  From 2004-2012 forty-two pts with type II EC underwent surgery followed by adjuvant RT at our department. Median age was 72 years. The majority were early stage carcinomas (FIGO I n = 27 [64.3%], FIGO II n = 4 [9.5%], FIGO III n = 11 [26.2%]. Seven pts (16.7%) received adjuvant chemotherapy (ChT). Pts were treated with external beam radiotherapy (EBRT) and brachytherapy (IVB) boost.
  
  
  RESULTS
  Five-year local recurrence free survival (LRFS), distant metastases free survival (DMFS) and overall survival (OS) were 85.4%, 78%, and 64.5% respectively. LRFS was better with lower pT stage, without lymphangiosis (L0), without haemangiosis (V0) and negative resection margins (R0). DMFS was prolonged in lymph node negatives (N0), L0, V0 and R0. OS was improved in younger pts, N0, L0, V0 and after lymphadenectomy (LNE). Multivariate analysis revealed haemangiosis (V1) as the only independent prognostic factor for OS (p = .014) and DMFS (p = .008). For LRFS pT stage remained as an independent prognostic factor (p = .028).
  
  
  CONCLUSIONS
  Adjuvant RT with EBRT/IVB ensures adequate local control in type II EC, but control rates remain lower than in type I EC. A benefit of additional adjuvant ChT could not be demonstrated and a general omission of EBRT cannot be recommended at this point. Lymphovascular infiltration and pT stage might be the best predictive factors for a benefit from combined local and systemic treatment.
authors.affiliation: Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany. robert.foerster@med.uni-heidelberg.de.
authors.forename: Robert
authors.initials: R
authors.lastname: Foerster
authors.forename: Robert
authors.initials: R
authors.lastname: Kluck
authors.forename: Harald
authors.initials: H
authors.lastname: Rief
authors.forename: Stefan
authors.initials: S
authors.lastname: Rieken
authors.forename: Juergen
authors.initials: J
authors.lastname: Debus
authors.forename: Katja
authors.initials: K
authors.lastname: Lindel
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000401:mortality* / Q000532:radiotherapy / Q000556:secondary; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000401:mortality*; D002291:Carcinoma, Papillary / Q000401:mortality* / Q000532:radiotherapy / Q000556:secondary; D018284:Cystadenocarcinoma, Serous / Q000401:mortality* / Q000532:radiotherapy / Q000556:secondary; D016889:Endometrial Neoplasms / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy; D009367:Neoplasm Staging; D011379:Prognosis; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate