title: The survival outcome and patterns of failure in node positive endometrial cancer patients treated with surgery and adjuvant radiotherapy with curative intent.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the patterns of failure, overall survival (OS), disease-free survival (DFS) and factors influencing outcome in endometrial cancer patients who presented with metastatic lymph nodes and were treated with curative intent.
  
  
  METHODS
  One hundred and twenty-six patients treated between January 1996 to December 2008 with surgery and adjuvant radiotherapy were identified from our service's prospective database. Radiotherapy consisted of 45 Gy in 1.8 Gy fractions to the whole pelvis. The involved nodal sites were boosted to a total dose of 50.4 to 54 Gy.
  
  
  RESULTS
  The 5-year OS rate was 61% and the 5-year DFS rate was 59%. Grade 3 endometrioid, serous, and clear cell histologies and involvement of upper para-aortic nodes had lower OS and DFS. The number of positive nodes did not influence survival. Among the histological groups, serous histology had the worst survival. Among the 54 patients relapsed, only three (6%) failed exclusively in the pelvis and the rest of the 94% failed in extrapelvic nodal or distant sites. Patients with grade 3 endometrioid, serous and clear cell histologies did not influence pelvic failure but had significant extrapelvic failures (p<0.001).
  
  
  CONCLUSIONS
  Majority of node positive endometrial cancer patients fail at extrapelvic sites. The most important factors influencing survival and extrapelvic failure are grade 3 endometrioid, clear cell and serous histologies and involvement of upper para-aortic nodes.
authors.affiliation: Peter MacCallum Cancer Centre and University of Melbourne, East Melbourne, VIC, Australia. rchrishanthi@hotmail.com.
authors.forename: Chrishanthi
authors.initials: C
authors.lastname: Rajasooriyar
authors.affiliation: Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Bernshaw
authors.affiliation: Rural Clinical School, University of Queensland, Toowoomba, Queensland, Australia.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Kondalsamy-Chennakesavan
authors.affiliation: Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
authors.forename: Linda
authors.initials: L
authors.lastname: Mileshkin
authors.affiliation: Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
authors.forename: Kailash
authors.initials: K
authors.lastname: Narayan
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000473:pathology / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018269:Carcinoma, Endometrioid / Q000473:pathology / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D018283:Cystadenocarcinoma, Papillary / Q000473:pathology / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D016889:Endometrial Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D016879:Salvage Therapy / Q000379:methods; D016019:Survival Analysis; D017211:Treatment Failure; D016896:Treatment Outcome
keywords: Endometrial neoplasms; Lymph nodes; Prospective studies; Radiotherapy; Survival rate