title: Management of endometrial cancer in Italy: a national survey endorsed by the Italian Society of Gynecologic Oncology.
abstract: BACKGROUND
  Endometrial carcinoma (EC) is a frequent cancer in developed countries, but with evidence for discrepant clinical management. Under the auspices of the Italian Society of Gynecologic Oncology (SIOG), we conducted a survey among Italian centers with ≥20 surgeries for gynecological cancer per year, trying to depict a reliable picture of EC management in our country.
  
  
  METHODS
  The questionnaire focused on preoperative/surgical staging and adjuvant treatment. Of the 283 questionnaires delivered, 35% were sent back.
  
  
  RESULTS
  Diagnostic hysteroscopy is performed in 78% of centers. In clinical stage I, 52% adopt a laparotomic access, 15% totally laparoscopic, 9% laparoscopic/vaginal, 2% vaginal, 22% tailored approach. Elective use of laparoscopy significantly differs between institutions (p < 0.001): 40% (≥20 EC/yr) vs. 12% (<20). Pelvic and aortic lymphadenectomy is selectively performed by 77% and 68% of centers, respectively, depending on pre/intraoperative factors. Non-endometrioid histology, poor-grade and deep myoinvasion are indicated as the highest-risk factors. Adjuvant therapy is given to pathologically node-negative patients by 60%, and to intermediate-risk patients by 47%. Elective adjuvant treatment is still radiotherapy, but chemotherapy is adopted, mostly combined with radiation, by 40%. There is a multidisciplinary team in 64% of centers, but in 59% adjuvant treatment is to be administered outside the institution.
  
  
  CONCLUSIONS
  These data demonstrate a significant improvement in the clinical care achieved over the last decades in Italy. Centralization of EC treatment would not be feasible neither useful. High-risk cases could be selected by an appropriate clinical screening, and these only referred to reference centers.
authors.affiliation: Gynecologic Oncology, National Cancer Institute of Naples, Via M. Semmola, 80131 Naples, Italy. Electronic address: s.greggi@istitutotumori.na.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Greggi
authors.affiliation: Obstetrics and Gynecology, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Franchi
authors.affiliation: Gynecologic Oncology, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Aletti
authors.affiliation: Gynecology and Obstetrics, University of Torino - Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Biglia
authors.affiliation: Gynecologic Oncology, National Cancer Institute of Milan, Via G. Venezian 1, 20133 Milano, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Ditto
authors.affiliation: Minimally Invasive Gynecology, University of Perugia - Santa Maria Hospital, Viale Tristano di Joannuccio 1, 05100 Terni, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Fagotti
authors.affiliation: Gynecologic Oncology, Comprehensive Cancer Centre of Aviano, Via F. Gallini 2, 33081 Aviano, PN, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Giorda
authors.affiliation: Gynecologic Oncology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Mangili
authors.affiliation: Gynecologic Oncology, University of Brescia, Viale Europa 11, 25123 Brescia, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Odicino
authors.affiliation: Obstetrics and Gynecology, Santa Chiara Hospital, Via Roma 67, 56100 Pisa, Italy.
authors.forename: Maria Giovanna
authors.initials: MG
authors.lastname: Salerno
authors.affiliation: Gynecologic Oncology, "Regina Elena" National Cancer Institute of Rome, Via E. Chianesi 53, 00144 Rome, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Vizza
authors.affiliation: Gynecologic Oncology, National Cancer Institute of Naples, Via M. Semmola, 80131 Naples, Italy.
authors.forename: Cono
authors.initials: C
authors.lastname: Scaffa
authors.affiliation: Obstetrics and Gynecology, University of Catania - Cannizzaro Hospital, Via Messina 829, 95126 Catania, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Scollo
mesh_terms: D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D016889:Endometrial Neoplasms / Q000628:therapy*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D015907:Hysteroscopy / Q000706:statistics & numerical data; D007558:Italy / Q000453:epidemiology; D010535:Laparoscopy / Q000706:statistics & numerical data; D008197:Lymph Node Excision / Q000706:statistics & numerical data; D009367:Neoplasm Staging; D010348:Patient Care Team; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
keywords: Endometrial cancer; Management in Italy; National survey