title: Lymphovascular space invasion and the treatment of stage I endometrioid endometrial cancer.
abstract: OBJECTIVE
  Treatment of clinical early-stage endometrioid endometrial cancer (EEC) in The Netherlands consists of primary hysterectomy and bilateral salpingo-oophorectomy. Adjuvant radiotherapy is given when 2 or more the following risk factors are present: 60 years or older, grade 3 histology, and 50% or more myometrial invasion. Lymphovascular space invasion (LVSI) is a predictor of poor prognosis and early distant spread. It is unclear whether adjuvant radiotherapy is sufficient in patients with LVSI-positive EEC.
  
  
  METHODS
  Eighty-one patients treated from 1999 until 2011 for stage I LVSI-positive EEC in 11 Dutch hospitals were included. The outcomes of patients with 0 to 1 risk factors were compared with those with 2 to 3 risk factors, and both were compared with the known literature.
  
  
  RESULTS
  Eighteen patients presented with recurrent disease, and 12 of those recurrences had a distant component. Overall and distant recurrence rates were 19.2% and 11.5% in patients with 0 to 1 risk factors followed by observation and 25.5% and 17% in patients with 2 to 3 risk factors who received adjuvant radiotherapy. Only 1 patient with grade 1 disease had a recurrence.
  
  
  CONCLUSIONS
  In stage I LVSI-positive EEC with 0 to 1 risk factors, observation might not be adequate. Moreover, despite adjuvant radiotherapy, a high overall and distant recurrence rate was observed in patients with 2 to 3 risk factors. The use of systemic treatment in these patients, with the exception of patients with grade 1 disease, should be investigated.
authors.affiliation: *Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands; †Comprehensive Cancer Center South, Eindhoven, The Netherlands; ‡Center of Research on Psychology in Somatic Diseases, Tilburg University, The Netherlands; §Department of Obstetrics and Gynaecology, Catharina Hospital, Eindhoven, The Netherlands; ∥Department of Obstetrics and Gynaecology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands; and ¶Department of Obstetrics and Gynaecology, TweeSteden Hospital, Tilburg, The Netherlands.
authors.forename: Louis J M
authors.initials: LJ
authors.lastname: van der Putten
authors.forename: Yvette P
authors.initials: YP
authors.lastname: Geels
authors.forename: Nicole P M
authors.initials: NP
authors.lastname: Ezendam
authors.forename: Hans W H M
authors.initials: HW
authors.lastname: van der Putten
authors.forename: Marc P M L
authors.initials: MP
authors.lastname: Snijders
authors.forename: Lonneke V
authors.initials: LV
authors.lastname: van de Poll-Franse
authors.forename: Johanna M A
authors.initials: JM
authors.lastname: Pijnenborg
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009215:Myometrium / Q000473:pathology*; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate