title: Chemotherapy reduces para-aortic node recurrences in endometrial cancer with positive pelvic and unknown para-aortic nodes.
abstract: OBJECTIVE
  The objective of this study was to evaluate how the administration of different adjuvant therapies influences the risk for developing recurrences in the para-aortic area in endometrial cancer (EC) with positive pelvic and unknown para-aortic nodes.
  
  
  METHODS
  We retrospectively evaluated the data of 58 patients with EC affected by stage IIIC1 who had undergone pelvic but not para-aortic lymphadenectomy from January 1, 1990 to December 31, 2011. Survival outcomes within the first 5 years after surgery were assessed using the Kaplan-Meier model.
  
  
  RESULTS
  Chemotherapy plus radiotherapy, chemotherapy only, and external radiotherapy only were administered in 12 (23%), 18 (34%), and 23 (43%) patients, respectively. Five (9%) patients, who were selected to forego adjuvant therapy due to poor performance status, were excluded from the analysis. Disease-free and overall survivals assessed at 5 years were 54%, and 61%, respectively. All para-aortic recurrences were observed among the patients with endometrioid EC, whereas no cases of para-aortic recurrences were found in patients with nonendometrioid histology (5/36 (14%) vs 0/17 (0%); P = 0.16); the latter were more likely to develop distant (hematogenous, peritoneal, and distant lymphatic) recurrences (P = 0.09). Type of adjuvant therapy was the only factor influencing para-aortic failure: chemotherapy (± radiotherapy) reduced the rate of para-aortic node recurrence in comparison with pelvic radiotherapy as a sole modality (P = 0.01). However, adjuvant therapy did not influence the 5-year survival outcomes (P > 0.05).
  
  
  CONCLUSIONS
  In the absence of local treatment (ie, para-aortic lymphadenectomy and radiotherapy), the administration of chemotherapy seems effective in reducing recurrences in the para-aortic area among patients with stage IIIC1 endometrioid EC.
authors.affiliation: *Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese; and †Department of Obstetrics and Gynecology, University of Bari, Bari, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bogani
authors.forename: Antonella
authors.initials: A
authors.lastname: Cromi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Serati
authors.forename: Edoardo
authors.initials: E
authors.lastname: Di Naro
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Donadello
authors.forename: Jvan
authors.initials: J
authors.lastname: Casarin
authors.forename: Federica
authors.initials: F
authors.lastname: Nardelli
authors.forename: Fabio
authors.initials: F
authors.lastname: Ghezzi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta; D018269:Carcinoma, Endometrioid / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology / Q000532:radiotherapy; D016889:Endometrial Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology / Q000532:radiotherapy; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000187:drug effects* / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D010388:Pelvis; D018714:Radiotherapy, Adjuvant; D012008:Recurrence; D012189:Retrospective Studies