title: The effect of lymphadenectomy and radiotherapy on recurrence and survival in endometrial carcinoma. Experience in a population reference centre.
abstract: OBJECTIVE
  To evaluate the effect of lymphadenectomy and/or radiotherapy on recurrence and survival patterns in endometrial carcinoma (EC) in a radiotherapy reference centre population.
  
  
  METHODS
  A retrospective population-based review was conducted on 261 patients with stages I-III EC. Univariate and multivariate analyses were carried out. Both recurrence and survival were analysed according to patient age, FIGO stage, tumour size, myometrial invasion, tumour grade, lymphadenectomy, external beam irradiation (EBI), and brachytherapy (BT).
  
  
  RESULTS
  Median age: 64.8 years. Median follow-up: 151 months. The following treatments were administered: surgery, 97.32%; lymph-node dissection, 54.4%; radiotherapy, 162 patients (62%) (EBI and BT: 64.1%, BT alone: 30.2%, EBI alone: 5.6%). Twenty-six patients (9.96%) suffered loco-regional recurrence, whilst 27 (10.34%) suffered distant failure. The 5-year overall survival (OS) for all stages was 80.1%. The 5-year disease free survival (DFS) was 92.1% for all patients. The 10-year DFS was 89.9%. The independent significant prognostic factors for a good outcome identified through the multivariate analysis were: age <75 years (p = 0.001); tumour size ≤2 cm (p = 0.003); myometrial invasion ≤50% (p = 0.011); lymphadenectomy (p = 0.02); EBI (p = 0.001); and BT (p = 0.031). Toxicity occurred in 114 of the 162 patients who received radiotherapy (70.5%). The toxicity was mainly acute, and late in only 28.3% (n = 45) of cases. The majority experienced G1-2 toxicity, and only 3% of patients experienced G3 late toxicity (5/162).
  
  
  CONCLUSIONS
  Our results suggest that age <75 years, tumour size ≤2 cm, myometrial invasion ≤50%, lymphadenectomy, EBI, and BT, are predictors of a good outcome in EC.
authors.affiliation: Radiation Oncology Department, Hospital Universitari Sant Joan de Reus, Institut d'Investigacions Sanitàries Pere Virgili (IISPV), Universitat Rovira i Virgili (URV), Tarragona, Spain.
authors.forename: Meritxell
authors.initials: M
authors.lastname: Arenas
authors.affiliation: Radiation Oncology Department, Hospital Universitari Sant Joan de Reus, Institut d'Investigacions Sanitàries Pere Virgili (IISPV), Universitat Rovira i Virgili (URV), Tarragona, Spain.
authors.forename: Marina
authors.initials: M
authors.lastname: Gascón
authors.affiliation: Gynaecologic Cancer Unit, Radiation Oncology Department, Institut Clínic de Malalties Hematològiques i Oncològiques (ICMHO), Hospital Clinic, Barcelona, Spain.
authors.forename: Àngels
authors.initials: À
authors.lastname: Rovirosa
authors.affiliation: Medical Physics and Radiation Protection Department, Hospital Universitari Sant Joan de Reus, IISPV, Spain.
authors.forename: Víctor
authors.initials: V
authors.lastname: Hernández
authors.affiliation: Pathology Department, Hospital Universitari Sant Joan de Reus, IISPV, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Riu
authors.affiliation: Radiation Oncology Department, Hospital Universitari Sant Joan de Reus, Institut d'Investigacions Sanitàries Pere Virgili (IISPV), Universitat Rovira i Virgili (URV), Tarragona, Spain.
authors.forename: Iolanda
authors.initials: I
authors.lastname: López
authors.affiliation: Radiation Oncology Department, Hospital Ramon y Cajal, Madrid, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Montero
authors.affiliation: Radiation Oncology Department, Complejo Hospitalario Universitario Albacete (CHUA), Spain.
authors.forename: Sebastià
authors.initials: S
authors.lastname: Sabater
keywords: Endometrial carcinoma; Lymphadenectomy; Prognostic factors; Radiotherapy