title: Lymphadenectomy in women with endometrial cancer: aspiration and reality from a radiation oncologist's point of view.
abstract: BACKGROUND
  To investigate the meaning of lymphadenectomy (LNE) in women with endometrial cancer (EC) for clinical outcome and secondly to determine the impact of the method of adjuvant radiotherapy (RT) on survival as well as to define prognostic factors.
  
  
  METHODS
  322 patients (pts) underwent adjuvant RT for endometrioid EC at our department from 2004 until 2012 and were included in this retrospective study. Chi-square test, LogRank test and Cox regression were used for statistical analyses.
  
  
  RESULTS
  Median age at diagnosis: 66 years. FIGO stages: FIGO I 69.4 %, FIGO II 15.3 %, FIGO III 14.5 %, FIGO IV 0.9 %. Surgical staging: 30.6 % pelvic/paraaortic LNE, 45 % sole pelvic LNE, 8.8 % sampling of suspicious lymph nodes, 15.6 % no LNE. Adjuvant chemotherapy (ChT): 3.2 %. Sole intravaginal brachytherapy (IVB): 60.2 %. IVB + external beam radiotherapy (EBRT): 39.8 %. 5-year local recurrence free survival (LRFS): 90.6 %, distant metastases free survival (DMFS): 89.8 %, overall survival (OS):79.3 %. In multivariate analysis age (p = .007), pT stage (p = .029), lymph node status (p = .003), grading (p = .011) and lymphovascular space invasion (LVSI; p = .008) remained as independent prognostic factors for OS. Resection status (p = .01) and LVSI (p = .014) were independent prognostic factors for LRFS and LVSI (p = .008) was the only independent prognostic factor for DMFS. There was no statistically significant survival benefit from LNE in LRFS (p = .561), DMFS (p = .981) or OS (p = .791). 5-year LRFS in stage I and II: 96.0 and 82.9 % after sole IVB, 90.8 and 81.6 % after combined IVB/EBRT (p = .105; p = .970). 5-year OS rates for stage I and II: 86.5 and 71.3 % after sole IVB, 84.2 % and 69.2 % after combined IVB/EBRT (p = .153; p = .619).
  
  
  CONCLUSIONS
  Comprehensive surgical staging is rarely performed and may be omitted in women with endometrioid EC in stages I-II. Sole IVB delivers equally good local control as combined IVB/EBRT in pts with FIGO stage I and II disease. LVSI deserves more attention as a prognostic factor and these pts may require a combined local and systemic therapy.
authors.affiliation: Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. robert.foerster@med.uni-heidelberg.de.
authors.forename: Robert
authors.initials: R
authors.lastname: Foerster
authors.affiliation: Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. robert.kluck@gmx.de.
authors.forename: Robert
authors.initials: R
authors.lastname: Kluck
authors.affiliation: Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. nathalie.arians@med.uni-heidelberg.de.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Arians
authors.affiliation: Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. stefan.rieken@med.uni-heidelberg.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Rieken
authors.affiliation: Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. harald.rief@med.uni-heidelberg.de.
authors.forename: Harald
authors.initials: H
authors.lastname: Rief
authors.affiliation: Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. sebastian.adeberg@med.uni-heidelberg.de.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Adeberg
authors.affiliation: Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. tilmann.bostel@med.uni-heidelberg.de.
authors.forename: Tilman
authors.initials: T
authors.lastname: Bostel
authors.affiliation: Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
authors.forename: Ingmar
authors.initials: I
authors.lastname: Schlampp
authors.affiliation: Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. juergen.debus@med.uni-heidelberg.de.
authors.forename: Juergen
authors.initials: J
authors.lastname: Debus
authors.affiliation: Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. katja.lindel@med.uni-heidelberg.de.
authors.forename: Katja
authors.initials: K
authors.lastname: Lindel
mesh_terms: D000368:Aged; D001918:Brachytherapy; D018269:Carcinoma, Endometrioid / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary* / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D005767:Gastrointestinal Diseases / Q000453:epidemiology / Q000209:etiology; D013509:Gynecologic Surgical Procedures; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D016522:Oncology Service, Hospital; D016016:Proportional Hazards Models; D011832:Radiation Injuries / Q000453:epidemiology / Q000209:etiology; D018787:Radiation Oncology; D011872:Radiology Department, Hospital; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D011882:Radiotherapy, High-Energy / Q000009:adverse effects; D012189:Retrospective Studies; D016896:Treatment Outcome