Endometrial Câncer: Pelvic Control with only Externai Beam Radiotherapy Following Surgery Without Lymphnode Dissection
DOI:
https://doi.org/10.32635/2176-9745.RBC.1999v45n3.2778Keywords:
Endometrial Cancer, Radiotherapy, BrachytherapyAbstract
Median incidence of endometrial câncer in Brazil is of 6 new cases/100.000 women/year. Radiation therapy has been used as adjuvant treatment either pre or post surgery, given as teletherapy or brachytherapy or both. There is a consensus that FIGO stages II and III should receive pelvic irradiation, with or without brachytherapy. However most of such patients (>75%) have stage I câncer at diagnosis. Thus, there are prognostic subgroups depending on how deep the miometrium is invaded and the histologic grade ofthe tumor. Stage I câncer that invades more than 1/2 miometrium and/or is of high grade usually is also treated with adjuvante irradiation. Does the addition of intracavitary vault brachytherapy to externai beam radiotherapy (EBRT) result in improvedpelvic control? This question is yet to be accurately answered. In our Service, patients with endometrial câncer who have indication of adjuvant radiation have received only EBRT without brachytherapy, since 1990. Basic surgery for those patients has been a total abdominal hysterectomy and bilateral salpingo-oophorectomy without routine lymphnode dissection. We reviewed retrospectively 61 patients with endometrial câncer treated this way between 1990-95, with Cobalt, 4 fields, total dose of 45Gy-50.4Gy in 25 to 28 fractions. Median follow up of33 months showed only one pelvic (vaginal) relapse, 6/61 patients died and only one patient had moderate late bowel complication. Those results compare with others published in the literature.
Downloads
References
Câncer no Brasil. Dados dos Registros de Base Populacional volume II. Ministério da Saúde, INCA, 1995
Wingo PA, Tong T, Bolden S. Câncer Statistics. CA Câncer J Clin 45:8, 1995 DOI: https://doi.org/10.3322/canjclin.45.1.8
Glassburns JR, Brady LW, Grigsby PW. Endometrium. in: Perez CA and Brady LW: Principies and Practice of Radiation Oncology, 3rd Ed, Philadelphia, Lipponcott-Raven, 1998, p 1835
Stokes S, Bedwinek J, Kao MS et al. Treatment of stage I adenocarcioma of the endometrium by histerectomy and adjuvante irradiation: a retrospective analysis of 314 patients. Int J Radiation Oncol Biol Phys 12:339, 1986 DOI: https://doi.org/10.1016/0360-3016(86)90348-2
Greven KM, Corns BW. Endometrial Câncer. Curr Probl Câncer 21:65-127, 1997 DOI: https://doi.org/10.1016/S0147-0272(97)80002-5
Creasman WT, Morrow CP, Bundy Bn et al. Surgical pathologic spread patterns of endometrial câncer. Câncer 60:2035, 1987 DOI: https://doi.org/10.1002/1097-0142(19901015)60:8+<2035::AID-CNCR2820601515>3.0.CO;2-8
Perez CA, Bedwinek JM, Breaux Sr. Patterns of failure after treatment fo gynecologic tumors. Câncer Treat Symp 2:217, 1983
Orr JW Jr, Holiman JL, Orr PF. Stage I corpus câncer: is teletherapy necessary? Am J Obstet Gynecol 176(4):778-88, 1997. DOI: https://doi.org/10.1016/S0002-9378(97)70601-X
Corns BW, Lanciano RM, Greven KM et al. Impact of improved irradiation technique, age and lymphdone sampling on the severe complication rate of surgically stage endometrial câncer patients: a multivariate analysis. J Clin Oncol 12:510-5, 1994 DOI: https://doi.org/10.1200/JCO.1994.12.3.510
Perez CA. Uterine Cervix. in: Perez CA and Brady LW: Principies and Practice of Radiation Oncology, 3rd Ed, Philadelphia, Lipponcott-Raven, 1998, p 1760
Einhorn N. Uterine Câncer (corpus uteri). Acta Oncol 35 (suppl 7): 81-5, 1996 DOI: https://doi.org/10.3109/02841869609101667
Bliss P, Cowie VJ. Endometrial carcinoma: does the addition of intracavitary vault caesium to externai beam therapy postoperatively result in improved control or increased morbidity? Clin Oncol (R Coll Radiol) 4: 373-6, 1992 DOI: https://doi.org/10.1016/S0936-6555(05)81130-6
Rush S, Gal D, Potters L et al. Pelvic control following externai beam radiation for surgical stage I endometrial adenocarcinoma. Int J Radiat Oncol Biol PHys 33:851-4, 1995 DOI: https://doi.org/10.1016/0360-3016(95)02012-8
Lybeert MLM, van Putten WLJ, Ribot JG et al. Endometrial carcinoma: high dose brachytherapy in combination with exter nai irradiation. A multivariate analysis of relapses. Radiother Oncol 16:245-252, 1989. DOI: https://doi.org/10.1016/0167-8140(89)90036-4
Nori D, Basil SH, Tome M et al. Combined surgery and radiation in endometrial carcinmas. An analysis of prognostic fac- tors. INtJ Radiat Oncol Biol Phys. 13:489- 497, 1987. DOI: https://doi.org/10.1016/0360-3016(87)90062-9
Piver MS, Hempling RE. A prospective trial of postoperative vaginal radium/cesium for grade 1-2 less than 50% myometrial invasion and pelvic radiation therapy for grade 3 or deep myometrial invasion for surgical Stage I endometrial adenocarcinoma. Câncer 66:1133-38, 1990 DOI: https://doi.org/10.1002/1097-0142(19900915)66:6<1133::AID-CNCR2820660610>3.0.CO;2-H
Stryker JA, Pdezaski E, Kanninski P et al. Adjuvant externai beam therapy for pathologic Stage I and occult Stage II endometria carcinoma. Câncer 67:2872-79, 1991 DOI: https://doi.org/10.1002/1097-0142(19910601)67:11<2872::AID-CNCR2820671128>3.0.CO;2-8
Torrisi JR, Bames WA, Popesc G et al. Post-operative adjuvant externai beam radiotherapy in surgical Stage I endometrial carcinoma. Câncer 64:1417-18, 1989 DOI: https://doi.org/10.1002/1097-0142(19891001)64:7<1414::AID-CNCR2820640708>3.0.CO;2-1
Greven KM, DAgostino RB Jr; Lanciano RM, Corn BW. Is there a role for a brachytherapy vaginal cuff boost in the adjuvant management of patients with uterine-confined endometrial câncer? Int J Radiat Oncol Biol Phys 42:101-4, 1998 DOI: https://doi.org/10.1016/S0360-3016(98)00173-4
Irwin C, Levin W, Eyles A, Pintilie M, Manchul L, Kirkbride P. The role of adjuvant radiotherapy in carcinoma of the endometrium-results in 550 patients with pathologic stage I disease. Gynecol Oncol 70:247-54, 1998. DOI: https://doi.org/10.1006/gyno.1998.5064
McEachrane M, Souhami L, Seymour R, Ereeman CR, Roman T, Senterman M. Is post-operative intracavitary therapy a necessary component of treatment for carcinoma of the endometrium? Am J Clin Oncol 14: 308-11, 1991 DOI: https://doi.org/10.1097/00000421-199108000-00007
