GYNAECOLOGYPreoperative Radiotherapy for Inoperable Stage II Endometrial Cancer: Insights into Improving Treatment and Outcomes
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INTRODUCTION
For women who have endometrial cancer with gross cervical involvement (clinical stage II), the National Comprehensive Cancer Network recommends either radical hysterectomy and bilateral salpingo-oophorectomy with pelvic and para-aortic lymphadenectomy, or, if the cancer is inoperable, dual modality treatment with pelvic radiotherapy followed by total abdominal hysterectomy and bilateral salpingo-oophorectomy with para-aortic lymphadenectomy.1 The British Columbia Cancer Agency has had a more
METHODS
We conducted a retrospective population-based cohort study of women in British Columbia who had received preoperative RT according to BCCA guidelines for clinical stage II endometrial cancer (external beam RT: 4500 cGy to the pelvis in 25 fractions and intracavitary low-dose radiation brachytherapy: 2700 cGy to point A).2 The goal of preoperative RT was to inactivate potential disease in the cervix and parametria. Potential remaining uterine disease was removed via TAHBSO performed by a
RESULTS
We included 29 patients from the BCCA provincial registry in this study. The mean age of diagnosis was 62 years (range 41 to 83).
All patients had clinical involvement of the cervix and received preoperative radiotherapy (external beam to pelvis + intracavitary brachytherapy) followed by extrafascial hysterectomy and removal of the remaining adnexa. Only one patient had a pelvic lymphadenectomy. Descriptions of clinical involvement of the cervix at diagnosis were highly variable, ranging from a 4 cm
DISCUSSION
We found that women with clinical stage II endometrial cancer who were treated with preoperative pelvic radiotherapy followed by TAHBSO in British Columbia had a significant risk of recurrence (27.6%), and the majority of recurrences were distant. Clinical staging of endometrial cancer correlates poorly with surgical staging3., 4., 5. and clinical outcomes.12., 13., 14. The advantage of primary surgical staging is that it provides specific prognostic information and facilitates directed therapy
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Competing Interests: None declared