Endometrial carcinoma : analysis of recurrence in patients treated with a strategy minimizing lymph node sampling and radiation therapy

To determine whether using a treatment strategy minimizing lymph node sampling and radiation therapy compromised outcome in patients with early endometrial carcinoma. One hundred three consecutive patients with International Federation of Gynecology and Obstetrics surgical stage I, II, or III endometrial carcinoma were treated with primary surgery followed by tailored adjuvant radiation therapy using a strategy designed to minimize lymph node sampling and whole pelvic radiation. Para-aortic lymph node dissection was performed only among patients with high-risk factors such as high-grade tumors, deep myometrial invasion, or stage II or III disease. Postoperative radiation therapy was tailored to the surgical and pathologic findings. Treatment with whole pelvic radiation was limited to patients with at least one of these high-risk factors. Thirty-four patients underwent para-aortic node dissection. Thirty-six patients received no adjuvant radiation therapy; 19 received vaginal radiation and 47 received whole pelvic radiation. Ninety-three patients (90%) have had no tumor recurrence during a median follow-up period of 30 months (range 8-96). Analysis of the recurrence pattern indicates that more aggressive use of lymph node evaluation or radiation therapy would not have lowered the recurrence rate. All of the patients who had recurrence were identified as high-risk and received aggressive therapy. Furthermore, the pattern of recurrence suggests that many of these patients had occult distant disease at the outset of therapy. The data suggest that this selective approach does not compromise survival in patients with early-stage endometrial carcinoma. This management strategy has the advantage of confining the morbidity of lymph node dissection and radiation therapy to those patients at greatest risk for lymph node metastases and recurrence, respectively. Further improvements in survival await the development of effective systemic therapy.