Stage IB endometrial cancer. Does lymphadenectomy replace adjuvant radiotherapy?
- PMID: 17960334
- DOI: 10.1007/s00066-007-1801-3
Stage IB endometrial cancer. Does lymphadenectomy replace adjuvant radiotherapy?
Abstract
Background: The role of surgical lymph node dissection and adjuvant radiation therapy (RT) in early stage endometrial cancer is no longer clearly defined. The increased appreciation of lymphadenectomy and the absence of survival advantage from adjuvant RT rise controversies how patients should adequately be treated in stage IB endometrial cancer. The aim of this review is to rule out the validity of either treatment option and determine which preference provides the best therapeutic benefit.
Methods: Reports of relevant studies obtained from a search of PubMed and studies referenced in those reports were reviewed.
Results: Based on the available data in the literature, for stage IB grade 1 or 2, the risk of pelvic relapse is considered too low to justify pelvic RT. However, intravaginal RT (IVRT) should be recommended for those >or= 60 years old or with lymphovascular invasion (LVI). For patients with stage IB grade 3 (and IC all grades), the treatment recommendation is mainly based on whether surgical lymph node staging was performed. These patients have--without surgical lymph node staging--a high risk of pelvic recurrence and should therefore primarily undergo relaparotomy for lymphadenectomy or pelvic RT as second choice. If these patients had a surgical lymph node staging, then IVRT alone is a reasonable alternative to pelvic RT.
Conclusion: Overall survival may not be the only ideal endpoint for stage IB endometrial cancer since causes of death are mostly other than endometrial cancer. Conventional pelvic RT may be overtreatment in some patients, in particular in those patients with a large number of negative lymph nodes after lymphadenectomy. However, negative surgical staging should not be understood as adjuvant RT can be omitted in all patients.
Similar articles
-
Intravaginal brachytherapy alone for intermediate-risk endometrial cancer.Int J Radiat Oncol Biol Phys. 2005 May 1;62(1):111-7. doi: 10.1016/j.ijrobp.2004.09.054. Int J Radiat Oncol Biol Phys. 2005. PMID: 15850910
-
[Pelvic lymphadenectomy as an alternative to adjuvant radiotherapy in early stage endometrial cancer at high risk of recurrent lymphatic metastases (stage I)].Minerva Ginecol. 2009 Feb;61(1):1-12. Minerva Ginecol. 2009. PMID: 19204656 Italian.
-
[Survival, prognostic factors and modern tendencies in adjuvant treatment of diagnosed endometrial cancer patients with or without lymph node dissection].Akush Ginekol (Sofiia). 2009;48 Suppl 1:3-11. Akush Ginekol (Sofiia). 2009. PMID: 20387272 Bulgarian.
-
When and how should adjuvant radiation be used in early endometrial cancer?Semin Radiat Oncol. 2006 Jul;16(3):158-63. doi: 10.1016/j.semradonc.2006.02.004. Semin Radiat Oncol. 2006. PMID: 16814156 Review.
-
[Endometrial carcinoma: which radiotherapy for which patient?].Cancer Radiother. 2003 Nov;7 Suppl 1:1s-7s. Cancer Radiother. 2003. PMID: 15124538 Review. French.
Cited by
-
Studies on the role of osteopontin-1 in endometrial cancer cell lines.Strahlenther Onkol. 2013 Dec;189(12):1040-8. doi: 10.1007/s00066-013-0434-y. Epub 2013 Oct 16. Strahlenther Onkol. 2013. PMID: 24126938
-
Staging of endometrial cancer with MRI: guidelines of the European Society of Urogenital Imaging.Eur Radiol. 2009 Jul;19(7):1565-74. doi: 10.1007/s00330-009-1309-6. Epub 2009 Feb 5. Eur Radiol. 2009. PMID: 19194709
-
Evolution of adjuvant treatment in endometrial cancer-no evidence and new questions?Strahlenther Onkol. 2018 Nov;194(11):965-974. doi: 10.1007/s00066-018-1339-6. Epub 2018 Aug 15. Strahlenther Onkol. 2018. PMID: 30112692 Review. English.
-
Utilization Trend and Comparison of Different Radiotherapy Modes for Patients with Early-Stage High-Intermediate-Risk Endometrial Cancer: A Real-World, Multi-Institutional Study.Cancers (Basel). 2022 Oct 19;14(20):5129. doi: 10.3390/cancers14205129. Cancers (Basel). 2022. PMID: 36291913 Free PMC article.
-
Hematogenous metastases in patients with Stage I or II endometrial carcinoma.Strahlenther Onkol. 2011 Dec;187(12):806-11. doi: 10.1007/s00066-011-2250-6. Epub 2011 Nov 17. Strahlenther Onkol. 2011. PMID: 22105770
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources