Recurrence Pattern after Adjuvant Radiotherapy for Endometrioid Type Endometrial Cancer

Abstract

Objective: To define recurrence pattern of endometrioid type endometrium cancer performed adjuvant radiotherapy.

Study Design: 351 patients who underwent at least total abdominal hysterectomy with bilateral salpingo-oophorectomy and followed by adjuvant radiotherapy (vaginal brachytherapy or pelvic radiotherapy or both) for endometrioid type endometrium carcinoma were included. The patients who received systemic adjuvant treatment after surgery were excluded from the study except for 18 patients who received concomitant chemo-radiotherapy. Recurrence was categorized as pelvic recurrence included areas distal to the pelvic inlet, as abdominal recurrence included areas between pelvic inlet and diaphragm and findings such as ascites and peritonitis carcinomatosa, and the rest of recurrences including lung, cutaneous, liver parenchyma and bone as extra-abdominal recurrence.

Results: The median age was 57 years (range; 29-82). 236 patients had stage I, 25 had stage II, 63 had stage III and 14 had stage IV disease (by FIGO 2009). Lymph node metastasis was determined in 21.8% of patients who underwent lymphadenectomy (n: 289). The median follow-up time was 46 months (range; 1-190). Throughout follow-up, recurrence was developed in 55 (15.7%) patients. Only pelvic recurrence was determined in 11 (3.1%) patients. There was recurrence beyond the pelvis in 44 (80%) of the recurrent patients. Thirty-five (%63.6) of recurrent patients had extra-abdominal recurrence. Twenty-three (41.8%) of recurrent patients had stage IB disease. The recurrence developed in 10% of patients with stage I&II, whereas it was occurred in 31% of patients with stage III&IV (p<0.0001).

Conclusion: Radiotherapy provides local control of the disease, but recurrence is likely to be extra-pelvic and extra-abdominal in this patient group.