[Stage 1 and 2 cancers of the endometrium. Value of the combination of pelvic radiotherapy and curietherapy followed by a total hysterectomy without lymph node removal]

Abstract

In a retrospective study of 108 patients with stage I-II EC, treated between 1976 and 1983 at CGFL (Dijon), we performed an analysis of the efficacy and tolerance of a treatment approach consisting of external and intracavitary pelvic irradiation followed, 6 weeks later, by hysterectomy without lymph node dissection. Forty-three patients underwent this treatment sequence (G1) and 65 patients (G2) were treated by other modalities (33 intracavitary irradiation and hysterectomy, 27 hysterectomy alone or followed by pelvic irradiation, 5 irradiation alone). The mean follow-up was seven years (5-12). The five year total actuarial survival rate was 82% for G1 and 74% for G2 (p = NS). The five-year disease-free survival probability was 80% for G1 and 67% for G2 (p less than 0.05). The post-therapy complications were 2% for G1 (one late post-irradiation complication) and 14% for G2 (one late post-irradiation complication and 6 post-surgical complications). Although G1 group has more pejorative clinical and histopathological features (72% T1b or T2 for G1 vs 42% for G2 (p less than 0.005) and 77% grade 2 or 3 for G1 vs 61% for G2 (p = 0.05], the efficacy and tolerance of EIH treatment sequence appear at least comparable to those of G2. These results redefine certain therapeutic aspects of stage I-II endometrial carcinoma which should be considered in future prospective approaches.