Compliance to surgical and radiation treatment guidelines in relation to patient outcome in early stage endometrial cancer

Rationale, aims and objectives We evaluated the adherence to treatment guidelines in early stage endometrial cancer and the influence of adherence to guidelines on overall survival. Method Patients were identified in the central region in the Netherlands from 1990 till 1995. Patient and tumour characteristics, surgical findings, radiation and follow-up data were abstracted from medical records. Endpoint was overall survival. Kaplan-Meier method was used to perform time-to-event analysis. Hazard ratios for overall survival were estimated with a Cox Proportional Hazards model. Results 359 patients were eligible for analysis. 335 patients presented with a clinical stage I cancer. 333 patients underwent a Total Abdominal Hysterectomy with Bilateral Salpingo Oophorectomy (TAH/BSO), of which 301 were staged as International Federation of Gynaecology and Obstetrics (FIGO) stage I, whereas 34 (10.2%) as FIGO stage II. Of the 24 patients with a clinical stage II cancer, 12 underwent a Radical Hysterectomy with Pelvic Lymph Node Dissection (RH/PLND), of which seven were diagnosed with FIGO stage II. In 72.1% of the patients adjuvant radiation was given or not in adherence to the guidelines. Whether treatment was given according to the guidelines or not did not affect 5 years overall survival. Conclusion This suggests that extensive surgical procedures are redundant in the treatment of occult stage II endometrial cancer.