Tailoring Adjuvant Radiotherapy in Endometrial Cancer

Objectives: The aim of this study was to examine the patterns of failure following adjuvant radiotherapy in patients with endometrial cancer according to: (a) the extent of the disease present at the time of primary surgery, (b) according to risk groups as agreed upon in the ESMO–ESGO–ESTRO consensus conference on endometrial cancer (Colombo et al. in Int J Gynecol Cancer Off J Int Gynecol Cancer Soc 26:2–30, 2016). Methods and Materials: One thousand two hundred and seven newly diagnosed endometrial cancer patients with endometrioid/serous, clear cell and serous histology, treated by primary surgery and presented to The Peter MacCallum Cancer Centre, between January 1996 and December 2014 for adjuvant radiotherapy, were analysed for patterns of any failure to study the efficacy of adjuvant radiotherapy. Results: Nine hundred and eight (75%) patients were alive at the last observation date, 826 without any evidence of disease. Two hundred and sixty-one patients have died, 147 (12%) from recurrent cancer. The median follow-up time was 5.4 years. 53% patients had LVSI, and 18% patients had positive nodes. 19% patients developed metastases. Pelvic, para-aortic and distant relapses were observed in 13, 11 and 8.5%, respectively. Conclusion: Vaginal vault brachytherapy was a very efficient form of radiotherapy that provided 99% control of disease at the vaginal vault in intermediate- and high-intermediate-risk patients in FIGO stages 1 and 2. In stage 3 and 4 patient, adjuvant pelvic radiotherapy and extended field radiotherapy provided a good pelvic and para-aortic control. Patients with lymphovascular space invasion recur more diffusely and at multi-sites. © 2017, Association of Gynecologic Oncologists of India.