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Postoperative radiotherapy for endometrial carcinoma. Stage I. Wide variation in referral patterns but no effect on long-term survival in a retrospective study in the southeast Netherlands.
Lybeert ML; van Putten WL; Bršolmann HA; Coebergh JW.
Eur J Cancer, 34(4):586-90 1998 Mar.The results of this study show that radiation therapy does not prolong survival in women with stage I endometrial cancer, and, on the contrary, may be associated with an excess death rate which is demonstrable up to 10 years from initial treatment.
Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial.
Carien L Creutzberg, et al.
Lancet 2000; 355: 1404 - 1411.The results of this study show that post-operative radiotherapy not only does not improve survival in women with stage I endometrial cancer, but also causes significant morbidity and adversely impact survival in those who experience tumor recurrence. The study was conducted on 715 women who, after receiving surgery for stage I uterine cancer, were randomly assigned to undergo either radiotherapy or no further treatment (control group). After an average follow-up of 52 months, mortality rates were slightly higher in women who underwent radiotherapy (19%), compared to those who received no further treatment (15%), although not significantly so. Nine percent of women who underwent radiotherapy died from the cancer, compared to 6% of those in the control group. Treatment-related complications occurred in 25% of women in the radiotherapy group, compared to 6% of those in the control group. Survival after tumor recurrence was significantly improved in the control versus the radiotherapy group. These data indicate that post-operative radiotherapy is not indicated in the management of women with stage I endometrial cancer.
Late effects of radiation therapy for cancer of the uterine cervix.
Zippin C; Lum D; Kohn HI; Bailar JC 3d.
Cancer Detect Prev, 4(1-4):487-92 1981.The results of this study show that women who were treated with radiation therapy for cancer of the uterine cervix between 1932 and 1951 had significantly higher rates of other cancers in the years following treatment, compared to the general population. In particular, over 5 years following treatment, the 497 women who received radiation treatment developed 108 cancers, compared to the expected 64. The excess cancer rate was observed for tumors of the ovary, vulva, vagina, rectum, small intestine, lung, head and neck, and central nervous system. Long-term mortality rates for diseases other than cancer of the uterine cervix were significantly higher in this cohort of women compared to the general population.
Radiotherapy in poor risk patients with stage I cancer of the endometrium: results of not giving external beam radiotherapy.
DeCruze B, Guthrie D.
Clin Oncol (R Coll Radiol) 1999;11(4):252-4.The results of this study show that women with poor-prognosis endometrial cancer who underwent radiation therapy fared no better in terms of survival, than those who received no treatment. Currently there is no available evidence indicating that radiation therapy improves survival in women with endometrial cancer.
A prospective trial comparing hysterectomy, hysterectomy plus vaginal radium, and uterine radium plus hysterectomy in stage I endometrial carcinoma.
Piver MS, Yazigi R, Blumenson L, Tsukada Y.
Obstet Gynecol 1979 Jul;54(1):85-9.The results of this study show that radiotherapy does not prolong survival in women with stage I endometrial cancer. The study was conducted on 189 women who were randomized to undergo treatment with surgery alone, surgery preceded by radiotherapy, or surgery followed by radiotherapy. No differences in survival were observed among the 3 groups during a minimum follow-up period of 10 years.
Surgery without radiotherapy for primary treatment of endometrial cancer.
Larson DM, Broste SK, Krawisz BR.
Obstet Gynecol 1998 Mar;91(3):355-9.The results of this study show that women with poor-prognosis endometrial cancer treated only with surgery have an excellent prognosis even if they do not receive radiation therapy.
Adjuvant chemotherapy for high-risk endometrial cancer.
Pustilnik T, Burke TW.
Semin Radiat Oncol 2000 Jan;10(1):23-8.This article emphasizes that there is no evidence demonstrating that radiation treatment or hormone treatment with progestins improve survival in women with endometrial cancer. In addition, the role of adjuvant chemotherapy is still undetermined, due to the lack of data from randomized trials evaluating its effectiveness in the management of this condition.
Systemic treatment of advanced and recurrent endometrial carcinoma: current status and future directions.
Moore TD, Phillips PH, Nerenstone SR, Cheson BD.
J Clin Oncol 1991 Jun;9(6):1071-88.This article highlights that progestins, used as standard treatment in women with diffuse endometrial cancer for over 30 years, do not halt disease progression nor improve survival, as shown by the results of several large randomized trials.
A randomized trial of progestogens in the primary treatment of endometrial carcinoma.
Macdonald RR, Thorogood J, Mason MK.
Br J Obstet Gynaecol 1988 Feb;95(2):166-74.The results of this randomized trial show that treatment with progesting does not prolong survival in women with uterine cancer.
Doxorubicin as an adjuvant following surgery and radiation therapy in patients with high-risk endometrial carcinoma, stage I and occult stage II:
A Gynecologic Oncology Group Study.
Morrow CP; et al.
Gynecol Oncol, 36(2):166-71 1990 Feb.The results of this study show that chemotherapy with doxorubicin does not prolong survival in patients with early uterine cancer. The study was conducted on 181 women who underwent surgery and radiation treatment for stage I and stage II endometrial cancer. Subsequently, patients were randomized to either receive chemotherapy treatment with doxorubicin or to undergo no further treatment. There were no differences in rates of survival between the two groups. Treatment-related deaths occurred in 3 women in the chemotherapy group and in 2 women in the radiation-only group
Hexamethylmelamine as first-line chemotherapy in the treatment of advanced or recurrent carcinoma of the endometrium: a phase II trial of the Gynecologic Oncology Group.
Thigpen JT; Blessing JA; Ball H; Hanjani P; Manetta A; Homesley H.
Gynecol Oncol, 31(3):435-8 1988 Nov.The results of this study show that the anti-cancer drug hexamethylmelamine is ineffective for the treatment of women with advanced stage endometrial cancer.
Costs and benefits of routine follow-up after curative treatment for endometrial cancer.
Agboola OO, Grunfeld E, Coyle D, Perry GA.
CMAJ 1997 Oct 1;157(7):879-86.The results of this study show that routine follow-up after complete surgical resection for endometrial cancer is not associated with prolonged survival in women with cancer recurrence. Four hundred thirty-two patients with uterine cancer who underwent surgery with curative intents were followed-up with routine Pap-tests during a 10-year period to detect eventual tumor relapses. Cancer recurred in 50 patients (12%). Survival rates in patients whose cancer was detected at screening (when patients had no symptoms of disease), were not different from those of patients whose cancer was found in the interval between screenings (when patients had symptomatic disease). The cost of follow-up was estimated at $19,200 for each patient with cancer recurrence. These data indicate that routine Pap test is ineffective at prolonging life expectancy in women with recurrent cancer, and it use is associated with significant utilization of health care resources.
Prognostic factors in endometrial cancer.
Ludwig H.
Int J Gynaecol Obstet, 49 Suppl():S1-7 1995.This article questions the appropriateness of performing surgery on women with extensive endometrial cancer in the attempt to better define the extension of their disease. There is concern that removal of the lymph nodes in the pelvis and around the aorta may be associated with increase morbidity, and that surgical exploration of the pelvic cavity may results in postoperative adhesions and bladder, intestine and urinary tract problems. The appropriateness of surgery is also questioned in light of the lack of evidence demonstrating that treatment improves survival in women with endometrial cancer extended outside the pelvis.
