Comprehensive staging surgery including complete pelvic and para-aortic lymphadenectomy followed by adjuvant vaginal brachytherapy improves survival rates for intermediate-risk endometrial cancer patients

Abstract

AIM: To investigate the survival of patients with intermediate-risk endometrial cancer treated with comprehensive staging surgery including complete pelvic and para-aortic lymphadenectomy and adjuvant vaginal brachytherapy (VBT).

METHODS: Between January 2000 and December 2009, we retrospectively reviewed the medical records of 156 patients who underwent comprehensive surgical staging consisting of total hysterectomy, adnexectomy, peritoneal cytology, and complete pelvic/para-aortic lymphadenectomy. There were 122 low-risk and 34 intermediate-risk patients, and intermediate-risk patients received adjuvant VBT.

RESULTS: During the follow-up period, 7 (4.5%) of the 156 patients developed recurrent disease: 3 (2.5%) of the 122 low-risk and 4 (11.8%) of the 34 intermediate-risk patients. Among the 7 patients with recurrent disease, only 1 intermediate-risk patient died of disease and 6 stayed alive for the rest of the follow-up period. Disease-free survival at 5 years was 95.7% in the low-risk patients and 81.6% in the intermediate-risk patients, and this difference was statistically significant (p = 0.009). There was no statistically significant difference in overall survival at 5 years between the two groups (100% in low-risk patients vs. 96.7% in intermediate-risk patients, p = 0.061). Overall, grade 3 toxicities were seen in 1 (2.9%) patient.

CONCLUSION: Comprehensive staging surgery including complete pelvic and para-aortic lymphadenectomy followed by adjuvant VBT improves survival rates for intermediate-risk endometrial cancer patients, which are comparable with those of low-risk patients.