ABSTRACT
Background
and Objective: There is marked controversy regarding optimal management patients with
stage IB grade III endometrial carcinoma. The present study analyzes the
current practices regarding adjuvant radiation therapy for those patients in
our institute and also assessed prognostic factor affecting overall survival
outcome. Patients and Methods: A total 66 patients with postoperative
FIGO stage 1B, grade III endometrial carcinoma were treated and evaluated
between the years 2009 and 2014. Risk factors assessed age (<60 versus ≥60),
tumor size (≤4 cm versus >4 cm), site of primary tumor (involvement of lower
uterine segment versus no involvement), Lymphadenectomy (performed versus not performed),
Lymph-vascular space invasion (positive or negative), type of surgery performed (less than total abdominal
hysterectomy and bilateral salpingo-ophorectomy (TH/BSO) versus greater than or
equal TH/BSO), radiation sequence with surgery (no radiation versus adjuvant
radiation), and type of radiation (pelvic external beam radiotherapy versus
vaginal brachytherapy versus both). Results: Adjuvant radiation therapy
after surgery was associated with significantly better time to relapse (p =
0.001) in comparison to those patients who underwent surgery alone. There was
statistically significant improvement of survival of patients who received
adjuvant radiation therapy in comparison with those who underwent surgery
alone. There was no statistically significant difference in relapse between external
pelvic radiotherapy, brachytherapy and both (p = 0.161). There was no
statistically significant difference in overall survival between different
types of adjuvant radiation therapy (p = 0.318). Adjuvant radiation therapy (HR
0.173, 95% CI 0.049 - 0.609, p = 0.006) and tumor size (HR 4.065, 95% CI 1.120 -
14.761, p = 0.033) were the only statistically significant predictors for
relapse in multivariate analysis. Adjuvant radiation therapy (HR 0.159, 95% CI
0.045 - 0.563, p = 0.004), age (HR 10.357, 95% CI 1.195 - 89.746, p = 0.034)
and lymphadenectomy (HR 0.240, 95% CI 0.071 - 0.811, p = 0.022) were statistically
significant predictors for overall survival. Conclusion: The current
study suggested that adjuvant radiation therapy definitely improve survival of
patients with stage IB, grade III endometrial cancer. There is a need for more
randomized trials to define patients who require adjuvant radiation therapy and
define what type of radiation should be received. Well defined guidelines are
very important to standardize treatment and cut costs in clinical practice.