Endometrial carcinoma: high dose-rate brachytherapy in combination with external irradiation; a multivariate analysis...

From June 1974 to June 1984, 347 women with endometrial carcinoma were referred to the radiotherapy department of the Catharina Hospital, Eindhoven, The Netherlands. Of this total number, 327 patients were considered eligible for analysis; 36 being referred for recurrences of previous surgically treated endometrial carcinoma, and 291 being referred for radiotherapy as part of the initial treatment. The 28% 5-year relapse-free survival (RFS) of the group of 36 patients demonstrated that endometrial carcinoma may behave as a radiosensitive tumour. The remaining 291 had all undergone surgery, except 10. Radiotherapy consisted of high dose-rate brachytherapy applied to the vaginal vault for pathological stage I tumours, well differentiated, and with superficial myometrial invasion. All other patients received external beam irradiation to a pelvic dose of 40 Gy in 4 weeks, followed by brachytherapy (4 fractions of 5 Gy each). The 5-year RFS for pathologically staged patients was: stage I (232 patients) 88%, stage II (27 patients) 68%, stage III and IV (22 patients) 50%. Treatment-related complications were minimal. In-field recurrences were rare: 5% locoregional, 2.2% both loco-regional and distant, versus 9.3% distant failures. Multivariate RFS analysis demonstrated age, stage and tumour differentiation as independent prognostic factors, tumour differentiation being the most important factor.