Postoperative whole abdomino-pelvic irradiation for patients with high risk endometrial cancer

Forty-seven patients with endometrial cancer, surgical Stage I through IV, received adjuvant whole abdomino-pelvic irradiation with a nodal and vaginal boost between August 1981 through December 1986. The median age was 66.5 years (range 37-86 years). Twenty-two patients were Stages I-II, 14 Stage III, and eleven patients Stage IV. Thirty-four patients (79%) had positive peritoneal cytology, 29 patients (62%) had deep myometrial involvement, 27 patients (58%) had high grade lesions, 18 patients (40%) had either serous-papillary or adenosquamous histologic variants, and ten patients (22%) had residual disease of up to 2 cm. remaining after operation, mostly in the form of nodal disease. Twenty-four patients (51%) had two or more life time laparotomies. Mean follow-up was 40.5 mo. (range 17-85 mo.). The 5-year actuarial survival was 68% and the 5-year relapse-free survival (RFS) was 77%. The 5 year relapse-free survival for Stages I/II, III, and IV were 85%, 78%, and 53%, respectively. The 5 year relapse-free survival for grades 1/2 was 100% and for grades 3/4 was 60%. (p value of 0.0017). Acute toxicity has been modest, and particularly evident in thinner patients (weight below 115 lbs.). Chronic toxicity of significance has been limited to one patient with a conservatively managed bowel obstruction. These results are very encouraging and suggest benefit to the use of more aggressive adjuvant irradiation.