Preoperative intracavitary irradiation of endometrial carcinoma stage I by a high dose rate afterloading technique

Preoperative intracavitary irradiation was administered to 366 patients with endometrial carcinoma stage I by a high dose rate afterloading method using 60Co sources (bulb-technique). In 275 cases hysterectomy and bilateral salpingo-oophorectomy were performed 6 weeks later and in 91 cases dilation and curettage was used to verify tumor eradication. In 58% of the hysterectomy specimens no residual carcinoma was detected at the histopathologic evaluation. In the group treated with radiotherapy alone 74% showed no carcinoma remnants in the curettings 3 months after therapy. The effect of the fractionation dose was evaluated in relation to the outcome of the histopathologic examination of the hysterectomy and curettage specimens. The proportion of specimens with no residual carcinoma increased from 27% for the 5 Gy per fraction group to 78% for the 10 Gy per fraction group. Recurrences were recorded in 13% in the hysterectomy group and in 29% in the group treated with radiotherapy alone. The nuclear grade of the tumor and the age of the patient were the most important risk factors for tumor recurrence. The 5-year crude survival rate for the combination-treated group was 84% and for the group treated with radiotherapy alone 47%. The corresponding corrected survival rates were 88 and 72% respectively. Serious late radiation reactions were noted in 6.6%. The significant risk factors for radiation reactions were dose per fraction and the age of the patient.