Canadian Association of Radiologists: treatment results in 2719 patients with carcinoma of the endometrium 1973-1977

A retrospective analysis of treatment results in 2719 patients with endometrial cancer registered at 14 Canadian cancer centres in the 5-year period 1973-1977 was performed. The patients had a median age of 61.5 years and an overall 5-year survival of 78.5% (relative survival rate 86.0%). After preoperative radiotherapy the number of poorly differentiated and deeply invasive lesions seen at hysterectomy was reduced. The 1063 patients with stage I cancer treated with preoperative radiotherapy had a 5-year survival rate of 85.9% and a 5-year actuarial complication rate of 3.8%. The 359 patients with stage I cancer who had a hysterectomy followed by radiotherapy had a survival rate of 81.6% and a complication rate of 11.9%. Both differences are statistically significant (p less than 0.05 and p less than 0.0001 respectively). External beam radiotherapy was associated with the majority of severe complications. The actuarial complication rate in patients treated with postoperative radiotherapy was 9.8%, but when radiotherapy had been given before hysterectomy, it was 4.4% (p less than 0.001). We conclude from this study that when adjuvant radiotherapy is indicated, in the (generally elderly) patient with endometrial cancer it is safer to give preoperative rather than postoperative treatment. This largely avoids administering external beam radiotherapy with its potential high complication rate and no benefit in extended survival.