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Primary Radiotherapy Versus Surgery in Early-Stage Endometrial Cancer Among High-Risk Surgical Patients: A
Lucia Gómez-Lavin Fernández1, Sergi Fernández-González2, Dina Najjari-Jamal3
1Department of Obstetrics and Gynecology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, 08202 Sabadell, Barcelona, Spain.
Definitive radiotherapy offers comparable survival and recurrence rates to surgery for medically inoperable early-stage endometrial cancer (EC). This treatment is a safe and effective alternative for high-risk patients unable to undergo surgery.
Area of Science:
- Gynecologic Oncology
- Radiation Oncology
- Surgical Oncology
Background:
- Surgery is standard for early endometrial cancer (EC), but inoperable patients require alternatives.
- Image-guided brachytherapy (BT) with or without external beam radiotherapy (EBRT) is a curative option.
- Comparative data between radiotherapy and surgery for EC is limited.
Purpose of the Study:
- Compare cancer-specific survival (CSS) at 2 and 5 years.
- Evaluate overall survival (OS), recurrence-free survival (RFS), disease-free survival (DFS), and toxicity.
- Assess definitive radiotherapy as an alternative to surgery for high-risk EC patients.
Main Methods:
- Retrospective comparative study of 72 patients (2011-2023).
- 36 medically inoperable patients treated with BT +/- EBRT.
- 36 matched patients treated with surgery.
Main Results:
- Five-year CSS was 97.2% for radiotherapy vs. 91.7% for surgery (p=0.39).
- Five-year RFS was 86.1% in both groups.
- Grade ≥3 toxicity: 19.4% (radiotherapy) vs. 8.3% (surgery).
Conclusions:
- Definitive BT +/- EBRT is effective for medically inoperable early-stage EC.
- Survival and recurrence outcomes are comparable to surgery.
- Radiotherapy is a valid therapeutic alternative for high-risk surgical patients.
