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British Journal of Cancer logoLink to British Journal of Cancer
. 1997;75(12):1836–1841. doi: 10.1038/bjc.1997.313

Treatment of node-positive endometrial cancer with complete node dissection, chemotherapy and radiation therapy.

T Onda 1, H Yoshikawa 1, K Mizutani 1, M Mishima 1, H Yokota 1, H Nagano 1, Y Ozaki 1, A Murakami 1, K Ueda 1, Y Taketani 1
PMCID: PMC2223619  PMID: 9192991

Abstract

We assessed the therapeutic significance of systematic aortic and pelvic lymphadenectomy followed by adjuvant therapy in node-positive endometrial carcinoma. Among 173 stage I-III patients, 30 (17%) had positive nodes: ten in the pelvic region alone (group P) and 20 in the aortic region alone or in both regions (group A). The adjuvant therapy was administered as follows: subjects in group P received 50 Gy pelvic radiation, including three post-surgical T3 (pT3) patients who received either one or three cycles of cisplatin-based chemotherapy before radiation. Subjects in group A were given three cycles of chemotherapy followed by 50 Gy pelvic and 50 Gy extended field periaortic radiation using a four-field or conformational technique. Five-year survival was 95% for 143 patients with negative nodes and 84% for 30 patients with positive nodes (100% for group P and 75% for group A). In group A, 5-year survival was 38% for eight patients with both pT3 and histology other than endometrioid type G1, and 91% for the remaining 12 patients. Either way, both group P and group A patients had a better prognosis than previously reported. In summary, aortic and pelvic lymphadenectomy and subsequent chemotherapy and radiation therapy based on node status seem to improve the survival of endometrial cancer patients with positive nodes.

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Selected References

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  1. Ayhan A., Yarali H., Urman B., Günalp S., Yüce K., Ayhan A., Havlioglu S. Lymph node metastasis in early endometrium cancer. Aust N Z J Obstet Gynaecol. 1989 Aug;29(3 Pt 2):332–335. doi: 10.1111/j.1479-828x.1989.tb01757.x. [DOI] [PubMed] [Google Scholar]
  2. Belinson J. L., Lee K. R., Badger G. J., Pretorius R. G., Jarrell M. A. Clinical stage I adenocarcinoma of the endometrium--analysis of recurrences and the potential benefit of staging lymphadenectomy. Gynecol Oncol. 1992 Jan;44(1):17–23. doi: 10.1016/0090-8258(92)90005-4. [DOI] [PubMed] [Google Scholar]
  3. Blythe J. G., Hodel K. A., Wahl T. P., Baglan R. J., Lee F. A., Zivnuska F. R. Para-aortic node biopsy in cervical and endometrial cancers: does it affect survival? Am J Obstet Gynecol. 1986 Aug;155(2):306–314. doi: 10.1016/0002-9378(86)90815-x. [DOI] [PubMed] [Google Scholar]
  4. Boronow R. C., Morrow C. P., Creasman W. T., Disaia P. J., Silverberg S. G., Miller A., Blessing J. A. Surgical staging in endometrial cancer: clinical-pathologic findings of a prospective study. Obstet Gynecol. 1984 Jun;63(6):825–832. [PubMed] [Google Scholar]
  5. Burrell M. O., Franklin E. W., 3rd, Powell J. L. Endometrial cancer: evaluation of spread and follow-up one hundred eighty-nine patients with Stage I or Stage II disease. Am J Obstet Gynecol. 1982 Sep 15;144(2):181–185. doi: 10.1016/0002-9378(82)90625-1. [DOI] [PubMed] [Google Scholar]
  6. Calais G., Descamps P., Vitu L., Body G., Lansac J., Bougnoux P., Le Floch O. Is lymphadenectomy useful in the treatment of endometrial carcinoma? Gynecol Oncol. 1990 Jul;38(1):71–75. doi: 10.1016/0090-8258(90)90014-c. [DOI] [PubMed] [Google Scholar]
  7. Chuang L., Burke T. W., Tornos C., Marino B. D., Mitchell M. F., Tortolero-Luna G., Levenback C., Morris M., Gershenson D. M. Staging laparotomy for endometrial carcinoma: assessment of retroperitoneal lymph nodes. Gynecol Oncol. 1995 Aug;58(2):189–193. doi: 10.1006/gyno.1995.1208. [DOI] [PubMed] [Google Scholar]
  8. Corn B. W., Lanciano R. M., Greven K. M., Schultz D. J., Reisinger S. A., Stafford P. M., Hanks G. E. Endometrial cancer with para-aortic adenopathy: patterns of failure and opportunities for cure. Int J Radiat Oncol Biol Phys. 1992;24(2):223–227. doi: 10.1016/0360-3016(92)90675-8. [DOI] [PubMed] [Google Scholar]
  9. Creasman W. T., Disaia P. J., Blessing J., Wilkinson R. H., Jr, Johnston W., Weed J. C., Jr Prognostic significance of peritoneal cytology in patients with endometrial cancer and preliminary data concerning therapy with intraperitoneal radiopharmaceuticals. Am J Obstet Gynecol. 1981 Dec 15;141(8):921–929. doi: 10.1016/s0002-9378(16)32684-9. [DOI] [PubMed] [Google Scholar]
  10. Creasman W. T., Morrow C. P., Bundy B. N., Homesley H. D., Graham J. E., Heller P. B. Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer. 1987 Oct 15;60(8 Suppl):2035–2041. doi: 10.1002/1097-0142(19901015)60:8+<2035::aid-cncr2820601515>3.0.co;2-8. [DOI] [PubMed] [Google Scholar]
  11. Creasman W. T. New gynecologic cancer staging. Obstet Gynecol. 1990 Feb;75(2):287–288. [PubMed] [Google Scholar]
  12. Faught W., Krepart G. V., Lotocki R., Heywood M. Should selective paraaortic lymphadenectomy be part of surgical staging for endometrial cancer? Gynecol Oncol. 1994 Oct;55(1):51–55. doi: 10.1006/gyno.1994.1246. [DOI] [PubMed] [Google Scholar]
  13. Feuer G. A., Calanog A. Endometrial carcinoma: treatment of positive paraaortic nodes. Gynecol Oncol. 1987 May;27(1):104–109. doi: 10.1016/0090-8258(87)90236-8. [DOI] [PubMed] [Google Scholar]
  14. Green J. B., 3rd, Green S., Alberts D. S., O'Toole R., Surwit E. A., Noltimier J. W. Carboplatin therapy in advanced endometrial cancer. Obstet Gynecol. 1990 Apr;75(4):696–700. [PubMed] [Google Scholar]
  15. Greven K. M., Lanciano R. M., Corn B., Case D., Randall M. E. Pathologic stage III endometrial carcinoma. Prognostic factors and patterns of recurrence. Cancer. 1993 Jun 1;71(11):3697–3702. doi: 10.1002/1097-0142(19930601)71:11<3697::aid-cncr2820711137>3.0.co;2-u. [DOI] [PubMed] [Google Scholar]
  16. Hancock K. C., Freedman R. S., Edwards C. L., Rutledge F. N. Use of cisplatin, doxorubicin, and cyclophosphamide to treat advanced and recurrent adenocarcinoma of the endometrium. Cancer Treat Rep. 1986 Jun;70(6):789–791. [PubMed] [Google Scholar]
  17. Hicks M. L., Piver M. S., Puretz J. L., Hempling R. E., Baker T. R., Mcauley M., Walsh D. L. Survival in patients with paraaortic lymph node metastases from endometrial adenocarcinoma clinically limited to the uterus. Int J Radiat Oncol Biol Phys. 1993 Jul 15;26(4):607–611. doi: 10.1016/0360-3016(93)90276-2. [DOI] [PubMed] [Google Scholar]
  18. Kadar N., Homesley H. D., Malfetano J. H. Prognostic factors in surgical stage III and IV carcinoma of the endometrium. Obstet Gynecol. 1994 Dec;84(6):983–986. [PubMed] [Google Scholar]
  19. Kilgore L. C., Partridge E. E., Alvarez R. D., Austin J. M., Shingleton H. M., Noojin F., 3rd, Conner W. Adenocarcinoma of the endometrium: survival comparisons of patients with and without pelvic node sampling. Gynecol Oncol. 1995 Jan;56(1):29–33. doi: 10.1006/gyno.1995.1005. [DOI] [PubMed] [Google Scholar]
  20. Kim Y. B., Niloff J. M. Endometrial carcinoma: analysis of recurrence in patients treated with a strategy minimizing lymph node sampling and radiation therapy. Obstet Gynecol. 1993 Aug;82(2):175–180. [PubMed] [Google Scholar]
  21. Komaki R., Mattingly R. F., Hoffman R. G., Barber S. W., Satre R., Greenberg M. Irradiation of para-aortic lymph node metastases from carcinoma of the cervix or endometrium. Preliminary results. Radiology. 1983 Apr;147(1):245–248. doi: 10.1148/radiology.147.1.6828738. [DOI] [PubMed] [Google Scholar]
  22. Larson D. M., Copeland L. J., Gallager H. S., Wharton J. T., Gershenson D. M., Edwards C. L., Malone J. M., Jr, Rutledge F. N. Prognostic factors in stage II endometrial carcinoma. Cancer. 1987 Sep 15;60(6):1358–1361. doi: 10.1002/1097-0142(19870915)60:6<1358::aid-cncr2820600633>3.0.co;2-o. [DOI] [PubMed] [Google Scholar]
  23. Morrow C. P., Bundy B. N., Kurman R. J., Creasman W. T., Heller P., Homesley H. D., Graham J. E. Relationship between surgical-pathological risk factors and outcome in clinical stage I and II carcinoma of the endometrium: a Gynecologic Oncology Group study. Gynecol Oncol. 1991 Jan;40(1):55–65. doi: 10.1016/0090-8258(91)90086-k. [DOI] [PubMed] [Google Scholar]
  24. Potish R. A., Twiggs L. B., Adcock L. L., Savage J. E., Levitt S. H., Prem K. A. Paraaortic lymph node radiotherapy in cancer of the uterine corpus. Obstet Gynecol. 1985 Feb;65(2):251–256. [PubMed] [Google Scholar]
  25. Rose P. G., Cha S. D., Tak W. K., Fitzgerald T., Reale F., Hunter R. E. Radiation therapy for surgically proven para-aortic node metastasis in endometrial carcinoma. Int J Radiat Oncol Biol Phys. 1992;24(2):229–233. doi: 10.1016/0360-3016(92)90676-9. [DOI] [PubMed] [Google Scholar]
  26. Seski J. C., Edwards C. L., Herson J., Rutledge F. N. Cisplatin chemotherapy for disseminated endometrial cancer. Obstet Gynecol. 1982 Feb;59(2):225–228. [PubMed] [Google Scholar]

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