IMPACT OF VARIOUS TREATMENT STRATEGIES ON LONG-TERM TREATMENT OUTCOMES IN PATIENTS WITH STAGE IAG3 ENDOMETRIAL CANCER

Endometrial cancer (EC) with an intermediate risk of locoregional recurrence and distant metastases includes stages IAG3 and IBG1–2 endometrial carcinomas. However, researchers often prefer to allocate stage IAG3 EC into a separate group of high-intermediate risk EC. The article analyzes treatment outcomes in 370 patients with stage IAG3 EC.

Objective: to evaluate the effectiveness of various methods and strategies for treatment of stage IAG3 EC.

 Materials and methods. Our retrospective study included patients with stage IAG3 EC registered for treatment in Belarus between 2006 and 2010. Of them, 55 women were diagnosed with stage IAG3 EC without myometrial invasion, whereas 315 women had stage IAG3 EC with myometrial invasion. A total of 151 patients received combined treatment that included surgery and radiotherapy (RT), 3 patients underwent surgical treatment (ST) only (standard hysterectomy with bilateral salpingoophorectomy), 25 patients received RT only and 191 patients had ST, RT, and chemotherapy (CT).

Results and discussion. Among patients without myometrial invasion, the five-year overall, cancer-specific and relapse-free survival rates were 79.7 ± 5.5; 86.6 ± 4.7 and 84.6 ± 5.0 % respectively, whereas in patients with myometrial invasion these rates were 75.6 ± 2.4; 81.3 ± 2.2 and 78.0 ± 2.4 % respectively. In both groups, CT did not improve survival over combined treatment, although in most of the patients relapses manifested as distant metastases. Low survival rates were observed in patients who received RT only. Among various combined treatment strategies, the best results were achieved in regimens that included adjuvant external RT on the pelvic area, but only in patients who did not undergo pelvic lymph node dissection in addition to standard hysterectomy with bilateral salpingoophorectomy.

Conclusions. CT gives no benefits for patients with stage IAG3 EC, although the majority of relapses manifested as distant metastases. Combination of CT and postoperative RT remains one of the best treatment options. In the case of standard hysterectomy with bilateral salpingoophorectomy and without pelvic lymphadenectomy, adjuvant external RT is recommended. Further studies are needed to assess the efficacy of extended surgeries with adjuvant contact RT.

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