Postoperative irradiation in carcinoma of the uterine corpus

From 1975 through 1994, 37 patients with cancer of the uterine corpus (36 endometrial cancers and 1 mixed Muellerian tumor) underwent postoperative radiation therapy. In these 37 patients, the influence of operative method was investigated upon the prognosis and complication rate. Radical hysterectomy or modified radical hysterectomy was performed in 23 patients, total hysterectomy in 13, and supravaginal hysterectomy in one. While pelvic lymph node dissection was done in all patients who underwent radical or modified radical hysterectomy, it was performed in only one patient who underwent total hysterectomy. According to the new FIGO classification 16 patients belonged to stage I, 4 to stage II, 15 to stage III, and 2 to stage IV. Postoperative irradiation was delivered to the greater area than the small pelvis in all but one. Intracavitary irradiation was performed in 9 patients. Ten patients suffered from relapse with 5 year relapse free survival rates of 87.5% and 52.9% for stage I+II and stage III+IV, respectively. The relapse free survival was not different by the operative methods. Concerning the site of relapse, the intrapelvic relapse was not seen in the patients treated by total abdominal hysterectomy and postoperative radiation therapy. Clinically significant complication occurred in 18% in 2 years. A tendency was seen that the patients undergoing intracavitary irradiation had rectal bleeding more frequently. The indication of the intracavitary irradiation must be seriously reconsidered. Because pelvic relapse was not seen in the irradiated patients without pelvic lymph node dissection, this less invasive option seems to be worth trying in selected patients. (author)