BJOG. 2007 Nov;114(11):1313-20.
Survival and recurrent disease after
postoperative radiotherapy for early endometrial
cancer: systematic review and meta-analysis.
Johnson N, Cornes P.
Department of Gynaecologic Oncology, Royal
United Hospital, Bath, UK. nicholasjohnson@msn.com
Objectives:
To clarify the effect of
postoperative (adjuvant) external-beam pelvic
radiotherapy (EBRT) for different grades of
early endometrial cancer. SEARCH STRATEGY:
Meta-analysis of data from randomised trials
stratified by histological risk factors
supported by cohort studies. SELECTION CRITERIA:
Cochrane methodology. DATA: Seven randomised
trials were identified. Five were eligible for
meta-analysis. Homogeneity was confirmed (I2 <
25%). MAIN OUTCOME MEASURES: Survival, site of
recurrence and added complications. MAIN
Results:
EBRT after hysterectomy for low-risk
disease increases the odds of death (OR for
overall survival 0.71; 95% CI 0.52-0.96). EBRT
does not appear to alter survival for
intermediate-risk cancers (stage ICG1/2 and
IBG3) (OR 0.97; 95% CI 0.69-1.35). In contrast,
EBRT offers a significant disease-free survival
advantage for high-risk cancer (OR 1.76; 95% CI
1.07-2.89). The survival advantage benefits one
in ten women. The definition of high risk is
variable across studies but focuses on ICG3
(deeply invasive, poorly differentiated)
tumours. Pelvic EBRT reduces the risk of pelvic
recurrent disease in all types of invasive
endometrial cancer (OR 0.27; 95% CI 0.16-0.44),
but local recurrence may respond to salvage
treatment. The risk of distant metastasis
appears to be increased significantly by
prophylactic EBRT (OR 1.58; 95% CI 1.07-2.35),
but this might be because pelvic relapse in
untreated women alters reporting of metastatic
disease. AUTHORS'
Conclusions:
Adjuvant EBRT
should not be used for low- (IA, IBG1) or
intermediate-risk (IBG2) cancer, but it is
associated with a 10% survival advantage for
high-risk (stage ICG3) endometrial cancer. This
challenges the role of a staging lymphadenectomy.
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