POSTOPERATIVE RADIOTHERAPY IN ENDOMETRIAL CARCINOMA: PROGNOSTIC FACTORS

The records of 440 patients with endometrial carcinoma treated by postoperative radiotherapy between January 1985 - June 1997 were reviewed retrospectively in order to determine the prognostic factors influencing overall, disease-free and local recurrence-free survival. Median age of the patients was 57 (range: 35-83). Histologically 80.2% were adenocarcinoma, 5.7% adenosquamous carcinoma, 5.2% clear-cell carcinoma and 4.3% serous papillary carcinoma. The distribution by stages for Stage I, II, III and IV were 62.2%, 20.0%, 14.9% and 2.8% respectively. All patients received postoperative external radiotherapy with 1.8-2.0 Gy daily fractions up to 36-68 Gy (median 54 Gy). Intracavitary brachytherapy was applied to 61.8% of the cases. Survival analysis were performed using the Kaplan-Meier method. Log-rank test was used for univariate analysis and Cox regression model for multivariate analysis. Median follow-up time was 53 months (7-173 months). Total failure rate was 15.2% with 2.7% of patients having only a local failure, 2.0% local and distant failure and 10.5% distant failure only. Five-year overall, disease-free and local recurrence-free survival rates were 81.6%, 80.7% and 94.6% respectively. According to univariate analysis prognostic factors influencing disease-free survival were histologic type (P=0.0067), histologic grade (P=0.0015), stage (P<0.0001), myometrial invasion (P<0.0001), peritoneal cytology (P=0.0013) and cervical involvement (P=0.0106) while the prognostic factors affecting local recurrence-free survival were stage (P=0.0277), myometrial invasion (P=0.0054), peritoneal cytology (P=0.0427). According to multivariate analysis prognostic factors influencing disease-free survival were histologic type (P=0.0194), myometrial invasion (P=0.0021) and histologic grade (P=0.0303) while the only prognostic factor influencing local recurrence-free survival was myometrial invasion (P=0.0241).