Adjuvant radiation for early stage endometrial cancer with lymphovascular invasion

ObjectiveTo determine the impact of the decrease in use of postoperative pelvic external beam radiation (EBRT) in favor of intravaginal RT (IVRT) alone in patients with early stage endometrial cancer who had lymphovascular invasion (LVI).MethodsBetween 11/1988 and 5/2005, 126 patients treated with simple hysterectomy and postoperative RT had a final pathologic diagnosis of stage IB–IIB adenocarcinoma of endometrioid histology with documented LVI. The patients were divided into two groups based on the era of treatment, (early era: 1988–1996, vs. late era: 1997–2005), in order to best capture the shift away from the routine use of EBRT in favor of surgical staging and IVRT.ResultsOf the 126 patients, 35% (n = 44) were treated in the early era and 65% (n = 82) in the late era. The two groups were balanced in regards to age, race, depth of myometrial invasion, histologic grade, and cervical involvement. Significantly more patients had surgical staging and received IVRT alone in the late than early era (p = 0.0001, 0.004, respectively). The rate of pelvic control was 93% for the early era compared to 97% for latter era (p = 0.3). There was no significant impact of the treatment era on vaginal control, disease-free survival, or overall survival.ConclusionsThese data suggest that the mere presence of LVI need not trigger the use of pelvic EBRT. Instead, the decision on whether to omit EBRT in patients with LVI should be made in the context of a patient's competing risk factors and comorbid conditions.