Clinical stage I endometrial cancer: Results of adjuvant irradiation and patterns of failure

Perry W. Grigsby, Carlos A. Perez, Abraham Kuten, Joseph R. Simpson, Delia M. Garcia, H. Marvin Camel, Ming Shian Kao, Andrew E. Galakatos

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40 Scopus citations


A retrospective analysis is reported in 858 patients with clinical Stage I carcinoma of the endometrium treated definitively from January 1960 through December 1986 with combined irradiation and total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO). Most patients received a preoperative intracavitary insertion (2500-4000 mgh to the uterus with Heyman capsules and tandem and 6500 cGy surface dose to the upper vagina) followed by a TAH-BSO within 6 weeks. Some patients received postoperative external beam irradiation (2000 cGy whole pelvis and an additional 3000 cGy to the parametria, with a midline stepwedge) when deep myometrial invasion was present. Occasionally patients were treated with preoperative external beam irradiation (2000 cGy whole pelvis) and intracavitary insertion. The 5-year overall survival for all patients was 84.0% compared to an expected survival of 88.8%. The 5-year progression-free survivals were 92% for FIGO clinical Stage IA and 86% for stage IB (p = 0.12). The dose to the uterine fundus from the preoperative intracavitary insertion was found to have a significant correlation with progression-free survival in patients with grade 3 tumors. Those receiving <2500 mgh to the uterine cavity had a 48.9% 5-year progression-free survival compared to 62.7% for 2500-3500 mgh and 87.4% for those receiving >3500 mgh. Analysis of sites of failure showed that less than 1% ( 7 858) failed in the pelvis alone, 3% ( 30 858) in the pelvis combined with distant sites, and 7% (60/858) developed distant metastasis only. The lateral pelvic sidewall was the most common site of failure within the pelvis ( 20 37) and intraperitoneal failures ( 28 90) and lung ( 21 90) were the most common sites of distant metastasis. The overall severe (grades 2, 3, and 4) complication rate was 2.7% ( 23 858).

Original languageEnglish
Pages (from-to)379-385
Number of pages7
JournalInternational journal of radiation oncology, biology, physics
Issue number2
StatePublished - Jul 1991


  • Brachytherapy
  • Endometrial carcinoma
  • Preoperative irradiation


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