S.A. Mavrichev, S.A. Krasniy
N.N. Alexandrov National Cancer Centre, Minsk, Belarus
Mavrichev S.A. ― head of the oncogynecology laboratory of the surgical department of N.N. Alexandrov National Cancer Centre
Lesnoy-2, Minsk district, Belarus, 223040, tel. +375-29-699-60-97, e-mail: firstname.lastname@example.org
Abstract. A retrospective study of the results of combined treatment (CT) of endometrial cancer (EС) of intermediate risk in Belarus for 2006-2010 was carried out. 918 women received treatment. Combined treatment, which used pre- and/or postoperative radiation therapy (RT), surgical treatment in the volume of standard or extended surgery was performed in 604 patients. Preoperative brachytherapy (PBT) was performed once in a single focal dose of 13.5 Gy on the eve of surgery, postoperative radiation in the form of remote radiation therapy (conventional radiotherapy) by normal fractions of 2 Gy to a total focal dose of 40-46 Gy per region pelvis with the inclusion of regional zones (pelvic lymph nodes). The standard operation included a hysterectomy with bilateral salpingo-oophorectomy (H-BSO). The expanded operation included, in addition to H-BSO, total pelvic lymphadenectomy (LAE). Despite recommendations at an intermediate risk to perform an extended operation, in the overwhelming majority of cases the standard was performed. So, out of 604 cases of CT, the expanded operation was performed only in 45 cases, and in 559 ― the standard H-BSO. In the overwhelming majority of cases, 394 patients with CT included PBT, standard H-BSO, and postoperative radiotherapy (EBRT). In 95 women, the standard operation without PBT was supplemented with postoperative radiotherapy. It is not clear for what reasons after the standard operation, no EBRT was prescribed in 69 women who had only PBT performed. It is believed that brachytherapy before surgery allows for local control, reducing the number of relapses in the vaginal stump, but it does not provide regional monitoring, as well as a standard operation without removal of pelvic lymph nodes. In contrast to this, we can assume that in 37 patients the treatment was superfluous, since the expanded operation with the pelvic LAE was supplemented with adjuvant radiotherapy, the indication for which was not intended. In general, the treatment of intermediate risk was not in line with current recommendations, but the optimal scheme for CT could be considered a scheme in which a simple H-BSO was supplemented with adjuvant EBRT. When assessing the long-term results of treatment, there was no statistically significant difference in the subgroups whose curative program included adjuvant EBRT. In contrast, in the subgroup in which PBT was performed and simple H-BSO, the results were statistically significantly worse. In addition, PBT did not improve survival with simple H-BSO and adjuvant EBRT. The use of two methods of regional control, pelvic LAE and adjuvant EBRT, did not improve survival.
Key words: endometrial cancer intermediate risk, combined treatment.