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KMID : 0377619960610100786
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Korean Jungang Medical Journal
1996 Volume.61 No. 10 p.786 ~ p.790
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Trends in the Management of Endometrial Carcinoma
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Geest, Koen De
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Abstract
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The perception that most women with endometrial carcinoma will have a favorable outcome contributes to the persisting confusion over the treatment of this disease. In a population based study, 81 % of women had surgical stage I and a five-year survival rate of 83 % ; 11 % had stage II, 6 % stage III and 2 % stage IV with survival rates of 73 %, 52 % and 27 % respectively´. Patients with disease confined to the uterus are highly curable, but there is no consensus on how to treat them.
Although surgery has become the primary treatment for 95 % of women with endometrial carcinoma, there has been reluctance to adopt surgical staging routinely for treatment planning. Adjuvant radiation therapy is widely used but its effect on survival has not been established. The risk of recurrent disease depends so strongly on the surgical and pathological findings that in 1988 the International Federation of Gynecology and Obstetrics adopted a surgical staging system to replace the clinical staging system previously used. The Gynecologic Oncology Group(GOG) has reported the relationship between surgical-pathological risk factor and outcome in group of 895 patients with clinical stage I and occult stage II endometrial cancer who were entered in a prospective staging study .2 Factors predictive of positive pelvic or paraaortic nodes included histological grade, depth of myometrial invasion, capillary-like space involvement, positive peritoneal cytology ; adnexal spread, cervix/isthmus involvement and gross intraperitoneal disease. In clinical stage I carcinoma, 22 % of 621 patients were found to have disease outside of the uterus.3 Only 24 of patients with clinical stage II endometrial cancer have surgical stage II disease. In this analysis, three levels of risk (low, <5 % ; intermediate, 5 % to 10 % ; high, >10 %) for nodal metastasis were identified, based on depth of invasion, histological grade, and extrauterine spread of disease. Although surgical staging can provide potentially useful information on the true extent of disease in endometrial carcinoma, arguments against its routine use include increased morbidity, an increased rate of complications in patients who undergo radiation therapy following lymphadenectomy, and no clear advantage over clinical staging, since highly effective therapy for patients with disseminated disease remains to be determined. Increased morbidity is an improtant consideration in this population of older, often heavier patients, presenting with a variety of medical problems, but who often have good prognosis endometrial carcinoma. In the GOG study there was a 19 % complication rate, including three deaths. Nevertheless, pelvic and paraaortic lymph node sampling is generally not thought to add significantly to the morbidity from hysterectomy or to increase com-
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