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Postoperative Radiotherapy in Stage I/II Endometrial Cancer: Retrospective Analysis of 883 Patients Treated at the University of Florence
  1. Vieri Scotti, MD*,
  2. Simona Borghesi, MD,
  3. Icro Meattini, MD*,
  4. Calogero Saieva, MD,
  5. Francesca Rossi, MD§,
  6. Alessia Petrucci, MD,
  7. Alessandra Galardi, MD*,
  8. Lorenzo Livi, MD*,
  9. Benedetta Agresti, MD*,
  10. Massimiliano Fambrini, MD,
  11. Mauro Marchionni, MD and
  12. Giampaolo Biti, MD*
  1. * Department of Radiation Oncology, University of Florence, Florence, Italy;
  2. Radiotherapy Unit, S. Donato Hospital, Arezzo, Italy;
  3. Molecular and Nutritional Epidemiology Unit, ISPO, Cancer Prevention and Research Institute, Florence, Italy;
  4. § Radiotherapy Unit, S.M. Annunziata Hospital, Florence, Italy;
  5. Radiotherapy Unit, Pistoia Hospital, Pistoia, Italy;
  6. Department of Gynaecology, Perinatology and Human Reproduction, University of Florence, Florence, Italy.
  1. Address correspondence and reprint requests to Vieri Scotti, MD, Department of Radiation Oncology, University of Florence, Viale Morgagni No. 85, Florence, Italy. E-mail: v.scotti{at}


Introduction: The efficacy of postoperative radiotherapy (RT) in the treatment of early-stage endometrial carcinoma (EC) is still under debate. This study was aimed to review the outcome and adverse effects in patients treated for EC with postoperative RT at a single center.

Methods: A total of 883 patients with pathological stages I to II EC were retrospectively analyzed. Surgery consisted of total abdominal hysterectomy and bilateral salpingo-oophorectomy, or vaginal hysteroannessiectomy in 532 patients (60.2%) with pelvic lymphadenectomy in 351 patients (39.8%). Seven hundred forty-seven patients (84.6%) underwent whole pelvic RT (WPRT) and 136 (15.4%) combined WPRT and vaginal brachytherapy (BT) boost.

Results: At a median follow-up of 9 years (range, 1.2-27.6 years), we observed 10.6% disease relapse. Forty-seven patients experienced local recurrence (LR), and 38 patients experienced distant metastases (DMs). At univariate analysis, age at diagnosis (P < 0.0001), stage (P < 0.04), and histological subtype (P < 0.0001) resulted in significant prognostic factors. At multivariate analysis, histotype emerged as an independent relapse predictor (P = 0.0001). Acute WPRT-related toxicity was mild; diarrhea was the most common adverse effect (19.8%). We recorded long-term adverse effects in 7.8% of the patients.

Conclusions: Our study showed that patients with early-stage EC have a good outcome in overall survival and disease-free survival. In our experience, standard surgery (including hysterectomy and bilateral salpingo-oophorectomy followed by WPRT with or without BT) showed an acceptable toxicity profile.

  • Endometrial cancer (EC)
  • Postoperative radiotherapy
  • External beam radiotherapy (EBRT)
  • Lymphadenectomy

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