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Lymphovascular Space Invasion and the Treatment of Stage I Endometrioid Endometrial Cancer
  1. Louis J.M. van der Putten, MD*,
  2. Yvette P. Geels, MD*,
  3. Nicole P.M. Ezendam, PhD,,
  4. Hans W.H.M. van der Putten, MD, PhD,§,
  5. Marc P.M.L. Snijders, MD, PhD,
  6. Lonneke V. van de Poll-Franse, PhD, and
  7. Johanna M.A. Pijnenborg, MD, PhD,
  1. *Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands;
  2. Comprehensive Cancer Center South, Eindhoven, The Netherlands;
  3. Center of Research on Psychology in Somatic Diseases, Tilburg University, The Netherlands;
  4. §Department of Obstetrics and Gynaecology, Catharina Hospital, Eindhoven, The Netherlands;
  5. Department of Obstetrics and Gynaecology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands; and
  6. Department of Obstetrics and Gynaecology, TweeSteden Hospital, Tilburg, The Netherlands.
  1. Address correspondence and reprint requests to Louis J.M. van der Putten, MD, Department of Obstetrics and Gynaecology, Radboud University Medical Center, PO Box 9101, 6500HB, Nijmegen, The Netherlands. E-mail: Louis.vanderputten{at}


Objectives Treatment of clinical early-stage endometrioid endometrial cancer (EEC) in The Netherlands consists of primary hysterectomy and bilateral salpingo-oophorectomy. Adjuvant radiotherapy is given when 2 or more the following risk factors are present: 60 years or older, grade 3 histology, and 50% or more myometrial invasion. Lymphovascular space invasion (LVSI) is a predictor of poor prognosis and early distant spread. It is unclear whether adjuvant radiotherapy is sufficient in patients with LVSI-positive EEC.

Methods/Materials Eighty-one patients treated from 1999 until 2011 for stage I LVSI-positive EEC in 11 Dutch hospitals were included. The outcomes of patients with 0 to 1 risk factors were compared with those with 2 to 3 risk factors, and both were compared with the known literature.

Results Eighteen patients presented with recurrent disease, and 12 of those recurrences had a distant component. Overall and distant recurrence rates were 19.2% and 11.5% in patients with 0 to 1 risk factors followed by observation and 25.5% and 17% in patients with 2 to 3 risk factors who received adjuvant radiotherapy. Only 1 patient with grade 1 disease had a recurrence.

Conclusions In stage I LVSI-positive EEC with 0 to 1 risk factors, observation might not be adequate. Moreover, despite adjuvant radiotherapy, a high overall and distant recurrence rate was observed in patients with 2 to 3 risk factors. The use of systemic treatment in these patients, with the exception of patients with grade 1 disease, should be investigated.

  • Endometrial cancer
  • Endometrioid carcinoma
  • Early stage
  • Lymphovascular space invasion
  • Adjuvant treatment

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  • The authors declare no conflicts of interest.