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Chemotherapy Reduces Para-aortic Node Recurrences in Endometrial Cancer With Positive Pelvic and Unknown Para-aortic Nodes
  1. Giorgio Bogani, MD*,
  2. Antonella Cromi, PhD*,
  3. Maurizio Serati, MD*,
  4. Edoardo Di Naro, MD,
  5. Nicoletta Donadello, MD*,
  6. Jvan Casarin, MD*,
  7. Federica Nardelli, MD* and
  8. Fabio Ghezzi, MD*
  1. *Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese; and
  2. Department of Obstetrics and Gynecology, University of Bari, Bari, Italy.
  1. Address correspondence and reprint requests to Giorgio Bogani, MD, Department of Obstetrics and Gynecology, University of Insubria, Piazza Biroldi 1, Varese, 21100, Italy. E-mail: giorgiobogani{at}


Objective The objective of this study was to evaluate how the administration of different adjuvant therapies influences the risk for developing recurrences in the para-aortic area in endometrial cancer (EC) with positive pelvic and unknown para-aortic nodes.

Methods We retrospectively evaluated the data of 58 patients with EC affected by stage IIIC1 who had undergone pelvic but not para-aortic lymphadenectomy from January 1, 1990 to December 31, 2011. Survival outcomes within the first 5 years after surgery were assessed using the Kaplan-Meier model.

Results Chemotherapy plus radiotherapy, chemotherapy only, and external radiotherapy only were administered in 12 (23%), 18 (34%), and 23 (43%) patients, respectively. Five (9%) patients, who were selected to forego adjuvant therapy due to poor performance status, were excluded from the analysis. Disease-free and overall survivals assessed at 5 years were 54%, and 61%, respectively. All para-aortic recurrences were observed among the patients with endometrioid EC, whereas no cases of para-aortic recurrences were found in patients with nonendometrioid histology (5/36 (14%) vs 0/17 (0%); P = 0.16); the latter were more likely to develop distant (hematogenous, peritoneal, and distant lymphatic) recurrences (P = 0.09). Type of adjuvant therapy was the only factor influencing para-aortic failure: chemotherapy (± radiotherapy) reduced the rate of para-aortic node recurrence in comparison with pelvic radiotherapy as a sole modality (P = 0.01). However, adjuvant therapy did not influence the 5-year survival outcomes (P > 0.05).

Conclusions In the absence of local treatment (ie, para-aortic lymphadenectomy and radiotherapy), the administration of chemotherapy seems effective in reducing recurrences in the para-aortic area among patients with stage IIIC1 endometrioid EC.

  • Endometrial cancer
  • Lymph node
  • Para-aortic lymphadenectomy
  • Chemotherapy
  • Radiotherapy

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  • The authors declare no conflicts of interest.