Introduction/Background Type II tumors account for 10 to 20 percent of all endometrial carcinomas. These include tumors of non-endometrioid histology: serous, clear cell, squamous, transitional cell, undifferentiated, and recently carcinosarcomas. They are mostly poorly differentiated, with tendency to deep myometrial invasion, distant metastasis, and poor prognosis. Thus, they are considered high-risk. The optimal management is not yet fully settled and still evolving. We sought to identify all clinico-pathological data, different treatment modalities and prognostic factors which affected the locoregional control (LC), disease-free survival (DFS), and overall survival (OS) of Type II endometrial cancer patients presented to our department during a 12-year period.
Methodology Data records of Type II endometrial carcinoma patients presented to the Radiotherapy department, National Cancer Institute, Cairo University during the period from (2000–2012) were retrospectively reviewed.
Results The study included 88 patients. 66% were above 60 years of age. Histological subtypes were: Carcinosarcoma 45.5% (n=40), Papillary serous 33% (n=29), Clear cell 12.5% (n=11),Undifferentiated 9% (n=8). Most common stage was FIGO stage IB (33%). 88.6% (n=78) of patients received adjuvant External beam Radiotherapy (EBRT) and 54.5% (n=48) received additional brachytherapy. Only 10.2% (n=9) received adjuvant chemotherapy.
The 5-year LC for the whole group was 65.1%. Age (p=0.028) and brachytherapy boost after EBRT (p=0.05) were significant contributors to local control. The 5-year DFS was 44.6%. Age (p=0.001) and FIGO stage (p=0.004) were significant factors affecting DFS. The 5-year OS was 69.1%. Age (p=0.02) and FIGO stage (p=0.004) significantly affected OS. Locoregional recurrence was noted in 19.3% of patients (n=17), most commonly in the vaginal vault (47.1%) followed by operative bed (23.5%). 31.8% (n=28) developed distant metastasis, commonly in the peritoneum (25%) (n=7).
Conclusion Type II endometrial carcinomas are a distinct, high-risk group with high tendency for distant failure.Age and FIGO stage were independent significant prognostic factors for OS and DFS. Age and brachytherapy boost after EBRT also significantly affected LC.Larger prospective studies are needed to define the optimum management.
Disclosure Nothing to disclose.
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