Research
Oncology
Optimizing the management of stage II endometrial cancer: the role of radical hysterectomy and radiation

Presented at the 39th Annual Meeting on Women's Cancer of the Society of Gynecologic Oncologists, Tampa, FL, March 9-12, 2008.
https://doi.org/10.1016/j.ajog.2008.11.003Get rights and content

Objective

The optimal management of stage II endometrial cancer remains uncertain. We examined the role of radical hysterectomy and adjuvant radiotherapy for stage II endometrial cancer.

Study Design

The Surveillance, Epidemiology, and End Results database was used to identify 1577 women with stage II endometrioid type endometrial adenocarcinoma who underwent surgical staging.

Results

The cohort included 1198 women who underwent simple hysterectomy (76%) and 379 who underwent radical hysterectomy (24%). Radical hysterectomy had no effect on survival (hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.61-1.23). Patients who did not receive radiation were 48% (HR, 1.48; 95% CI, 1.14-1.93) more likely to die than those who underwent adjuvant radiotherapy. The survival benefit from radiation was most pronounced in women who underwent radical hysterectomy.

Conclusion

Adjuvant radiation improves survival. Although the routine performance of radical hysterectomy does not appear to be justified, patients with high-risk stage II tumors appear to benefit from combination therapy with radical hysterectomy and radiotherapy.

Section snippets

Materials and Methods

The National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) database was utilized to identify women with stage II endometrial cancer who underwent surgical staging. SEER is a population-based cancer registry composed of a number of geographically distinct tumor registries that includes approximately 26% of the US population.16 The demographic characteristics of the SEER registries are representative of the general population within the United States.17 Data from SEER 17

Comment

The ideal management for stage II endometrial cancer remains a subject of active debate. Our findings suggest that adjuvant radiation improves survival for women with stage II disease but that the type of hysterectomy performed has little influence on outcome. Women who did not receive radiation were 48% more likely to die from their tumors. The benefit of adjuvant radiation is most pronounced in women with high-risk pathologic features who underwent radical hysterectomy.

Radical hysterectomy is

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Cite this article as: Wright JD, Fiorelli J, Kansler AL, et al. Optimizing the management of stage II endometrial cancer: the role of radical hysterectomy and radiation. Am J Obstet Gynecol 2009;200:419.e1-419.e7.

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