Adjuvant Radiotherapy May Improve Survival in Stage III Node-positive Uterine Cancer

Researchers from the University of California at San Francisco have reported that adjuvant radiotherapy improves survival of women with stage III node-positive uterine cancer. The details of this study appeared in the November, 2009 issue of Gynecologic Oncology.[1]

Women with stage III uterine cancer are treated with hysterectomy, bilateral salpingo-oophorectomy and pelvic lymph node dissection with or without removal of aortic lymph nodes. The value of adjuvant radiotherapy and/or chemotherapy has not been well documented. Researchers affiliated with the Gynecologic Oncology Study Group have previously reported that chemotherapy with Adriamycin® (doxorubicin) and Platinol® (cisplatin) was superior to whole abdominal irradiation for adjuvant therapy of stage III-IV endometrial cancer (see second item of related news).

The current study involved 943 women with stage III uterine cancer who were lymph-node positive. They were identified from the Surveillance Epidemiology and End Results program of the U.S. National Cancer Institute from 1988 to 2001. A total of 67.5% of women in this cohort underwent adjuvant radiotherapy and the remainder underwent surgery only. The five-year disease-specific survival for patients receiving radiotherapy was 67.9% compared with 53.4% for those not receiving radiotherapy. In subgroup analyses patients with only one positive lymph node had the greatest benefit from radiotherapy, which improved survival from 54.4% to 74.3%. Patients with two to five positive nodes had an improvement in survival from 52.4% to 59.7%, which was not statistically significant (p=0.089). Older age, non-endometrioid histology and lack of adjuvant radiotherapy were associated with a worse outcome. These authors stated that randomized trials would be needed to confirm these findings.

Comments: In the absence of randomized trials the appropriate therapy for women with node-positive stage III uterine cancer will remain uncertain.