Background: Surgical resection is the primary treatment in stage I endometrial carcinoma. Retrospective analyses support the value of local vaginal irradiation to avoid vaginal recurrences to be relatively proven. The impact of an additional external beam irradiation of the pelvis considering different prognostic criteria is still unclear.
Patients and methods: From January 1986 to December 1995 a total of 128 patients with a stage I endometrial carcinoma were treated in our clinic with postoperative radiotherapy. Depending on the prognostic factors from literature, 68 patients received an HDR-brachytherapy and 60 patients a combined treatment with external beam irradiation and HDR-brachytherapy. The median follow-up was 62.1 months. The statistical analysis was performed as a retrospective cohort study.
Results: Depth of tumor invasion and grading could be identified as statistically significant prognostic factors for local recurrence-free and tumor-specific survival. It could be shown that an additional external beam irradiation is indicated with a tumor invasion of more than 50% of the myometrium. In the majority of cases grade I and II radiation-associated side effects were observed. Chronic side effects grade 3 and 4 at the bowel and the rectum occurred in less than 4% of cases in the combined treatment group.
Conclusions: The addition of external beam irradiation to intravaginal brachytherapy is useful in tumors with more than 50% infiltration of the myometrium. Severe side effects were seen in less than 4% in combination treatment.