Radiation Therapy as Exclusive Treatment for Medically Inoperable Patients with Stage I and II Endometrioid Carcinoma of the Endometrium

hysterectomy, bilateral salpingo-oophorectomy, and lymph From 1975 to 1992, 54 patients with clinical Stage I and II node sampling when appropriate.Radiation therapy before endometrioid carcinoma of the endometrium, representing 3.5% or after surgery has been added to improve local control of all such patients, were deemed medically inoperable and excluof the pelvic region for selected patients with unfavorable sively received radiation therapy.A cohort of 108 operable patients prognostic findings such as high grade lesions and deep myoadjusted for age, clinical stage, and grade served as a control metrial tumor invasion [1-7].Approximately 10-20% of group.The 5-year actuarial cancer-specific survivals for patients endometrial cancer patients have severe medical conditions with Stage I inoperable, Stage II inoperable, Stage I operable, which render them medically inoperable [8-16].These paand Stage II operable disease were 80, 85, 98, and 100%.The tients tend to be elderly, obese, and have multiple medical corresponding 5-year overall survival rates were 30, 24, 88, and problems such that they frequently die from intercurrent dis-85%.Inoperable patients had a median disease-free interval of 36 ease.Several studies have demonstrated the effectiveness of months for clinical Stage I and 50 months for Stage II disease versus 74.5 and 77 months for the operable patients (P Å 0.001).exclusive radiation therapy in medically inoperable patients Inoperable patients with Stage I disease had a median survival of [8-16]; however, results of primary radiation therapy have 37 months versus 50 months for Stage II (P Å NS), with only 7 varied among institutions due to patient and treatment selec-(13%) of these patients dying with endometrial cancer.Operable tion factors, such as pretreatment medical status, tumor hispatients had a median survival of 75 and 79 months in Stage tology, definition of inoperability, and institution-dependent I and II, respectively, with 14 patients dying with endometrial treatment policies.carcinoma (13%).Stage I and II inoperable patients had signifi-In this report, we present 54 patients with clinical Stage cantly shorter survival than operable patients (P õ 0.0001).More I and II endometrioid carcinoma of the endometrium who deaths from intercurrent disease occurred within the inoperable were considered medically inoperable and were prospec-Stage I group than with the operable group (28 of 32 vs 3 of 15, tively classified by the American Society of Anesthesiolo-P õ 0.0001).Inoperable patients had a significantly shorter overall survival and more deaths due to intercurrent disease than operable gists (ASA) physical status score and ECOG performance patients (P õ 0.0001).However, inoperable patients who did not status.Retrospectively, we have compared primary radiation die from intercurrent disease had a median 5-year survival which therapy for medically inoperable patients to a cohort of 108 approaches that of operable patients.Our study demonstrates that patients from the same institution, matched for age, clinical exclusive radiation therapy is a well-tolerated and effective treatstage, grade, and year of treatment who were treated by ment for medically inoperable patients.᭧ 1996 Academic Press, Inc.surgical therapy with or without adjuvant radiation therapy.