Terapia adiuvante nell'adenocarcinoma dell'endometrio ad alto rischio

Introduction Endometrial cancer is the most common gynecological cancer in developed countries and is diagnosed in 75-80% of cases at FIGO stage I with a 5 years survival rate of 80-90%. Furthermore, patients with high grade tumors, deep myometrial invasion or advanced stage disease have a poor prognosis and receive adjuvant therapy after surgery. It is not clear whether radiotherapy (RT), chemotherapy (CT) or radiochemotherapy (RT/CT) is better. Materials and Methods We reviewed all high risk endometrial cancer cases (Stage IB G3; IC G2-3; IIA G3 or IIA G2 with myometrial invasion > 50%; IIB; IIIA-B-C) with no residual tumors after surgery referred to S.Gerardo Hospital from Genuary 1988 to December 2011. We divided them into four groups based on the different adjuvant therapy used (RT, CT, RT/CT, none) and we have recorded, for each group, relapses and deaths. The aim of the study is to establish the best adjuvant therapy in term of overall survival and progression free survival. Results 357 patients were eligible for the study; 141 (39,5%) have received no adjuvant therapy, 114 (53,2%) RT; 62 (28,7%) CT; 40 (18%) RT/CT. Relapses were 29 (20%), 31 (27%), 22 (35%), 6 (15%) respectively with p=0.66. Median progression free survival was similar for observation arm and CT-RT arm, while RT alone and CT alone did significantly worse; overall survival was significantly better in the CT-RT arm. Conclusion The arm radiochemotherapy has a better progression-free survival and a better overall-survival, despite the fact that the patients with the most severe risk factors for relapse were preferably treated with the combined therapy. The poor performance of chemotherapy deserves further analysis.