Effect of Postoperative Radiotherapy on Endometrial Carcinoma: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

WEI Dongmei ¹ , MEI Ling ¹ ,  FANG Fang ¹ , WU Taixiang ² , LIU Guanjian ²

1. Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Chengdu 610041, China2. Chinese Evidence-Based Medicine Center /INCLEN CERTC,West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

FANG Fang, Email: wdmlb@yahoo.com.cn

Keywords：

Adjuvant radiotherapy; Endometrial carcinoma; Systematic review; Randomized controlled trial; Meta-analysis

DOI：

10.7507/1672-2531.20080054

Video：

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Objective　 To evaluate the clinical effectiveness, safety and cost-effectiveness of postoperative radiotherapy on endometrial carcinoma.
Methods　 We searched The Cochrane Library, The Cochrane Central Register of Controlled Trials (CENTRAL), The National Research Register, Health Technology Assessment Database (HTA), MEDLINE, EMbase, CancerLit, CBMdisc, VIP, WANFANG DATABASE and CNKI to March 2007. Relevant journals were also hand searched. Study selection and assessment, data collection and analyses were undertaken by two reviewers independently according to the Cochrane Handbook for Systematic Reviews of Interventions. Meta-analyses were performed.
Results　 Three RCTs involving 1126 patients were included. Each of the 3 RCTs compared adjuvant radiotherapy (external beam radiotherapy, EBRT) versus chemotherapy. Two trials (730 patients) compared adjuvant radiotherapy versus CAP chemotherapy (carboplatin + adriamycin + cisplatin). The other trial (396 patients) compared adjuvant radiotherapy versus AP chemotherapy (adriamycin + cisplatin). The meta-analyses showed that for patients with endometrial cancer at stage Ic, II or III, there were no significant differences between adjuvant radiotherapy and CAP in 5-year overall survival (OS), 5-year progress-free survival (PFS) and 5-year recurrence (local, distant, total). For patients with endometrial cancer at stage III or IV, adjuvant radiotherapy was superior to AP regimen on 5-year OS and 5-year PFS. The incidence of grade 3/4 toxicities of digestive system and urogenital system was similar between the two groups of patients. The chemotherapy group showed a higher incidence of grade 3/4 toxicities of hematology than the radiotherapy group.
Conclusion　 The effect of adjuvant pelvic radiotherapy for endometrial carcinoma at stage Ic, II or III is similar to that of adjuvant chemotherapy. However, for endometrial carcinoma at stage III or IV, the effect of radiotherapy is superior to that of chemotherapy. Radiotherapy has a lower role of myelosuppression than chemotherapy. No significant difference was observed between the radiotherapy and chemotherapy in grade 3/4 toxicities of the digestive system and the urogenital system.

Citation： WEI Dongmei,MEI Ling,FANG Fang,WU Taixiang,LIU Guanjian. Effect of Postoperative Radiotherapy on Endometrial Carcinoma: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2008, 08(4): 244-251. doi: 10.7507/1672-2531.20080054 Copy

1.	?9 Abeler VM, Kjorstad KE. Endometrial squamous cell carcinoma: Report of three cases and review of the literature. Gynecol Oncol, 1990, 36(2): 21.
2.	Eitan R, Saenz CC, Venkatraman ES, et al. Pilot study prospectively evaluating the use of the measurement of preoperative sonographic endometrial thickness postmenopausal patients with endometrial cancer. Menopause, 2005, 12(1): 27-30.
3.	Purdie DM, Green AC. Epidemiology of endometrial cancer: best practice and research. Clin Obstet Gynaecol, 2001, 15(1): 341-354.
4.	Jeffrey JF, Krepart GV, Lotocki RJ. Papillary serous adenocarcinoma of the endometrium. Obstet Gynecol, 1986, 67(5): 670-674.
5.	Dunton CJ, Balsara G, Mcfarland M, et al. Uterine papillary serous carcinoma: A review. Obstet Gynecol Surv, 1991, 46(8): 97-102.
6.	吴鸣, 郎景和. 子宫内膜癌的特殊类型--子宫乳头状浆液性癌. 中华妇产科杂志, 1996, 31(1): 3-7.
7.	Sherman AL. Progesterone caproate in the treatment of endometnal cancer. Obstet Gynecal, 1992, 28(6): 309.
8.	吴鸣, 沈铿, 郎景和. 子宫内膜癌206 例临床分析. 中华妇产科杂志. 2002, 37(5): 620.
9.	Abeler VM, Kjorstad KE. Clear cell carcinoma of the endometrium: A histo-pathological and clinical study of 97 cases. Gynecol Oncol, 1991, 40(6): 207.
10.	Creasman WT, Odicino F, Maisonneuve P, et al. Carcinoma of the corpus uteri. Int J Gynaecol Obstet, 2003, 83(Suppl 1): 79-118.
11.	Martinez AA, Stitt JA, Speiser BL, et al. Clinical applications of brachytherapy II: high2dose2rate. In: Perez CA, Brady LW, eds.Principles and practice of radiation oncology. 3rd ed. Philadelphia Lippincott-Raven, 1998. 5732576.
12.	中华医学会妇产科学会, 中华妇产科杂志编辑委员会. 妇科常见恶性肿瘤诊断治疗规范(草案). 中华妇产科杂志, 1998, 33(4): 701-704.
13.	Ball HG, Elkadry EA. Endometrial cancer: current concepts and management. Surg Oncol Clin N Am, 1998, 7(1): 271-284.
14.	Creasman WT, Morrow CP, Bundy BN, et al. Surgical pathologic spread patterns of endometrial cancer, A Gynecologic Oncology Group Study. Cancer, 1987, 60(suppl.8): 2035-2041.
15.	Morrow CP, Bundy BN, Kurman RJ, et al. Relationship between surgical-pathological risk factors and outcome in clinical stage 1 and II carcinoma of the endometrium: a Gynecologic Oncology Group study. Gynecol Oncol, 1991, 40(8): 55-65.
16.	Kadar N, Malfetano JH, Homesley HD. Determinants of survival of surgically staged patients with endometrial carcinoma histologically confined to the uterus: implications for therapy. Obstel Gynecol, 1992, 80(6): 655-659.
17.	Randall ME, Wilder J, Greven K, et al. Role of intracavitary cuff boost after adjuvant external irradiation in early endometrial carcinoma. Int J Radiat Oncol Biol Phys, 1990, 19(7): 49-54.
18.	Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions 4.2.4 [updated March 2005]. In: The Cochrane Library, Issue 2, 2005.
19.	Maggi R, Lissoni A, Spina F, et al. Adjuvant chemotherapy vs radiotherapy in high-risk endometrial carcinoma: results of a randomised trial. J British of cancer, 2006, 95(9): 266-271.
20.	Randall ME, Filiaci VL, Muss H, et al. A randomized phase III trial of whole abdominal irradiation versus doxorubicin-cisplatin chemotherapy in advanced endometrial carcinoma: A Gynecologic Oncology Group study. J Clin Oncol, 2006, 24(8): 36-44.
21.	Sagae S, Udagawa Y, Susumu N, et al. Randomized phase III trial of whole pelvic radiotherapy versus cisplatin-based combined chemotherapy in patients with inertmediate risk endometrial carcinoma (slide).
22.	Fanning J, Hoffman ML, Andrews SJ, et al. Cost-effectiveness analysis Of the treatment for intermediate risk endometrial cancer: postoperativebrachy therapy versus observation. Gynecol Oncol, 2004, 93(6): 632-636.
23.	Laupacis A, Feeny D, Detsky AS, et al. How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluation. Can Med Assoc J, 1992, 146(11): 473-481.

1. ?9 Abeler VM, Kjorstad KE. Endometrial squamous cell carcinoma: Report of three cases and review of the literature. Gynecol Oncol, 1990, 36(2): 21.
2. Eitan R, Saenz CC, Venkatraman ES, et al. Pilot study prospectively evaluating the use of the measurement of preoperative sonographic endometrial thickness postmenopausal patients with endometrial cancer. Menopause, 2005, 12(1): 27-30.
3. Purdie DM, Green AC. Epidemiology of endometrial cancer: best practice and research. Clin Obstet Gynaecol, 2001, 15(1): 341-354.
4. Jeffrey JF, Krepart GV, Lotocki RJ. Papillary serous adenocarcinoma of the endometrium. Obstet Gynecol, 1986, 67(5): 670-674.
5. Dunton CJ, Balsara G, Mcfarland M, et al. Uterine papillary serous carcinoma: A review. Obstet Gynecol Surv, 1991, 46(8): 97-102.
6. 吴鸣, 郎景和. 子宫内膜癌的特殊类型--子宫乳头状浆液性癌. 中华妇产科杂志, 1996, 31(1): 3-7.
7. Sherman AL. Progesterone caproate in the treatment of endometnal cancer. Obstet Gynecal, 1992, 28(6): 309.
8. 吴鸣, 沈铿, 郎景和. 子宫内膜癌206 例临床分析. 中华妇产科杂志. 2002, 37(5): 620.
9. Abeler VM, Kjorstad KE. Clear cell carcinoma of the endometrium: A histo-pathological and clinical study of 97 cases. Gynecol Oncol, 1991, 40(6): 207.
10. Creasman WT, Odicino F, Maisonneuve P, et al. Carcinoma of the corpus uteri. Int J Gynaecol Obstet, 2003, 83(Suppl 1): 79-118.
11. Martinez AA, Stitt JA, Speiser BL, et al. Clinical applications of brachytherapy II: high2dose2rate. In: Perez CA, Brady LW, eds.Principles and practice of radiation oncology. 3rd ed. Philadelphia Lippincott-Raven, 1998. 5732576.
12. 中华医学会妇产科学会, 中华妇产科杂志编辑委员会. 妇科常见恶性肿瘤诊断治疗规范(草案). 中华妇产科杂志, 1998, 33(4): 701-704.
13. Ball HG, Elkadry EA. Endometrial cancer: current concepts and management. Surg Oncol Clin N Am, 1998, 7(1): 271-284.
14. Creasman WT, Morrow CP, Bundy BN, et al. Surgical pathologic spread patterns of endometrial cancer, A Gynecologic Oncology Group Study. Cancer, 1987, 60(suppl.8): 2035-2041.
15. Morrow CP, Bundy BN, Kurman RJ, et al. Relationship between surgical-pathological risk factors and outcome in clinical stage 1 and II carcinoma of the endometrium: a Gynecologic Oncology Group study. Gynecol Oncol, 1991, 40(8): 55-65.
16. Kadar N, Malfetano JH, Homesley HD. Determinants of survival of surgically staged patients with endometrial carcinoma histologically confined to the uterus: implications for therapy. Obstel Gynecol, 1992, 80(6): 655-659.
17. Randall ME, Wilder J, Greven K, et al. Role of intracavitary cuff boost after adjuvant external irradiation in early endometrial carcinoma. Int J Radiat Oncol Biol Phys, 1990, 19(7): 49-54.
18. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions 4.2.4 [updated March 2005]. In: The Cochrane Library, Issue 2, 2005.
19. Maggi R, Lissoni A, Spina F, et al. Adjuvant chemotherapy vs radiotherapy in high-risk endometrial carcinoma: results of a randomised trial. J British of cancer, 2006, 95(9): 266-271.
20. Randall ME, Filiaci VL, Muss H, et al. A randomized phase III trial of whole abdominal irradiation versus doxorubicin-cisplatin chemotherapy in advanced endometrial carcinoma: A Gynecologic Oncology Group study. J Clin Oncol, 2006, 24(8): 36-44.
21. Sagae S, Udagawa Y, Susumu N, et al. Randomized phase III trial of whole pelvic radiotherapy versus cisplatin-based combined chemotherapy in patients with inertmediate risk endometrial carcinoma (slide).
22. Fanning J, Hoffman ML, Andrews SJ, et al. Cost-effectiveness analysis Of the treatment for intermediate risk endometrial cancer: postoperativebrachy therapy versus observation. Gynecol Oncol, 2004, 93(6): 632-636.
23. Laupacis A, Feeny D, Detsky AS, et al. How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluation. Can Med Assoc J, 1992, 146(11): 473-481.

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Effect of Postoperative Radiotherapy on Endometrial Carcinoma: A Systematic Review

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