Objective To assess the clinical effectiveness, safety and cost-effectiveness of adjuvant radiotherapy
(RT) for endometrial cancer compared to other treatmen.
Method The following electronic databases were searched: MEDLINE, EMBAS, CancerLit, CBMdisc, CNKI. The Cochrane Library (Issue 3, 2007). Correlative websites, such as ‘google’, were searched by hand. The studies included in the references of eligible studies were additionally searched RCTs of adjuvant radiotherapy before March, 2007 comparing adjuvant radiotherapy with other treatment for endometrial cancer were included. Eligible RCTs were assessed for quality by two reviewers independently: criteria of concealment of treatment, blinding, standard validity and reliability of outcome measures, withdraw rate, intention-to-treat analysis and homogeneity between centers were analyzed for each study. All data were performed by a meta-analysis.
Result Seven RCTs met the inclusion criteria/ Methodological quality was level B. Five RCTs were compared adjuvant radiotherapy (external beam radiotherapy (EBRT) and /or intracavitary radiotherapy (ICRT) with other treatment, Two RCTs including one RCT was compared two different fractionation schedules for postoperative vagina high-dose-rate(HDR) irradiation in endometrial carcinoma the other RCT was compared two different radiotherapy method (pelvic radiotherapy and vagina radiotherapy vs vagina radiotherapy) for endometrial carcinoma. No survival different were identified; none of the studies was powered enough to show a survival benefit. But who received RT had fewer local (pelvic and/or vagina) recurrences compared to women not receiving RT. Adverse effects is found more often in RT than in not RT, there is less localrecurrences in combined radiotherapy (pelvic radiotherapy and vagina radiotherapy) than in vagina radiotherapy. lowdose vagina radiotherapy had few vagina shortening than high-dose radiotherapy, there are the same 5-overall surviva, local recurrences and distant recurrences.
Conclusions Adjuvant radiotherapy for endometrial can cer can better control local recurrences than observation for postoperative endometrial cancer. Effects about overall survival, distant recurrences and disease-free survival are similar; low-dose vagina radiotherapy has few vagina shortening than high-dose radiotherapy, there are the same 5-years overall survival, local recurrences and distant recurrences for endometrial cancer, there is less local recurrences in combined radiotherapy (pelvic radiotherapy plus vagina radiotherapy) than in vagina radiotherapy for endometrial cancer; postoperative high-dose brachytherapy can get good cost-effectiveness; Effect of adjuvant radiotherapy for overall survival and disease-free survival of endometrial carcinoma are needed to further assessed by rigorously designs, randomized, double-blind, placebo-controlled trials adjuvant radiotherapy for endometrial carcinoma.
Citation： WEI Dongmei,MEI Ling,FANG Fang,WU Taixiang,LIU Guanjian. Adjuvant Radiotherapy for Endometrial Cancer: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2009, 09(4): 465-475. doi: 10.7507/1672-2531.20090086 Copy