Objectives: This retrospective study assessed the number and type of complications following surgery and adjuvant radiotherapy in the treatment of high-risk endometrial cancer. Methods: Endometrial cancer patients who received surgery and postoperative radiotherapy (pelvic radiotherapy and/or vaginal brachytherapy) from April 1997 until October 2010 were evaluated. Short-term (≤6 months) and long-term (>6 months) complications (e.g., genitourinary/gastrointestinal complications) were comprehensively reviewed. Results: We identified 109 high-risk endometrial cancer patients who completed adjuvant radiotherapy following either a total abdominal hysterectomy (TAH; n = 53) or minimally invasive hysterectomy (MIS; n = 56). The combined impact of surgery and radiotherapy on complication type did not reach statistical significance (p > 0.05). However, surgery type and the development of a complication were significantly related (p < 0.001). The MIS patients developed complications at a more accelerated rate compared to the TAH patients (21 vs. 45 months), although the incidence of toxicity of grade 3 or 4 was much higher in the TAH group. Conclusions: The impact of MIS and adjuvant radiotherapy may have adversely affected the development of complications compared to TAH patients who received adjuvant radiotherapy, although higher-grade patient toxicity was more prevalent in the TAH group.

Keywords:
Adjuvant radiotherapy, Brachytherapy, Endometrial cancer, Hysterectomy, Minimally invasive surgery
1.
Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D: Global cancer statistics. CA Cancer J Clin 2011;61:69–90.
2.
Eiriksson L, Cuartero J, Steed H, Pearcey R, Capstick V, Schepansky A, et al: Assessment of outcomes in surgically staged I/II endometrial adenocarcinoma patients treated with postoperative vaginal vault radiotherapy only. Int J Gynecol Cancer2010;20:1356–1362.
3.
Gaia G, Holloway RW, Santoro L, Ahmad S, Di Silverio E, Spinillo A: Robotic-assisted hysterectomy for endometrial cancer compared with traditional laparoscopic and laparotomy approaches: a systematic review. Obstet Gynecol 2010;116:1422–1431.
4.
ASTEC/EN.5 Study Group, Blake P, Swart AM, Orton J, Kitchener H, Whelan T, et al: Adjuvant external beam radiotherapy in the treatment of endometrial cancer (MRC ASTEC and NCIC CTG EN.5 randomised trials): pooled trial results, systematic review, and meta-analysis. Lancet 2009;373:137–146.
5.
Scotti V, Borghesi S, Meattini I, Saieva C, Rossi F, Petrucci A, et al: Postoperative radiotherapy in stage I/II endometrial cancer: retrospective analysis of 883 patients treated at the University of Florence. Int J Gynecol Cancer2010;20:1540–1548.
6.
Hsu WC, Chung NN, Chen YC, Ting LL, Wang PM, Hsieh PC, et al: Comparison of surgery or radiotherapy on complications and quality of life in patients with the stage IB and IIA uterine cervical cancer. Gynecol Oncol 2009;115:41–45.
7.
Chen MC, Chiang FF, Hsu TW, Chen JB, Chao TH, Ma HF, et al: Clinical experience in 89 consecutive cases of chronic radiation enterocolitis. J Chin Med Assoc 2011;74:69–74.
8.
NIH Common Terminology Criteria for Adverse Events (CTCAE v4.0). Washington, National Institutes of Health, 2009.
9.
Barillot I, Maingon P: Endometrial carcinoma: which radiotherapy for which patient (in French). Cancer Radiother 2003;7(suppl 1): 1–7.
10.
Holland C: Unresolved issues in the management of endometrial cancer. Expert Rev Anticancer Ther 2011;11:57–69.
11.
Kong A, Powell M, Blake P: The role of postoperative radiotherapy in carcinoma of the endometrium. Clin Oncol (R Coll Radiol) 2008;20:457–462.
12.
Macchia G, Ferrandina G, Deodato F, Bibbò R, Massaccesi M, Ippolito E, et al: 3D conformal postoperative radiotherapy with concomitant boost in uterine cancer: results of a phase I-II study (ADA-RT-1). Gynecol Oncol 2011;120:485–488.
13.
Bell MC, Torgerson J, Seshadri-Kreaden U, Suttle AW, Hunt S: Comparison of outcomes and cost for endometrial cancer staging via traditional laparotomy, standard laparoscopy and robotic techniques. Gynecol Oncol 2008;111:407–411.
14.
Abdelmonem A, Wilson H, Pasic R: Observational comparison of abdominal, vaginal and laparoscopic hysterectomy as performed at a university teaching hospital. J Reprod Med 2006;51:945–954.
15.
Keys HM, Roberts JA, Brunetto VL, Zaino RJ, Spirtos NM, Bloss JD, et al: A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study. Gynecol Oncol 2004;92:744–751.
16.
Nick AM, Lange J, Frumovitz M, Soliman PT, Schmeler KM, Schlumbrecht MP, et al: Rate of vaginal cuff separation following laparoscopic or robotic hysterectomy. Gynecol Oncol 2011;120:47–51.
17.
Magrina JF, Kho RM, Weaver AL, Montero RP, Magtibay PM: Robotic radical hysterectomy: comparison with laparoscopy and laparotomy. Gynecol Oncol 2008;109:86–91.
18.
Chung YL, Jian JJ, Cheng SH, Hsieh CI, Tan TD, Chang HJ, et al: Extended-field radiotherapy and high-dose-rate brachytherapy with concurrent and adjuvant cisplatin-based chemotherapy for locally advanced cervical cancer: a phase I/II study. Gynecol Oncol 2005;97:126–135.
19.
Matsushita K, Ochiai T, Shimada H, Kato S, Ohno T, Nikaido T, et al: The effects of carbon ion irradiation revealed by excised perforated intestines as a late morbidity for uterine cancer treatment. Surg Today 2006;36:692–700.
© 2011 S. Karger AG, Basel
2011
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