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Annals of Oncology Advance Access first published online on March 7, 2007
This version published online on March 19, 2007
Annals of Oncology, doi:10.1093/annonc/mdm066
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© 2007 European Society for Medical Oncology

review

Adjuvant radiotherapy for stage I endometrial cancer: systematic review and meta-analysis

A Kong1,*, I Simera2, M Collingwood3, C Williams4, H Kitchener On behalf of Cochrane Gynaecological Cancer Group5

1 Radiotherapy Department, St Bartholomew's Hospital, London EC1
2 Centre for Statistics in Medicine, Wolfson College Annexe, University of Oxford, Linton Road, Oxford OX2 6UD
3 Radiotherapy Department, Churchill Hospital, Old Road, Headington, Oxford OX3 7LJ
4 Bristol Haematology and Oncology Centre, Horfield Road, Bristol BS2 8ED
5 Academic Unit of Obstetrics and Gynaecology, University of Manchester, St Mary's Hospital, Whitworth Park, Manchester M13 0JH, UK

* Correspondence to: Dr A. Kong, Cancer Research UK London Research Institute, 44 Lincoln's Inn Fields, London WC2A 3PX. Tel: +44-207-269-3054; Fax: +44-207-269-3094; E-mail: anthonyhkong{at}hotmail.com

The role of adjuvant radiotherapy in stage I endometrial cancer following surgery remains unclear. The management for these patients varies widely, particularly in stage I patients with different risk factors. Using the methodology of Cochrane Collaboration, we did a systematic and meta-analysis of all know randomised controlled trials which compared adjuvant radiotherapy versus no radiotherapy following surgery for patients with stage I endometrial cancer. The meta-analysis was carried out on four trials (three published and one unpublished) and a total of 1770 patients. The addition of pelvic external beam radiotherapy to surgery reduced locoregional recurrence, a relative risk (RR) of 0.28 [95% confidence interval (CI) 0.17–0.44, P < 0.00001], which is a 72% reduction in the risk of pelvic relapse (95% CI 56% to 83%) and an absolute risk reduction of 6% (95% CI of 4% to 8%). The reduction in the risk of locoregional recurrence did not translate into a reduction in the risks of death from all causes, endometrial cancer death or distant recurrence. A subgroup analysis showed a trend towards the reduction in the risks of death from all causes and endometrial cancer in patients with multiple high risk factors (including stage 1c and grade 3). External beam pelvic radiotherapy should be considered in patients with multiple high-risk features including stage 1c and grade 3. However, it carries an inherent risk of damage and toxicity and should be avoided in stage 1 endometrial cancer patients with no high risk factors.

stage I endometrial carcinoma, adjuvant radiotherapy, systematic review and meta-analysis, death from all causes, locoregional recurrence, endometrial cancer-related deaths

"This version contains a corrected address for correspondence and also the correct in-text citation for the references."

Received for publication January 23, 2007. Accepted for publication January 26, 2007.


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Annals of Oncology, 11 Apr 2007 [Full text]

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