Electronic Letters to:
|
|
E-letters: Electronic letters published:
-
![[Read eLetter]](/icons/misc/sectionDOWN.gif)
To the Editor
- Sukran Ulger, Ferah Yildiz Enis Ozyar I.Lale Atahan (11 April 2007)
|
|
|||
|
Sukran Ulger, MD Research Asistant Hacettepe University Faculty of Medicine Department of Radiat. Oncol. Sihhiye 06100 ANKARA TURKEY, Ferah Yildiz Enis Ozyar I.Lale Atahan
Send e-letter to journal:
|
We read the meta-analysis by Kong A. et al. which was published in Annals of Oncology on March 19, 2007 with great interest. It was an important review as still there is no common consensus on the treatment of early stage endometrial carcinoma (1). However, we think that the results of this meta analysis did not clarify this highly controversial issue and might even confound the role of adjuvant treatment in the early stage disease. The review analyzed four randomized controlled trials, namely, Aalders study, GOG study, PORTEC and Soderini study. The patient characteristics, mode of staging (clinical vs surgical) are quite heterogenous in these randomized studies. It is evident that lymphatic evaluation is the major determinant in current surgical staging system. Hovewer, this approach is not accepted for low risk patients currently. In the meta analysis, GOG and Soderini study has included patients with lymphatic dissection/sampling, but also there is no published data yet and we do not know how many lymph nodes were dissected in the Soderini study (2,3). Although GOG study has done only by lymphatic sampling - not by complete lymphatic dissection- it was evaluated in the subgroup analysis of meta anlysis with Soderini trial (4). We have evaluated our early-stage endometrium carcinoma patients retrospectively and we published our results recently (5). In our study 130 intermediate and high risk patients were treated with adjuvant High Dose Rate (HDR) brachytherapy alone according to our institutional protocol after complete surgical staging. The median account of lymph nodes removed in our series is 33 (range: 10-93). Among 130 patients, 16 patients were stage IC G3, and 5 year reccurence free survival in these patients is 100 %, without any severe complication. We think that treatment toxicity profile is important for choosing and recommending adjuvant treatment modality. Only, PORTEC study has published their detailed treatment toxicity and the treatment related complications have occurred 25 % of patients treated with external radiotherapy. We know that vaginal brachytherapy alone does not lead to serious acute and late side effects and when we are considering the quality of life of patients, we think that it may not be appropriate to recommend pelvic external radiotherapy for favorable early stage endometrial cancer patients after complete surgical staging. REFERENCES 1. Kong A, Simera I, Collingwood M, Williams C, Kitchener H. Adjuvant radiotherapy for stage I endometrial cancer: systematic review and meta- analysis. Annals of Oncology Advance Access published on March 19, 2007; doi: doi:10.1093/annonc/mdm066 2. Gretz H, Economos K, Husain A, et al. The Practice of Surgical Staging and Its Impact on Adjuvant Treatment Recomendations in Patients with Stage I Endometrial Carcinoma.Gynecologic Oncology. 61:409-415:1996. 3. Messalli EM, Scaffa C, Mainini G, et al. A Therapeutic Algorithm for Early-Stage Endometrial Cancer: Indications, Patient Selection, and Feasibility. Eur J Gynaecol Oncol. 27; 385-388:2006. 4. Keys H, Roberts J, Brunetto V, et all. A Phase III Trial of Surgery with or without Adjunctive External Pelvic Radiation Therapy in Intermediate Risk Endometrial Adenocarcinoma: A Gynecologic Oncology Group Study. 92:744-751.2004 5. Atahan L, Ozyar E, Genc M, et al. HDR Brachitherapy Alone in the Management of Intermediate- High Risk Endometrial Cancer Patients After Complete Surgical Staging. International Journal of Radiation Oncology,Biology,Physics. 01 November 2006 (Vol. 66, Issue 3 (Supplement), Page S406) Conflict of Interest:None declared |
|||