Comparison Of Efficacy Between Postoperative Radiotherapy And Chemotherapy In High-risk Stage Ⅰ Endometrial Adenocarcinoma

Objective:To investigate the efficacy of postoperative adjuvant radiotherapy and chemotherapy in high-risk stage Ⅰ endometrial adenocarcinoma.Methods:2000-2010,122 cases of postoperative high-risk stage Ⅰ endometrial adenocarcinoma in Anhui Provincial Hospital had been enrolled in this study. According to different therapeutic methods,they were divided into 2 groups,72 cases in radiotherapy group and 50 cases in chemotherapy group.3-year DFS,5-year DFS, distant metastasis rate and local recurrence rate were compared, and the influence factors of recurrence and metastasis were analyzed.Results:(1) 3-year disease-free survival rate of radiotherapy group 94.9%(68/72) was statistically different from that of chemotherapy group 80%(40/50) (P<0.05).(2) 5-year DFS of radiotherapy group 91.7%(66/72) was statistically different from that of chemotherapy group 76%(38/50) (P<0.01).(3) Local recurrence rates of chemotherapy group and radiotherapy group were 22%(11/50) and 4.2%(3/72) respectively.The difference was statistically significant (P=0.002). Distant metastasis rates were 2%(1/50) and 4.2%(3/72) respectively.The difference was not statistically significant. (4) The analysis of the influence factors of recurrence and metastasis suggested that age (> 60 years old), tumor diameter (>2 cm),lymphatic vascular invasion (LVSI), and lower uterine segment or cervical glands infiltration are high risk factors. The recurrence rate of patients who received postoperative chemotherapy was higher than that in patients who received radiotherapy (P=0.016). (5) The gastrointestinal and urinary reactions are the mainly short-term toxicity of radiotherapy. Most of the toxicity were grade 1-2, however,5 cases developed grade 3 radiation enteritis, and 1 case developed grade 3 myelosuppression. In the chemotherapy group, the most common short-term toxicity is myelosuppression, a total of 6 cases (12%) developed grade 3-4 myelosuppression. The long-term toxicity mainly occurred in the radiotherapy group, including vaginal stenosis,chronic radiation cystitis and enteritis, and so on, which influence the life quality of the patients seriously.Conclusions:(1) The adjuvant postoperative radiotherapy is superior to chemotherapy in the high-risk stage I endometrial carcinoma. It can reduce local recurrence rate effectively, meanwhile, improve 3-year DFS and 5-year DFS. But the toxicity of radiotherapy is worse than chemotherapy, especially the long-term toxicity such as vaginal stenosis,chronic radiation enteritis and cystitis, and so on, which influence the life quality of the patients seriously.(2) Age (> 60 years old), LVSI, tumor diameter (>2 cm) and lower uterine segment or cervical glands infiltration are independent risk factors that influence the prognosis of high-risk stage I endometrial carcinoma patients,and the recurrence rate was higher in patients who received chemotherapy than in patients who received radiotherapy.