A Meta Analysis Of Adjuvant Radiotherapy For Early Endometrial Cancer

Objective:To assess the clinical effectiveness of adjuvant radiotherapy (RT) in the treatment of early stage endometrial cancer.Method:1,Search strategy We searched PUBMED,MEDLINE, CNKI, CBMdisc, wan fang data base and reference lists of articles. Gynecological carcinoma related magazines in library of Shandong University were searched manually. Languages were restricted to Chinese and English.2,Selection criteria Trials were included if they were randomized controlled trials about adjuvant radiotherapy for early endometrial cancer.3,Data collection and analysis Data extraction and quality assessment was performed independently by the author. All the calculations and statistical tests were done with the RevMan 4.2 software.Main results:There were nine RCTs met the inclusion criteria. Seven were were considered as high quality studies, two were considered as low quality studies. The findings suggest that:(1) Comparing postoperative vaginal irradiation with surgery alone in early stage low-risk endometrial carcinoma, there were no statistical significance in the recurrence rate and overall survival among the 2 groups. External beam radiotherapy (EBRT) can better control local recurrences and overall recurrences than observation for postoperative intermediate-risk or high-risk early-stage endometrial cancer. There were no statistical significance in overall survival, distant recurrences and disease-free survival among the 2 groups.(2) Comparing two different radiotherapy methods (pelvic radiotherapy VS vaginal radiotherapy) for early endometrial carcinoma, there were no statistical significance in overall survival, local recurrences, distant recurrences, overall recurrences and disease-free survival among the 2 groups. But the adverse effects were minor and the quality of life was better in patients treated with postoperative vaginal irradiation than with pelvic radiotherapy.(3) There is less local recurrences in combined radiotherapy (pelvic radiotherapy and vagina radiotherapy) than vaginal radiotherapy. But there were no statistical significance in overall survival and overall recurrences among the 2 groups.(4) There were the same 5-overall survival, local recurrences and distant recurrences in low-dose vaginal radiotherapy group and high-dose radiotherapy group.(5) Comparing postoperative vaginal irradiation with hormone therapy after surgery in early endometrial carcinoma, there were the same 5-overall survival, local recurrences and distant recurrences.Conclusions Adjuvant radiotherapy can better control local recurrences. There were no statistical significance in overall survival and distant recurrences. Comparing two different radiotherapy methods for early endometrial carcinoma, effects about overall survival, local recurrences, distant recurrences, overall recurrences and disease-free survival are similar. But the adverse effects were minor and the quality of life was better in patients treated with postoperative vaginal irradiation than pelvic radiotherapy. There were less local recurrences in combined radiotherapy (pelvic radiotherapy and vagina radiotherapy) than in vaginal radiotherapy. Effects about overall survival and overall recurrences are similar. There are the same 5-year overall survival, local recurrences and distant recurrences in low-dose vagina radiotherapy group and high-dose radiotherapy group. Comparing postoperative vaginal irradiation with hormone therapy after surgery in early endometrial carcinoma, there are the same 5-year overall survival, local recurrences and distant recurrences. Further conclusions to be drawn need a number of high-quality, large sample randomized controlled clinical trials to prove.