Lymphadenectomy And Postoperative Radiotherapy In Endometrial Carcinoma: A Systematic Review

Objective systematicly assess the effectiveness and safety of pelvic lymphadenectomy and radiotherapy in early-stage endometrial carcinoma.Method We searched Cochrane collaboration,pubmed,Embase, CBM, CNKI, VIP, WHOITCRP, web sites of some clinical trials such as Clinical trials, Current controlled trials till March 2010 irrespective of language,and we also handsearched relative proffessional magzine in order to collect RCTs about lymphadenectomy and post-operative radiotherapy of early-stage endometrial carcinoma. Study selection and quality assessment,data extraction and analyses were undertaken by two reviewers independently according to the Cochrane Handbook for Systematic Reviews of interventions.Meta-analyses were also performed.Results Ten RCTS involving 5727 participants were included.Three RCTs (1981 participants) compared lymphadenectomy and non-lymphadenectomy; Five RCTs(2674 participants)compared postoperative external radiotherapy and no-external radiotherapy;One RCT(645 participants) compared postoperative vaginal brachytherapy and sugery alone; One RCT (427 participants) compared postoperative external radiotherapy and postoperative vaginal brachytherapy. The Meta-analysis showed that:â‘ TAH+BSO +lymphadenectomy VS TAH+BSO:overall survival, DFS, endometrial-related death, recurrence rate, loco-regional recurrence, distant recurrence showed no statistical significance in two groups,but a higher rate of lymphocyst in lymphadenectomy group.â‘¡sugery plus external radiotherapy VS no-external radiotherapy:overall survival,endometrial related death, distant recurrence showed no statistical difference while on the other hand loco-regional recurrence decreased significantly in EBRT group along with higher incidence of adverse effect.â‘¢(Low-risk patients)sugery+vaginal radiotherapy VS surgery:analysis showed no statistical difference in survival and recurrence.Vaginal adverse effect G1 happened more frequently in VBT group.â‘£(HIR patients) postoperative EBRT VS postoperative VBT:analysis showed no statistical difference in survival and recurrence. Gastrointestinal adverse effect G1-2 happened more frequently in EBRT group.Conclusion Lymphadenectomy in early stage endometrial carcinoma will not affect the survival and recurrence,on the other hand it will increase the incidence of adverse effects especially in lymphocyst.Post-operative radiotherapy could significantly decrease the loco-regional recurrence but also with a higher incidence of adverse effects.For patients who are diagnosed with low-risk endometrial carcinoma,post-operative vaginal radiotherapy show limit treatment effect.For high intermediate risk patients,postoperative EBRT and postoperative VBT showed no difference in survival and recurrence,but VBT showed lower incidence of adverse effect which indicate that it might be a better treatment modality for HIR patients.As many biases has been assessed,more well-designed RCTs are still needed to confirm the effectiveness and safety of lymphadenectomy and adjuvant radiotherapy in early stage endometrial cancer.