Preoperative irradiation for carcinoma of the endometrium: Indications and results

One hundred thirty patients with carcinoma of the endometrium were treated preoperatively with external irradiation (4000 rad) and radium application (2500 mg/hr or 2000 rad). Criteria for preoperative irradiation included: large uterus 19], signs of myometrial invasion on hysterogram 50], cervical involvement 37], poorly differentiated or anaplastic carcinoma 13], adenosquamous cell carcinoma 10], or squamous cell carcinoma 1]. Hysterography was performed as part of the pretreatment work-up in 93 patients (71%). Diffuse, multiple or single large defects were observed in the fundus in 72%, 8% had defects in the lower uterine segment, and the remaining 20% showed no gross defects on hysterography. Eighty-seven (67%) had no residual tumor in the hysterectomy specimen, while residual carcinoma was seen in forty-three (33%). No local recurrence has developed in the pelvis or vagina. Six patients have developed extra-pelvic metastasis, and four have died of disease. Overall survival is 97% with follow-up of 1 to 6 years.