Endometrial carcinoma with cervical involvement (stage II): prognostic factors and value of combined radiological-surgical treatment

Tumor infiltration into the cervical mucosa, defined as infiltration into either glandular and/or squamous epithelium and the underlining stroma, could, when reevaluated, be verified in only 96 (56.3%) out of 174 cases originally recorded as Stage II endometrial cancer. The finding of “free floating tumor cells” in the cervical scraping material was associated with a lower frequency of blood/lymph vessel invasion, and these cases had a prognosis similar to Stage I disease. Poor prognostic factors were grossly invaded cervix, enlarged uterine cavity, deep myometrial infiltration, invasion into endothelial lined spaces, and poorly differentiated tumors. Clear cell carcinomas had significantly poorer prognoses than pure adenocarcinomas. The majority of the patients received preoperative radium packing. Six patients experienced major complications, all occurring in cases treated with a combination of intracavitary radium packing and external irradiation. The complication risk was clearly related to the irradiation dosage from the radium packing. In the prospective clinical trial 40 cases with Stage II adenocarcinomas receiving 4000 rad postoperative irradiation to the pelvic lymph nodes (Group B) had a similar 5-year survival rate (85%) as the 44 cases receiving no external radiotherapy (Group A). Moreover, seven pelvic recurrences were seen in Group B, and only one in Group A (P < 0.05). No subgroup of patients could be identified for which external radiotherapy improved the outcome.