Compliance to surgical and radiation treatment guidelines in relation to patient outcome in early stage endometrial cancer

J Eval Clin Pract. 2006 Apr;12(2):196-201. doi: 10.1111/j.1365-2753.2006.00618.x.


Rationale, aims and objectives: We evaluated the adherence to treatment guidelines in early stage endometrial cancer and the influence of adherence to guidelines on overall survival.

Method: Patients were identified in the central region in the Netherlands from 1990 till 1995. Patient and tumour characteristics, surgical findings, radiation and follow-up data were abstracted from medical records. Endpoint was overall survival. Kaplan-Meier method was used to perform time-to-event analysis. Hazard ratios for overall survival were estimated with a Cox Proportional Hazards model.

Results: 359 patients were eligible for analysis. 335 patients presented with a clinical stage I cancer. 333 patients underwent a Total Abdominal Hysterectomy with Bilateral Salpingo Oophorectomy (TAH/BSO), of which 301 were staged as International Federation of Gynaecology and Obstetrics (FIGO) stage I, whereas 34 (10.2%) as FIGO stage II. Of the 24 patients with a clinical stage II cancer, 12 underwent a Radical Hysterectomy with Pelvic Lymph Node Dissection (RH/PLND), of which seven were diagnosed with FIGO stage II. In 72.1% of the patients adjuvant radiation was given or not in adherence to the guidelines. Whether treatment was given according to the guidelines or not did not affect 5 years overall survival.

Conclusion: This suggests that extensive surgical procedures are redundant in the treatment of occult stage II endometrial cancer.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Combined Modality Therapy
  • Endometrial Neoplasms / pathology
  • Endometrial Neoplasms / radiotherapy*
  • Endometrial Neoplasms / surgery*
  • Female
  • Guideline Adherence*
  • Humans
  • Middle Aged
  • Neoplasm Staging
  • Treatment Outcome