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VII Reunión y I Online SoGOCyL 2021

En 2021 la Reunión de la Sociedad de Ginecología Oncológica de Castilla y León se celebrará online los días 2 y 3 de junio.

Jornadas SoGOCyL 2020

La VII Reunión de la Sociedad de Ginecología Oncológica de Castilla y León tendrá lugar los días 7 y 8 de mayo de 2020 en León.

Conclusiones de las Jornadas SoGOCyL 2019

Éstas son las conclusiones que los profesionales extraemos de la VI Reunión de la Sociedad de Ginecología Oncológica y Patología Mamaria de Castilla y León.

Jornadas SoGOCyL 2018

Se celebrará la V Reunión de la Sociedad de Ginecología Oncológica y Patología Mamaria de Castilla y León los días 3, 4 y 5 de Mayo de 2018

Inicio Adjuvant external beam radiotherapy in the treatment of endometrial cancer (MRC ASTEC and NCIC CTG EN.5 randomised trials): pooled trial results, systematic review, and meta-analysis

Adjuvant external beam radiotherapy in the treatment of endometrial cancer (MRC ASTEC and NCIC CTG EN.5 randomised trials): pooled trial results, systematic review, and meta-analysis

Lunes, 03 de Enero de 2011 11:20

Adjuvant external beam radiotherapy in the treatment of endometrial cancer (MRC ASTEC and NCIC CTG EN.5 randomised trials): pooled trial results, systematic review, and meta-analysis

The Lancet, Volume 373, Issue 9658, Pages 137 - 146, 10 January 2009 <Previous Article|Next Article>doi:10.1016/S0140-6736(08)61767-5Cite or Link Using DOI

Published Online: 13 December 2008

The ASTEC/EN.5 writing committee on behalf of the ASTEC/EN.5 Study Group‡

Summary

Background

Early endometrial cancer with low-risk pathological features can be successfully treated by surgery alone. External beam radiotherapy added to surgery has been investigated in several small trials, which have mainly included women at intermediate risk of recurrence. In these trials, postoperative radiotherapy has been shown to reduce the risk of isolated local recurrence but there is no evidence that it improves recurrence-free or overall survival. We report the findings from the ASTEC and EN.5 trials, which investigated adjuvant external beam radiotherapy in women with early-stage disease and pathological features suggestive of intermediate or high risk of recurrence and death from endometrial cancer.

Methods

Between July, 1996, and March, 2005, 905 (789 ASTEC, 116 EN.5) women with intermediate-risk or high-risk early-stage disease from 112 centres in seven countries (UK, Canada, Poland, Norway, New Zealand, Australia, USA) were randomly assigned after surgery to observation (453) or to external beam radiotherapy (452). A target dose of 40—46 Gy in 20—25 daily fractions to the pelvis, treating five times a week, was specified. Primary outcome measure was overall survival, and all analyses were by intention to treat. These trials were registered ISRCTN 16571884 (ASTEC) and NCT 00002807 (EN.5).

Findings

After a median follow-up of 58 months, 135 women (68 observation, 67 external beam radiotherapy) had died. There was no evidence that overall survival with external beam radiotherapy was better than observation, hazard ratio 1·05 (95% CI 0·75—1·48; p=0·77). 5-year overall survival was 84% in both groups. Combining data from ASTEC and EN.5 in a meta-analysis of trials confirmed that there was no benefit in terms of overall survival (hazard ratio 1·04; 95% CI 0·84—1·29) and can reliably exclude an absolute benefit of external beam radiotherapy at 5 years of more than 3%. With brachytherapy used in 53% of women in ASTEC/EN.5, the local recurrence rate in the observation group at 5 years was 6·1%.

Interpretation

Adjuvant external beam radiotherapy cannot be recommended as part of routine treatment for women with intermediate-risk or high-risk early-stage endometrial cancer with the aim of improving survival. The absolute benefit of external beam radiotherapy in preventing isolated local recurrence is small and is not without toxicity.

Funding

Medical Research Council, National Cancer Research Network, National Cancer Institute of Canada, with funds from the Canadian Cancer Society.

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