Management of high-grade stage I XXXX : hysterectomy following low dose external beam pelvic irradiation.

@entity1 @entity420 @entity189
Sixty-eight @entity1 with FIGO stage I, grade 2 or 3 @entity420 were treated according to a protocol involving 10 Gy external pelvic irradiation, prompt hysterectomy with surgical staging, and postoperative therapy individualized according to surgical-pathologic findings. Five-year survival for the entire group was 78%, 87% for those with grade 2 disease, and 59% for those with grade 3 disease. For @entity1 whose disease was found to be confined to the uterus, surgical stage I, the 5-year survival was 98%. @entity1 with surgical stage I, grades 2 and 3 disease had 97 and 100% probabilities of surviving 5 years, respectively. Five-year disease-free probability was 96% for all @entity1 with surgical stage I @entity189 , 97% for @entity1 with grade 2 disease, and 94% for @entity1 with grade 3 disease. Myometrial penetration influenced survival; no @entity1 with less than 50% myometrial penetration died or suffered a relapse, while only 40% of @entity1 with deeper penetration survived 5 years. Twenty-three percent of @entity1 with surgically confirmed disease spread beyond the corpus survived 5 years; 29% remained disease-free at this interval. Ten of the 68 @entity1 developed recurrences, none has had a known pelvic recurrence. Two major complications, one requiring surgery, were seen, both in @entity1 receiving postoperative external beam irradiation. The rationale behind low-dose, preoperative external pelvic irradiation is described, and an approach to high-grade, FIGO stage I @entity420 is outlined.
