Lymphovascular space invasion in early-stage endometrial cancer: adjuvant treatment and patterns of recurrence

Background: In early-stage endometrial cancer, lymphovascular space invasion (LVSI) is an independent predictor of relapse of disease and poorer survival. Nevertheless, adjuvant treatment for LVSI-positive patients is variable. Methods: Early-stage endometrial cancer patients with LVSI, treated in Melbourne between 2000 and 2010, were retrospectively reviewed. Outcomes of patients observed after hysterectomy were compared with those who had had adjuvant EBRT or VBT. Results: A total of 95 patients met the inclusion criteria. After surgery, 40 patients were observed, 48 patients received adjuvant EBRT and 7 adjuvant VBT. Nineteen patients developed recurrent disease (20.0%), of which 12.5% were in the observation group, 27.1% in the EBRT group and 14.3% in the VBT group (p-value 0.217). Fewer vaginal recurrences and more distant recurrences were found in both the RT groups (p-value 0.636 and 0.648 respectively). Multivariate analysis for overall survival (OS) and cancer-related survival (CRS) revealed a non-significant decrease of hazards in both the radiotherapy (RT) groups when compared with the observation group. Conclusions: In patients with LVSI, adjuvant RT was not shown to reduce recurrence rates or improve OS or CRS. Previous reports have suggested that LVSI may be as important as nodal status for the risk of distant recurrence, therefore the use of systemic therapy should be further investigated.