Also, the overall cost of surgical care is higher. The influence of lymphadenectomy on long-term QOL is less clear. For the above reasons, it is important to limit the performance and the extent of lymphadenectomy to patients who may potentially benefit from it. Although lymphadenectomy is aimed at documenting the presence of lymphatic metastases, there is still no consensus about the best adjuvant approach selleck in EC patients with positive lymph nodes. The Gynecologic

Oncology Group 122 trial[50] suggested that chemotherapy (doxorubicin and cisplatin) provides better survival than radiotherapy (whole abdominal irradiation) in stage III or IV and with 2 cm or less of residual disease. However, chemotherapy decreased the distant recurrence rate (from 19% to 10%) at the cost of a higher pelvic recurrence Rucaparib mouse rate (from 13% to 18%). Interestingly, the authors reported that chemotherapy was not significantly better than abdominal radiation in patients with non-endometrioid tumors.[50] Similarly, the results of two randomized

studies (NGSO/ERTC and MaNGO ILIADE-III), including high-risk EC patients (stage I to III), indicated that the addition of adjuvant chemotherapy to radiation improved disease-free survival overall, especially in the subgroup with grade 1 and 2 endometrioid EC. Chemotherapy was less likely to be beneficial in patients with endometrioid grade 3 and type 2 EC.[51] In agreement with the above results, we recently demonstrated that chemotherapy did not significantly impact prognosis in stage III patients with high-risk histology (endometrioid grade 3 and type 2 EC).[18] Although in our study radiotherapy

(with or without chemotherapy) independently influenced survival in patients from with stage III poorly differentiated cancer, the treatment failure rates remained extremely high, with a 67% recurrence rate at 3 years in patients with stage III and lymphovascular invasion.[18] Similarly, Sutton et al.,[52] in another Gynecologic Oncology Group study, reported that patients with stage III and IV high-risk histology (serous and clear cell) experienced 3-year recurrence-free and overall survival of 27% and 35%, respectively, when treated with whole abdominal radiotherapy. Owing to the fact that radiotherapy seems to provide adequate locoregional protection of the targeted tissues but not systemic control, several authors suggested that combining radiotherapy and chemotherapy may guarantee better locoregional and systemic protection.[53, 54] Secord et al.,[55] in a multi-institutional series of 265 stage IIIC EC (type 1 and type 2), reported that patients undergoing chemotherapy alone had a 2.2- and 4.0-fold increased risk of recurrence and death than patients who had chemotherapy plus radiotherapy. In contrast, there was no difference in survival between patients undergoing radiotherapy alone versus chemotherapy plus radiotherapy.