Stefano Greggi1, Massimo Franchi2, Giovanni Aletti3, Nicoletta Biglia4, Antonino Ditto5, Anna Fagotti6, Giorgio Giorda7, Giorgia Mangili8, Franco Odicino9, Maria Giovanna Salerno10, Enrico Vizza11, Cono Scaffa12, Paolo Scollo13. 1. Gynecologic Oncology, National Cancer Institute of Naples, Via M. Semmola, 80131 Naples, Italy. Electronic address: s.greggi@istitutotumori.na.it. 2. Obstetrics and Gynecology, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy. 3. Gynecologic Oncology, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy. 4. Gynecology and Obstetrics, University of Torino - Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy. 5. Gynecologic Oncology, National Cancer Institute of Milan, Via G. Venezian 1, 20133 Milano, Italy. 6. Minimally Invasive Gynecology, University of Perugia - Santa Maria Hospital, Viale Tristano di Joannuccio 1, 05100 Terni, Italy. 7. Gynecologic Oncology, Comprehensive Cancer Centre of Aviano, Via F. Gallini 2, 33081 Aviano, PN, Italy. 8. Gynecologic Oncology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy. 9. Gynecologic Oncology, University of Brescia, Viale Europa 11, 25123 Brescia, Italy. 10. Obstetrics and Gynecology, Santa Chiara Hospital, Via Roma 67, 56100 Pisa, Italy. 11. Gynecologic Oncology, "Regina Elena" National Cancer Institute of Rome, Via E. Chianesi 53, 00144 Rome, Italy. 12. Gynecologic Oncology, National Cancer Institute of Naples, Via M. Semmola, 80131 Naples, Italy. 13. Obstetrics and Gynecology, University of Catania - Cannizzaro Hospital, Via Messina 829, 95126 Catania, Italy.
Abstract
INTRODUCTION: Endometrial carcinoma (EC) is a frequent cancer in developed countries, but with evidence for discrepant clinical management. Under the auspices of the Italian Society of Gynecologic Oncology (SIOG), we conducted a survey among Italian centers with ≥20 surgeries for gynecological cancer per year, trying to depict a reliable picture of EC management in our country. METHODS: The questionnaire focused on preoperative/surgical staging and adjuvant treatment. Of the 283 questionnaires delivered, 35% were sent back. RESULTS: Diagnostic hysteroscopy is performed in 78% of centers. In clinical stage I, 52% adopt a laparotomic access, 15% totally laparoscopic, 9% laparoscopic/vaginal, 2% vaginal, 22% tailored approach. Elective use of laparoscopy significantly differs between institutions (p < 0.001): 40% (≥20 EC/yr) vs. 12% (<20). Pelvic and aortic lymphadenectomy is selectively performed by 77% and 68% of centers, respectively, depending on pre/intraoperative factors. Non-endometrioid histology, poor-grade and deep myoinvasion are indicated as the highest-risk factors. Adjuvant therapy is given to pathologically node-negative patients by 60%, and to intermediate-risk patients by 47%. Elective adjuvant treatment is still radiotherapy, but chemotherapy is adopted, mostly combined with radiation, by 40%. There is a multidisciplinary team in 64% of centers, but in 59% adjuvant treatment is to be administered outside the institution. CONCLUSIONS: These data demonstrate a significant improvement in the clinical care achieved over the last decades in Italy. Centralization of EC treatment would not be feasible neither useful. High-risk cases could be selected by an appropriate clinical screening, and these only referred to reference centers.
INTRODUCTION:Endometrial carcinoma (EC) is a frequent cancer in developed countries, but with evidence for discrepant clinical management. Under the auspices of the Italian Society of Gynecologic Oncology (SIOG), we conducted a survey among Italian centers with ≥20 surgeries for gynecological cancer per year, trying to depict a reliable picture of EC management in our country. METHODS: The questionnaire focused on preoperative/surgical staging and adjuvant treatment. Of the 283 questionnaires delivered, 35% were sent back. RESULTS: Diagnostic hysteroscopy is performed in 78% of centers. In clinical stage I, 52% adopt a laparotomic access, 15% totally laparoscopic, 9% laparoscopic/vaginal, 2% vaginal, 22% tailored approach. Elective use of laparoscopy significantly differs between institutions (p < 0.001): 40% (≥20 EC/yr) vs. 12% (<20). Pelvic and aortic lymphadenectomy is selectively performed by 77% and 68% of centers, respectively, depending on pre/intraoperative factors. Non-endometrioid histology, poor-grade and deep myoinvasion are indicated as the highest-risk factors. Adjuvant therapy is given to pathologically node-negative patients by 60%, and to intermediate-risk patients by 47%. Elective adjuvant treatment is still radiotherapy, but chemotherapy is adopted, mostly combined with radiation, by 40%. There is a multidisciplinary team in 64% of centers, but in 59% adjuvant treatment is to be administered outside the institution. CONCLUSIONS: These data demonstrate a significant improvement in the clinical care achieved over the last decades in Italy. Centralization of EC treatment would not be feasible neither useful. High-risk cases could be selected by an appropriate clinical screening, and these only referred to reference centers.