GYNECOLOGIC

ONCOLOGY

3, I03- 107 ( 1975)

The Value of Hysterogram of Endometrial

for the Prognosis Cancer

J. P. WOLFF, E. GOLDFARB,CL.RUMEAU-ROUQUETTE, AND G.BREART Department of Gynecology, Institut Gustave-Roussy, Paris, France Received January 20, 1975 The study of cancer of the uterine body, using hysterography performed before any treatment and after the first exposure to radium, shows that the following factors have a clear prognostic value: Volume of the endometrial cavity before treatment; volume of the tumor before treatment; decrease of the cavity, after the first exposure to radium; decrease of the tumor volume after the first exposure to radium. In addition, this study confirms the efficiency of preoperative radiotherapy in endometrial cancers.

Most cancers of the uterine body are diagnosed when the lesion in still confined to the endometrial cavity (T,) but their course is often quite different from one case to another. The purpose of this paper is to evaluate the prognostic factors that hysterography could alford. In 240 adenocarcinomas of the uterine body treated at the Gustave-Roussy Institute from 1949 to 1964, 175 patients underwent hysterography before treatment, and 82 patients between the two exposures to radium (the treatment included an initial phase in two sessions: an endouterine exposure followed, 3 wk later, by an uterovaginal one). After that initial phase, the patient underwent surgery or a secondary external irradiation according to the possibilities. The following factors have been studied: Uterus. Whole volume of the cavity; volume of the endometrial cavity; volume of the endocervical cavity; changes after the first endouterine exposure to radium Tumor. Type (fungating, infiltrating, multifocal); volume (maximum diameter and its perpendicular dimension); localization; changes after the first endouterine exposure to radium. RESULTS Results as a whole are shown in Tables 1 and 2. These tables show:

(1) that the length of the uterus including the endometrial and endocervical cavity became shortened after the first exposure to radium; (2) that, in most instances, the tumor is fungating and its volume often decreases after the first exposure to radium; (3) the uterine fundus is invaded in 70% of cases and, in most instances, this invasion is accompanied by an extension to one or both horns, to the anterior, posterior, or lateral uterine wall; (4) Rarely is the isthmus or the en103 Copyright @ 1975 by Academic Press, Inc. All rights of reproduction in any form reserved.

104

WOLFF

ET AL.

TABLE

1

HYSTEROGRAPHY:

cavity

Length of the endocervical

cavity

TABLE

Tumor

Perpendicular dimension to maximum diameter

TABLE SURVIVAL

Observed Survival

TUMOR

Fungating Infiltrating Infiltrating and fungating Multifocal or diffuse Before treatment After treatment Before treatment After treatment

diameter

(yr)

3

AS A WHOLE

survival

%

1811220 1301217 119/213

82 60 54

82 62 59

TABLE SURVIVAL

RATE

4 ACCORDING

Age W

rate

73% 71% 52% 32%

TABLE

Whole uterine cavity Endocervical cavity Endometrial cavity

TO AGE

Adjusted survival

550 5 l-60 61-70 >70

Length (mean)

Adjusted survival

%

ADJUSTED

VALUE

8% 2% 18% 8 Cases 36 mm (Mean) 13 mm 21 mm 10 mm

Number of cases

1 3 5

PROGNOSTIC

mm (Mean) mm mm mm mm mm

2

HYSTEROGRAPHY:

Tumor Maximum

71 60 43 35 28 25

Before treatment After treatment Before treatment After treatment Before treatment After treatment

Whole length Length of the endometrial

UTERUS

OF THE UTERINE

Survival

5

LENGTH

5 yr 69 mm No significant modification 41 mm

Significance No Yes

HYSTEROGRAPHY

IN ENDOMETRIAL TABLE

CANCER

10.5

DIAGNOSIS

6

PROGNOSTICVALUE OF THE TUMOR VOLUME ACCORDINGTO HYSTEROGRAPHY Survival

Maximum

diameter of the tumor