The Prognostic Impact of Time Interval Between Hysterectomy and Initiation of Adjuvant Radiation Treatment in Women With Early-Stage Endometrial Carcinoma

2020 ◽  
Vol 108 (3) ◽  
pp. e472
Author(s):  
S. Zhu ◽  
R. Khalil ◽  
O. Altairy ◽  
C. Burmeister ◽  
I. Dimitrova ◽  
...  
Keyword(s):  
Endometrial Carcinoma ◽  
Radiation Treatment ◽  
Early Stage ◽  
Time Interval ◽  
Adjuvant Radiation ◽  
Prognostic Impact

Increased risk of recurrence in early-stage endometrial carcinoma after delays in adjuvant radiation treatment

2020 ◽  
Vol 31 (1) ◽  
pp. 73-77
Author(s):  
Simeng Zhu ◽  
Remonda Khalil ◽  
Osama Altairy ◽  
Charlotte Burmeister ◽  
Irina Dimitrova ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Endometrial Carcinoma ◽  
Radiation Treatment ◽  
Early Stage ◽  
Time Interval ◽  
Adjuvant Radiation ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Adjuvant Radiation Therapy ◽  
Disease Specific

ObjectiveThe benefits of adjuvant radiation treatment after hysterectomy have been confirmed in select patients with early-stage endometrial carcinoma. The goal of this study was to evaluate the prognostic impact of the time interval between hysterectomy and starting adjuvant radiation treatment in patients with early-stage endometrial carcinoma.MethodsOur database was searched for women with early-stage endometrioid endometrial cancer who received adjuvant radiation therapy after hysterectomy. The patients were classified into two groups based on the time interval to adjuvant radiation therapy (≤8 weeks or >8 weeks) after hysterectomy. Recurrence-free survival, disease-specific survival, and overall survival were compared between the two groups.ResultsFour hundred and sixty patients were identified. Median follow-up was 70.5 months (range 1–360). One hundred and seventy-six patients (38%) were 2009 International Federation of Gynecology and Obstetrics stage IA, 207 (45%) stage IB, and 77 (17%) stage II. Three hundred and fifty-four women (77%) received adjuvant radiation therapy within 8 weeks after hysterectomy. There was no statistically significant difference between the two groups in baseline demographics, disease and treatment characteristics, except for the modality of adjuvant radiation therapy. Patients who received adjuvant radiation therapy within 8 weeks experienced significantly less disease recurrence (9% vs 18%; p=0.01) and particularly less isolated vaginal recurrence (0% vs 6%, p=0.04). Five-year recurrence-free survival was 89% versus 80% (p=0.04), 5-year disease-specific survival was 93% for both groups, and 5-year overall survival was 86% versus 85% for patients who received adjuvant radiation therapy ≤8 and >8 weeks, respectively (p=0.88).ConclusionOur study suggests that delaying adjuvant radiation therapy beyond 8 weeks after hysterectomy is associated with significantly more cancer recurrences for women with early-stage endometrial carcinoma.

Predictors of Survival After Recurrence in Women With Early-Stage Endometrial Carcinoma

2016 ◽  
Vol 26 (6) ◽  
pp. 1137-1142 ◽  
Author(s):  
Yiqing Xu ◽  
Charlotte Burmeister ◽  
Rabbie K. Hanna ◽  
Adnan Munkarah ◽  
Mohamed A. Elshaikh
Keyword(s):  
Endometrial Carcinoma ◽  
Cox Regression ◽  
Radiation Treatment ◽  
Early Stage ◽  
Pelvic Recurrence ◽  
Study Cohort ◽  
Adjuvant Radiation ◽  
Endometrioid Carcinoma ◽  
Entire Study ◽  
Cox Regression Analysis

ObjectiveFactors predictive of survival after recurrent early-stage endometrial carcinoma have not been thoroughly investigated. The purpose of this study was to explore factors that impact disease-specific survival (DSS) and overall survival (OS) after recurrence in women with early-stage endometrial carcinoma.Materials and MethodsAfter institutional review board approval, we identified 104 women with 2009 International Federation of Gynecology and Obstetrics stage I to II uterine endometrioid carcinoma who developed disease recurrence between January 1990 and December 2014. The Kaplan-Meier approach and Cox regression analysis were used to assess DSS and OS after recurrence and to determine factors influencing these survival end points.ResultsMedian age of the study cohort was 65 years with a median follow-up time of 42.8 months after hysterectomy. Median time to recurrence was 15.8 months. Recurrences were diagnosed in 60 patients (57.7%) who were originally managed with observation after hysterectomy and in 44 patients (42.3%) who were initially managed with adjuvant radiation treatment. Fifty-six patients (54%) had pelvic recurrence (vaginal and/or pelvic), whereas 48 (46%) had extrapelvic recurrence. Five-year DSS and OS for the entire study population was 44% and 37%, respectively. Five-year DSS and OS were longer for patients with pelvic recurrence compared with patients with extrapelvic recurrence (66% vs 18% and 55% vs 17%, P < 0.0001). Five-year DSS was also longer for radiation-naive patients than for radiation-treated patients (51% vs 34%, P = 0.023). On multivariate analysis of DSS and OS, pelvic recurrence (P < 0.001) was the only significant predictor of longer DSS and OS.ConclusionsIn women with recurrent early-stage endometrioid carcinoma, our study suggests that site of recurrence (pelvic vs extra pelvic) is the only predictor of survival. In addition, we found that radiation naivete and pelvic recurrence correlated with longer DSS and OS.

Salvage Versus Adjuvant Radiation Treatment for Women With Early-Stage Endometrial Carcinoma

2016 ◽  
Vol 26 (2) ◽  
pp. 307-312 ◽  
Author(s):  
Sean Vance ◽  
Charlotte Burmeister ◽  
Nabila Rasool ◽  
Thomas Buekers ◽  
Mohamed A. Elshaikh
Keyword(s):  
Endometrial Carcinoma ◽  
Radiation Treatment ◽  
Early Stage ◽  
Adjuvant Radiation

Patterns of Recurrence in Stage I Endometrioid Endometrial Adenocarcinoma With Lymphovascular Space Invasion

2013 ◽  
Vol 23 (1) ◽  
pp. 98-104 ◽  
Author(s):  
Fiona Simpkins ◽  
Andrea Papadia ◽  
Charles Kunos ◽  
Chad Michener ◽  
Heidi Frasure ◽  
...  
Keyword(s):  
Radiation Treatment ◽  
Early Stage ◽  
Endometrial Adenocarcinoma ◽  
Myometrial Invasion ◽  
Adjuvant Radiation ◽  
Recurrence Rates ◽  
Stage Ib ◽  
Gynecology And Obstetrics ◽  
Patterns Of Recurrence ◽  
Related Survival

ObjectiveThe objective of this study was to determine the patterns of recurrence of stage IB–IIA endometrioid endometrial adenocarcinoma (EMCA) with lymphovascular invasion (LVSI).MethodsA multicenter retrospective study of 1988 International Federation of Gynecology and Obstetrics stage IB–IIA EMCA patients with LVSI treated with surgery with or without radiation was conducted. Those with papillary serous or clear cell histologies and women treated with chemotherapy were excluded. Data regarding surgical-pathologic factors, treatment, and outcome were collected. Data were analyzed using χ2test, Kaplan-Meier estimates, and Cox multivariate proportional hazards models.ResultsFrom 1997 to 2008, we identified 131 patients with LVSI who met entry criteria among 5 institutions. Median age was 67 years (25%–75%: 60–75 years), and median follow-up was 4.25 years (25%–75%: 3–10 years). Following surgery, 45 patients were observed (Obs), and 86 patients received adjuvant radiation. We observed 30 total relapses 30/131 (23%): 11/45 (24%) in the Obs group and 19/86 (22%) in the adjuvant radiation group. Recurrence rates were similar between staged and unstaged patients: 24% (20/84) and 21% (10/47), respectively. Among Obs patients, 82% of relapses were local, whereas in patients treated with adjuvant radiation, 84% were distant. Relapses were significantly associated with invasion of the lower uterine segment (LUS) (P= 0.035). Both cancer-related survival and overall survival (OS) were not significantly impacted by adjuvant radiation, because of distant failure rates. Adjuvant radiation significantly improved pelvic control (P= 0.007). In a multivariate analysis, OS correlated with LUS invasion (P= 0.008) and was borderline-associated with stage (P= 0.06), whereas age (P= 0.12), grade (P= 0.31), myometrial invasion (P= 0.99), and radiation treatment (P= 0.23) were not.ConclusionsOverall recurrence rates for stage IB–IIA EMCA patients with LVSI are high (23%). Although adjuvant radiation therapy improved pelvic control, it did not impact recurrence rates, cancer-related survival, and OS, likely secondary to distant failures. The role of systemic therapy with or without radiotherapy for early-stage EMCA with LVSI should be evaluated, particularly in patients with high-grade tumors or involvement of the LUS.

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