Improved survival with adjuvant brachytherapy in stage IA endometrial cancer of unfavorable histology

ObjectiveTo evaluate trends in use of radiation therapy and its impact on overall survival in low- and high-grade stage I endometrioid endometrial carcinoma.MethodsPatients with stage I endometrial cancer who underwent hysterectomy from 2004 to 2013 were identified through the National Cancer Database and classified as: stage IA G1/2, stage IA G3, stage IB G1/2, and stage IB G3. Trends in use of vaginal brachytherapy and external beam radiation therapy were assessed. Overall survival was measured from surgery and estimated using the Kaplan-Meier method. The effect of radiation therapy on overall survival was assessed within each stage/grade group using Cox proportional hazards analysis in propensity-matched treatment groups.ResultsA total of 132 393 patients met inclusion criteria, and 81% of patients had stage IA and 19% had stage IB endometrial cancer. Adjuvant therapy was administered in 18% of patients: 52% received vaginal brachytherapy, 30% external beam radiation therapy, and 18% chemotherapy ±radiation therapy. External beam radiation therapy use decreased from 9% in 2004 to 4% in 2012, while vaginal brachytherapy use increased from 8% to 14%. Stage IA G1/2 patients did not benefit from either external beam radiation therapy or vaginal brachytherapy, while administration of vaginal brachytherapy improved overall survival in stage IB G1/2 compared with no treatment (p<0.0001). In stage IB G1/2 and stage IA G3, vaginal brachytherapy was superior to external beam radiation therapy (p=0.0004 and p=0.004, respectively). Stage IB G3 patients had improved overall survival with either vaginal brachytherapy or external beam radiation therapy versus no treatment but no difference in overall survival was seen between vaginal brachytherapy and external beam radiation therapy (p=0.94).ConclusionsThe delivery of adjuvant radiation therapy in patients with stage IA G1/2 endometrial carcinoma is not associated with improvement in overall survival. Patients with stage IB G1/2 and G3 as well as stage IA G3 are shown to benefit from improved overall survival when adjuvant radiation therapy is administered. These findings demonstrate potential opportunities to reduce both overtreatment and undertreatment in stage I endometrial cancer patients.

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The Revised 2009 FIGO Staging System for Endometrial Cancer: Should the 1988 FIGO Stages IA and IB Be Altered?

International Journal of Gynecological Cancer ◽

10.1097/igc.0b013e31820cc305 ◽

2011 ◽

Vol 21 (3) ◽

pp. 511-516 ◽

Cited By ~ 31

Author(s):

Nadeem R. Abu-Rustum ◽

Qin Zhou ◽

Alexia Iasonos ◽

Kaled M. Alektiar ◽

Mario M. Leitao ◽

...

Keyword(s):

Endometrial Cancer ◽

Prediction Models ◽

Predictive Ability ◽

Staging System ◽

Stage I ◽

Oncologic Outcomes ◽

Figo Staging ◽

Primary Surgery ◽

Gynecology And Obstetrics ◽

Stage Ia

ObjectivesThe revised 2009 International Federation of Gynecology and Obstetrics (FIGO) staging system for endometrial cancer included many changes over the 1988 system, particularly for stage I subgroups. We sought to describe the overall survival (OS) of women with stage I endometrial cancer and examine how the estimated stage-specific OS is altered in the 2009 system.MethodsA prospectively maintained institutional endometrial database was analyzed. All patients underwent primary surgery between January 1993 and June 2009.ResultsData from 1658 women were analyzed, including 1307 patients with FIGO 1988 stage I disease. The 5-year OS for the 1988 stages IA (92.4%), IB (87.3%), and IC (75.7%) significantly differed (P < 0.001). When patients were restaged using the 2009 system, we identified 1411 stage I patients with 5-year OS for 2009 stage IA of 89.2%, versus OS of 75.1% for IB (P = 0.001). The adjusted concordance probabilities for the 1988 stage I group and 2009 stage I group were 0.612 (SD, 0.0014) and 0.536 (SD, 0.0111), respectively.ConclusionsThe 1988 FIGO classification of stage I endometrial cancer correctly identified 3 subgroups of patients who had significantly different OS. Specifically, 1988 FIGO stages IA and IB had distinct oncologic outcomes. The revised 2009 system eliminates the most favorable group from the new classification system, and estimates of stage-specific OS for stage IB are substantially altered by the changes made in 2009. The revised system for stage I did not improve its predictive ability over the 1988 system. These data highlight the importance of developing individualized risk-prediction models and nomograms in endometrial cancer.

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Survival after stage IA endometrial cancer; can follow-up be altered? A prospective nationwide Danish survey

Acta Obstetricia Et Gynecologica Scandinavica ◽

10.1111/j.1600-0412.2012.01438.x ◽

2012 ◽

Vol 91 (8) ◽

pp. 976-982 ◽

Cited By ~ 25

Author(s):

HENRIK LAJER ◽

SANDRA ELNEGAARD ◽

RENÉ D. CHRISTENSEN ◽

GITTE ORTOFT ◽

DORIS E. SCHLEDERMANN ◽

...

Keyword(s):

Endometrial Cancer ◽

Stage Ia ◽

Danish Survey

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Low-dose adjuvant vaginal cylinder brachytherapy for early-stage non-endometrioid endometrial cancer: recurrence risk and survival outcomes

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-001623 ◽

2020 ◽

Vol 30 (12) ◽

pp. 1908-1914

Author(s):

Alicia Smart ◽

Daniela Buscariollo ◽

Gabriela Alban ◽

Ivan Buzurovic ◽

Teresa Cheng ◽

...

Keyword(s):

Overall Survival ◽

Endometrial Cancer ◽

Lymphovascular Invasion ◽

Low Dose ◽

Early Stage ◽

Pelvic Recurrence ◽

High Dose ◽

Recurrence Rates ◽

Stage Ia ◽

Endometrioid Endometrial Cancer

ObjectiveThe aim of this study was to evaluate recurrence patterns and survival outcomes for patients with early-stage non-endometrioid endometrial adenocarcinoma treated with adjuvant high-dose rate vaginal brachytherapy with a low-dose scheme.MethodsA retrospective review was performed of patients with International Federation of Gynecology and Obstetrics (FIGO) stage I–II non-endometrioid endometrial cancer who received adjuvant vaginal brachytherapy with a low-dose regimen of 24 Gy in six fractions from November 2005 to May 2017. All patients had >6 months of follow-up. Rates of recurrence-free survival, overall survival, vaginal, pelvic, and distant recurrence were calculated by the Kaplan–Meier method. Prognostic factors for recurrence and survival were evaluated by Cox proportional hazards modeling.ResultsA total of 106 patients were analyzed. Median follow-up was 49 months (range 9–119). Histologic subtypes were serous (47%, n=50), clear cell (10%, n=11), mixed (27%, n=29), and carcinosarcoma (15%, n=16). Most patients (79%) had stage IA disease, 94% had surgical nodal assessment, and 13% had lymphovascular invasion. Adjuvant chemotherapy was delivered to 75%. The 5-year recurrence-free and overall survival rates were 74% and 83%, respectively. By histology, 5-year recurrence-free/overall survival rates were: serous 73%/78%, clear cell 68%/88%, mixed 88%/100%, and carcinosarcoma 56%/60% (p=0.046 and p<0.01). On multivariate analysis, lymphovascular invasion was significantly associated with recurrence (HR 3.3, p<0.01). The 5-year vaginal, pelvic, and distant recurrence rates were 7%, 8%, and 21%, respectively. Vaginal and pelvic recurrence rates were highest for patients with carcinosarcoma, lymphovascular invasion and/or FIGO stage IB/II disease. At 5 years, vaginal and pelvic recurrence rates for patients with lymphovascular invasion were 33% and 40%, respectively. Patients with stage IA disease or no lymphovascular invasion had 5-year vaginal recurrence rates of 4% and pelvic recurrence rates of 6% and 3%, respectively.ConclusionsAdjuvant high-dose rate brachytherapy with a low-dose scheme is effective for most patients with early-stage non-endometrioid endometrial cancer, particularly stage IA disease and no lymphovascular invasion. Pelvic radiation therapy should be considered for those with carcinosarcoma, lymphovascular invasion and/or stage IB/II disease.

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Association of adjuvant therapy in early-stage low-risk endometrial cancer with increased mortality: A statewide cancer registry analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.5095 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 5095-5095

Author(s):

Michael R. Milam ◽

Bin Huang ◽

Mana Moghadamfalahi ◽

Lynn Parker ◽

Daniel Metzinger ◽

...

Keyword(s):

Endometrial Cancer ◽

Adjuvant Therapy ◽

Cancer Registry ◽

Cox Regression ◽

Early Stage ◽

Low Risk ◽

Cox Regression Analysis ◽

Increased Risk ◽

Stage Ia ◽

Registry Analysis

5095 Background: National Comprehensive Cancer Network (NCCN) guidelines state that patients with early stage low risk endometrial cancer (defined with 2009 criteria as stage IA endometrioid endometrial cancer) may be managed with observation with consideration of adjuvant therapy.The premise of this study is to review the patterns of care of those patients who received adjuvant therapy and its impact on survival. Methods: This is a retrospective cohort analysis of 1044 women from 2004-2008 in the Kentucky Cancer Registry (KCR) one of the affiliates utilized in the Surveillance, Epidemiology and End Results (SEER) Program database. Inclusion criteria for the patients in this analysis were those women with 2009 Stage IA uterine cancer of endometrioid histology, moderate and well differentiated tumor grade, who received definitive primary surgery. Adjuvant therapy was defined as any postoperative radiotherapy and/or chemotherapy after definitive surgical treatment. Patients with adjuvant therapy after surgery (AT) were compared to those patients who underwent surgery only (SO). Chi-square tests were used to identify associations between type of treatment and clinical/demographic factors. K-M plots and Cox regression models were used to examine survival between the two treatment groups. Results: 5.3% (55/1044) of patients with early stage low risk endometrial cancer were treated with AT compared to 94.7% (989/1044) of SO patients.No statistical differences in mean age, race, tumor size, smoking status, insurance status, lymph node dissection and gynecologic oncology care were found among the AT or SO groups. Five year survival was significantly better in the SO cohort compared to the AT cohort (92% alive at 5 years for SO vs. 66% alive at 5 years; p<0.0001). Controlling for other confounders in the multivariate Cox regression analysis, SO patients had substantially less risk for death compared to the AT groups (HR: 0.21; 95%CI 0.12-0.38; p<0.0001). Conclusions: In this statewide cancer registry analysis, adjuvant therapy after surgery in early stage low risk endometrial cancer patients is uncommon and is associated with an increased risk of mortality.

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Indications and choice of adjuvant treatment for stage IA G1 endometrioid endometrial cancer with myometrial invasion

Онкогинекология ◽

10.52313/22278710_2018_3_45 ◽

2018 ◽

pp. 45-54

Author(s):

S.A. Mavrichev

Keyword(s):

Endometrial Cancer ◽

Adjuvant Treatment ◽

Myometrial Invasion ◽

Stage Ia ◽

Endometrioid Endometrial Cancer

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The Prognosis of Stage IA Mixed Endometrial Carcinoma

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqz083 ◽

2019 ◽

Vol 152 (5) ◽

pp. 616-624 ◽

Cited By ~ 3

Author(s):

Wenhui Li ◽

Lei Li ◽

Ming Wu ◽

Jinghe Lang ◽

Yalan Bi

Keyword(s):

Overall Survival ◽

Endometrial Cancer ◽

Endometrial Carcinoma ◽

Disease Free Survival ◽

Survival Outcomes ◽

Group A ◽

Stage Ia ◽

Definition Of ◽

Group B ◽

Endometrial Carcinomas

AbstractObjectivesTo explore the survival and definition of stage IA mixed endometrial carcinoma.MethodsFrom June 1, 2010, to June 1, 2017, cases with stage IA endometrial cancer were included in this study. The survival outcomes were compared among patients with endometrioid (group A), nonendometrioid (group B), and mixed subtypes (group C) and among patients with different proportions of nonendometrioid components (<5%, >50%, and others).ResultsIn total, 890 cases were included, comprising 808 (90.8%), 33 (3.7%), and 47 (5.3%) cases in groups A, B, and C, respectively. After a median follow-up of 55.9 months, groups B and C had significantly more inferior disease-free survival, overall survival, and cancer-specific overall survival. Patients with a nonendometrioid proportion of more than 50% and serous subtype also had a significantly more inferior prognosis. Adjuvant therapy could improve the prognosis in mixed endometrial carcinomas.ConclusionsPatients with endometrial cancer of mixed subtypes had inferior survival outcomes.

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