The Role of Intravaginal Brachytherapy in Surgically-Staged 1988 Figo Stage IC Grade 3 Endometrial Cancer

AbstractBackgroundThe aim of the study was to determine if the endometrial tumor volume (TV) measured by magnetic resonance imaging (MRI-TV) is associated with survival in endometrial cancer and lymph nodes metastases (LN+).Patients and methodsWe evaluated the MRI imaging and records of 341 women with endometrial cancer and preoperative MRI from 2008 to 2018. The MRI-TV was calculated using the ellipsoid formula measuring three perpendicular tumor diameters. Tumor myometrial invasion was also analyzed.ResultsHigher MRI-TV was associated with age ≥ 65y, non-endometrioid tumors, grade-3, deep-myometrial invasion, LN+ and advanced FIGO stage. There were 37 patients with LN+ (8.8%). Non-endometrioid tumors, deep-myometrial invasion, grade-3 and MRI-TV ≥ 10 cm3 were the factors associated with LN+. Using a receiver operating characteristic [ROC] curve, the MRI-TV cut-off for survival was 10 cm3 (area under curve [AUC] = 0.70; 95% CI: 0.61–0.73). 5 years disease-free (DFS) and overall survival (OS) was significantly lower in MRI-TV ≥ 10 cm3 (69.3% vs. 84.5%, and 75.4% vs. 96.1%, respectively). MRI-TV was considered an independent factor of DFS (HR: 2.20, 95% CI: 1.09–4.45, p = 0.029) and OS (HR: 3.88, 95% CI: 1.34–11.24, p = 0.012) in multivariate analysis.ConclusionsMRI-TV was associated with LN+, and MRI-TV ≥ 10 cm3 was an independent prognostic factor of lower DFS and OS. The MRI-TV can be auxiliary information to plan the surgery strategy and predict the adjuvant treatment in women with endometrial cancer.

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Sacral metastases in an endometrial cancer patient after treatment with sequential chemo-radiotherapy: A case report

Archive of oncology ◽

10.2298/aoo1002038b ◽

2010 ◽

Vol 18 (1-2) ◽

pp. 38-39

Author(s):

Christopher Bryant ◽

Jay Shah ◽

Sanjeev Kumar ◽

Adnan Munkarah ◽

Robert Morris ◽

...

Keyword(s):

Endometrial Cancer ◽

High Risk ◽

Early Stage ◽

Case Reports ◽

Combined Modality Therapy ◽

Endometrial Adenocarcinoma ◽

Figo Stage ◽

Therapeutic Modality ◽

Risk Patients ◽

Grade 3

The incidence of bone metastases in endometrial cancer is reported to occur in less than 15% of patients with metastatic disease. The medical literature is limited to only case reports, although none describing a sacral recurrence after adjuvant chemo-radiation therapy. We present the case of a 64-year-old woman who underwent surgery for endometrial adenocarcinoma followed by 'sandwich' chemoradiation therapy at our institution, July 2006 (FIGO stage IB grade 3). In spite of adjuvant therapy, which was delivered in August 2008 the patient, developed an isolated sacral recurrence. The optimal therapeutic modality for endometrial cancer patients with high-risk disease remains controversial. The increasing use of combined modality therapy for early stage, high-risk patients may produce different recurrence patterns than described in historical controls.

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Postoperative Radiation Therapy for Endometrial Cancer: American Society of Clinical Oncology Clinical Practice Guideline Endorsement of the American Society for Radiation Oncology Evidence-Based Guideline

Journal of Clinical Oncology ◽

10.1200/jco.2015.62.5459 ◽

2015 ◽

Vol 33 (26) ◽

pp. 2908-2913 ◽

Cited By ~ 52

Author(s):

Larissa A. Meyer ◽

Kari Bohlke ◽

Matthew A. Powell ◽

Amanda N. Fader ◽

Gregg E. Franklin ◽

...

Keyword(s):

Radiation Therapy ◽

Endometrial Cancer ◽

Radiation Oncology ◽

Myometrial Invasion ◽

Adjuvant Radiation ◽

Postoperative Radiation Therapy ◽

Grade 3 ◽

American Society ◽

Evidence Based Guideline

Purpose To provide guidance on the role of adjuvant radiation therapy in the treatment of endometrial cancer. Methods “The Role of Postoperative Radiation Therapy for Endometrial Cancer: An ASTRO Evidence-Based Guideline” by Klopp et al, published in 2014 in Practical Radiation Oncology, was reviewed for developmental rigor by methodologists. The American Society for Radiation Oncology (ASTRO) guideline content and recommendations were further reviewed by the American Society of Clinical Oncology (ASCO) Endorsement Panel. Results The ASCO Endorsement Panel determined that the recommendations from the ASTRO guideline are clear, thorough, and based on the most relevant scientific evidence. ASCO endorsed the ASTRO guideline with several qualifying statements. Recommendations Surveillance without adjuvant radiation therapy is a reasonable option for women without residual disease in the hysterectomy specimen and for women with grade 1 or 2 cancer and < 50% myometrial invasion, especially when no other high-risk features are present. For women with grade 1 or 2 cancer and ≥ 50% myometrial invasion or grade 3 cancer and < 50% myometrial invasion, vaginal brachytherapy is as effective as pelvic radiation therapy at preventing vaginal recurrence and is preferred. Patients with grade 3 cancer and ≥ 50% myometrial invasion or cervical stroma invasion may benefit from pelvic radiation to prevent pelvic recurrence. For women with high-risk early-stage disease and advanced disease, the ASCO Endorsement Panel added qualifying statements to the ASTRO recommendations to provide stronger statements in favor of chemotherapy (with or without radiation therapy).

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Prevalence and clinical implications of mismatch repair (MMR) deficiency in unselected non-serous epithelial ovarian cancer (EOC) patients (pts).

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.1521 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 1521-1521

Author(s):

Mariana Scaranti ◽

Krithika Murali ◽

Cecilia Orbegoso ◽

Katherine Vroobel ◽

Susana N. Banerjee ◽

...

Keyword(s):

Ovarian Cancer ◽

Endometrial Cancer ◽

Significant Proportion ◽

Disease Free Survival ◽

Figo Stage ◽

Significant Difference ◽

Serous Epithelial Ovarian Cancer ◽

Average Body Mass ◽

Mixed Histology

1521 Background: It has previously been reported that 6-7% of clear cell (CC) and endometrioid (E) ovarian cancers are MMR deficient (MMRd). The prevalence of MMRd in other histological subtypes and correlation with germline (g) MMR (Lynch Syndrome) mutations in unselected non-serous EOC pts is less clear. MMRd in solid tumors has been associated with enhanced response to immunotherapy, hence knowledge of MMR status has therapeutic and familial implications. We aimed to study the prevalence and implications of MMRd and gMMRd in unselected pts with non-serous EOC. Methods: Routine immunohistochemistry (IHC) was performed for the MMR proteins MLH1, MSH2, MSH6 and PMS2 in all non-serous EOC pts from June 2016; retrospective MMR IHC testing in pts in follow-up was performed. Pts with MMRd tumors were referred for gMMR testing. Results: We analyzed 66 unselected pts with non-serous EOC. Median age was 56.4 years (yrs). The majority had E ovarian cancer (54.5%) followed by CC (25.8%), mixed histology (12.1%), mucinous (4.5%) and mullerian (3%) subtypes. Endometriosis was noted in 45.5% of pts, and 75% were FIGO stage I and II at diagnosis. Seventeen pts (25.8%) had concurrent endometrial cancer, all Grade I. On IHC, 15.2% were MMRd: 5 E, 2 CC, 2 mixed and 1 mullerian-type. Of these, 3 pts (30%) had gMMR mutation, 2/3 did not meet the Revised Bethesda criteria for testing. A lower average body mass index (Kg/m2) was noted in MMRd 25.9 versus 30.1 in MMR proficient (MMRp). Median age at diagnosis was 53.5 yrs in the MMRd and 57.7 yrs in MMRp. A higher frequency of concurrent endometrial cancer was observed on the MMRd group (60%) versus (20%) on MMRp (p = 0.007). No statistically significant difference in overall survival or disease-free survival was observed between the MMRd and MMRp population. Conclusions: Our study has shown a higher prevalence of somatic MMRd in non-serous EOC (15.2%) than in previously published literature with a significant proportion found to carry gMMR mutations (4.5%). These interim findings support the role of universal MMR IHC testing in non-serous EOC regardless of family history. [Table: see text]

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Adjuvant carboplatin and paclitaxel chemotherapy followed by radiotherapy in high-risk endometrial cancer: A retrospective analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e17115 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e17115-e17115

Author(s):

Renata RC Colombo Bonadio ◽

Renata Gondim Meira Velame Azevedo ◽

Guilherme Harada ◽

Vanessa Costa Miranda ◽

Patricia Alves de Oliveira Ferreira ◽

...

Keyword(s):

Endometrial Cancer ◽

Prognostic Factors ◽

High Risk ◽

Retrospective Analysis ◽

Disease Free Survival ◽

Figo Stage ◽

Cancer Center ◽

Peritoneal Cytology ◽

Hematologic Toxicity ◽

Grade 3

e17115 Background: It remains unclear which is the best chemotherapy (CT) regimen and what is the role of adding radiotherapy (RT) to adjuvant CT in high-risk endometrial cancer. Methods: We performed a retrospective analysis of the patients (pts) with high-risk endometrial cancer (endometrioid histology stages III-IVA or carcinossarcoma/ clear cells/ serous histology stages I-IVA) treated with adjuvant carboplatin (AUC 5) and paclitaxel (175 mg/m2), every 3 weeks, for 6 cycles, followed by RT (conformal external beam radiotherapy to pelvic or pelvic and paraortic fields with 45Gy-54Gy plus weekly vaginal brachytherapy with 20Gy in 4 fractions). Pts were treated from 2010 to 2016 at a Brazilian public cancer center. Medical records were reviewed for demographic, clinicopathologic and outcome information. Data was analyzed for overall survival (OS), disease-free survival (DFS), prognostic factors and toxicity. The Kaplan-Meier method was used for survival analysis and Cox proportional hazard model for prognostic factors. Results: 146 consecutive pts were evaluated. Median age was 62 years (range 35-81). Most patients had ECOG 0-1 (98%), endometrioid (53%) or serous histology (26%), grade 3 tumor (57%) and FIGO stage III (77%). Median follow-up was 26.5 months. The OS rates were 85% (95% CI 75 – 91%) in 3 years and 73% (95% CI 58 – 84%) in 5 years. Factors that significantly affected OS in a multivariate analysis were FIGO stage (p = .009), pelvic lymphadenectomy (yes vs no, p = .023) and positive peritoneal cytology (yes vs no, p = .002). 3-year and 5-year DFS rates were 79% (95% CI 70 – 86%) and 68% (95% CI 52 – 80%), respectively. The initial site of recurrence was limited to the pelvis in 3% of the pts, within the abdomen in 1% and extra-abdominal in 11%. Grade 3/4 AEs occurred in 47% of the pts and were mainly hematologic toxicity (43%). There were only 3 cases of febrile neutropenia and 4 cases of hospitalization due to toxicity. Conclusions: Our data suggests that adjuvant carboplatin and paclitaxel, followed by RT, in high-risk endometrial cancer is safe and effective. Low rates of pelvic recurrence were observed, which might be explained by the addition of RT to adjuvant CT.

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A protocol with adjuvant chemotherapy (CT) and radiotherapy (RT) for endometrial cancer: Results.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e16549 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e16549-e16549

Author(s):

Margarita Romeo ◽

Laia Capdevila ◽

Sara Cros ◽

Antoni Tarrats ◽

Maya Takeuchi ◽

...

Keyword(s):

Endometrial Cancer ◽

Statistical Significance ◽

Acute Diarrhoea ◽

Phase Iii ◽

Kaplan Meier ◽

Key Points ◽

Phase Iii Trials ◽

Advanced Stages ◽

Grade 3

e16549 Background: The classic adjuvant treatment for high-risk endometrial cancer is RT. Several phase III trials explored the role of CT, as single treatment or added to RT sequentially (ST) or concurrently (CR), but design heterogeneity hampers conclusions. We report the results of a single-institution protocol with adjuvant CT + RT for advanced stages or type II histologies. Key points: (1) ST and CR permitted. (2) CT used pre-, post- and/or during RT: carboplatin AUC 5 + paclitaxel 175 mg/m2 (150 during RT) Q3W, 4-6 cycles (“carbotaxol”). (3) since 2010, cisplatin 50 mg/m2 was used for CR (on day 1 and 28 of RT). CR was preceded/followed by carbotaxol. Methods: All patients (PT) included in the protocol between 1/2005 and 9/2011 were retrospectively revised. Endpoints were survival and toxicity grade 3-4. Kaplan Meier and Fisher test were used. Conclusions: CR-carbotaxol showed a longer progression-free and overall survival than ST without reaching statistical significance (log rank, p= 0.14 and p=0.33). Median survivals with CR-cisplatin were not reached because of shorter follow-up. Statistical differences in toxicities were not found. In the CR-carbotaxol arm, 5 PT had grade 3-4 acute diarrhoea vs none in the others. [Table: see text]

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The role of adjuvant chemotherapy in FIGO stage IB grade 3 endometrial endometrioid adenocarcinoma treated with surgery and postoperative radiotherapy

Gynecologic Oncology ◽

10.1016/s0090-8258(21)01229-4 ◽

2021 ◽

Vol 162 ◽

pp. S303-S304

Author(s):

Leonid Reshko ◽

Jeremy Gaskins ◽

Sara Dryden ◽

Daniel Metzinger ◽

Sarah Todd ◽

...

Keyword(s):

Adjuvant Chemotherapy ◽

Postoperative Radiotherapy ◽

Figo Stage ◽

Endometrioid Adenocarcinoma ◽

Stage Ib ◽

Grade 3 ◽

Endometrial Endometrioid Adenocarcinoma

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Emodin Enhances the Chemosensitivity of Endometrial Cancer by Inhibiting ROS-Mediated Cisplatin-resistance

Anti-Cancer Agents in Medicinal Chemistry ◽

10.2174/1871520618666171219113036 ◽

2018 ◽

Vol 18 (7) ◽

pp. 1054-1063 ◽

Cited By ~ 4

Author(s):

Ning Ding ◽

Hong Zhang ◽

Shan Su ◽

Yumei Ding ◽

Xiaohui Yu ◽

...

Keyword(s):

Drug Resistance ◽

Endometrial Cancer ◽

Cancer Cells ◽

Chemotherapeutic Agent ◽

Annexin V ◽

Chemotherapeutic Agents ◽

Endometrial Cancer Cell ◽

Animal Survival ◽

Apoptosis Level

Background: Endometrial cancer is a common cause of death in gynecological malignancies. Cisplatin is a clinically chemotherapeutic agent. However, drug-resistance is the primary cause of treatment failure. Objective: Emodin is commonly used clinically to increase the sensitivity of chemotherapeutic agents, yet whether Emodin promotes the role of Cisplatin in the treatment of endometrial cancer has not been studied. Method: CCK-8 kit was utilized to determine the growth of two endometrial cancer cell lines, Ishikawa and HEC-IB. The apoptosis level of Ishikawa and HEC-IB cells was detected by Annexin V / propidium iodide double-staining assay. ROS level was detected by DCFH-DA and NADPH oxidase expression. Expressions of drug-resistant genes were examined by real-time PCR and Western blotting. Results: Emodin combined with Cisplatin reduced cell growth and increased the apoptosis of endometrial cancer cells. Co-treatment of Emodin and Cisplatin increased chemosensitivity by inhibiting the expression of drugresistant genes through reducing the ROS levels in endometrial cancer cells. In an endometrial cancer xenograft murine model, the tumor size was reduced and animal survival time was increased by co-treatment of Emodin and Cisplatin. Conclusion: This study demonstrates that Emodin enhances the chemosensitivity of Cisplatin on endometrial cancer by inhibiting ROS-mediated expression of drug-resistance genes.

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PET Parameters are Useful in Predicting Endometrial Cancer Risk Classes and Prognosis

Nuklearmedizin ◽

10.1055/a-1267-8976 ◽

2020 ◽

Author(s):

Adnan Budak ◽

Emrah Beyan ◽

Abdurrahman Hamdi Inan ◽

Ahkam Göksel Kanmaz ◽

Onur Suleyman Aldemir ◽

...

Keyword(s):

Endometrial Cancer ◽

High Risk ◽

Myometrial Invasion ◽

Risk Groups ◽

Total Sample ◽

Tumor Stage ◽

Low Risk ◽

Tumor Diameter ◽

Grade 3 ◽

Fdg Pet Ct

Abstract Aim We investigate the role of preoperative PET parameters to determine risk classes and prognosis of endometrial cancer (EC). Methods We enrolled 81 patients with EC who underwent preoperative F-18 FDG PET/CT. PET parameters (SUVmax, SUVmean, MTV, TLG), grade, histology and size of the primary tumor, stage of the disease, the degree of myometrial invasion (MI), and the presence of lymphovascular invasion (LVI), cervical invasion (CI), distant metastasis (DM) and lymph node metastasis (LNM) were recorded. The relationship between PET parameters, clinicopathological risk factors and overall survival (OS) was evaluated. Results The present study included 81 patients with EC (mean age 60). Of the total sample, 21 patients were considered low risk (endometrioid histology, stage 1A, grade 1 or 2, tumor diameter < 4 cm, and LVI negative) and 60 were deemed high risk. All of the PET parameters were higher in the presence of a high-risk state, greater tumor size, deep MI, LVI and stage 1B-4B. MTV and TLG values were higher in the patients with non-endometrioid histology, CI, grade 3 and LNM. The optimum cut-off levels for differentiating between the high and low risk patients were: 11.1 for SUVmax (AUC = 0.757), 6 for SUVmean (AUC = 0.750), 6.6 for MTV(AUC = 0.838) and 56.2 for TLG(AUC = 0.835). MTV and TLG values were found as independent prognostic factors for OS, whereas SUVmax and SUVmean values were not predictive. Conclusions The PET parameters are useful in noninvasively differentiating between risk groups of EC. Furthermore, volumetric PET parameters can be predictive for OS of EC.

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