Should the Optimal Adjuvant Treatment for Patients With Early-Stage Endometrial Cancer With High-Intermediate Risk Factors Depend on Tumor Grade?

Introduction: Risk stratification of patients with early endometrial cancer for recurrence is inadequate. Objectives: To study factors that influence recurrence in uterus-confined, early stage endometrial cancer (UCD). Patients and Methods: We studied 140 consecutive patients with endometrial cancer, operated at Action Cancer Hospital, Delhi, from August 2010 to September 2015. All patients underwent staging laparotomy, TAH + BSO + BLPND + para-aortic LN sampling, and omental biopsy. Adjuvant treatment was given as per the NCCN guidelines. They were followed up 3 monthly for 2 years, and 6 monthly thereafter. 121 patients (86.4%) had UCD (FIGO stages IA, IB, II). Excluding one post-operative mortality, and 4 who were lost to follow up, we included 116 patients in this study. Results: The median age of these patients was 60.5 years (range: 35-81 years), with median BMI of 31.2 kg/m2 (range=19.8-57.5). Diabetes or hypertension was present in either or both of 76 (65.5%) patients. The median pelvic LN harvest was 17 (range: 4-42). Eight (6.9%) patients had non-endometroid histology, and 5 (4.3%) patients had LVSI. Grade 1, 2, and 3 tumor was found in 74 (63.8%), 30 (25.9%), and 12 (10.3%) patients, respectively. The median follow up was 28 months (range 5-61 months), and recurrence was seen in 13 (11.2%) patients. On univariate analysis we found that age, co-morbidities (DM and HT), LVSI, and non-endometroid histology were related to recurrence. The tumor grade and adjuvant treatment did not influence recurrence rates. On multivariate analysis, presence of comorbidities and non-endometroid histology were independently related to disease recurrence (p=0.044, and 0.011, respectively). Conclusions: Disease recurrence was seen in one in ten patients with UCD, despite stage-appropriate treatment. Presence of co-morbidities and non-endometroid histology were independently related to recurrence.

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Faculty of 1000 evaluation for Phase II trial of vaginal cuff brachytherapy followed by chemotherapy in early stage endometrial cancer patients with high-intermediate risk factors.

F1000 - Post-publication peer review of the biomedical literature ◽

10.3410/f.718174837.793487070 ◽

2013 ◽

Author(s):

Paul Sabbatini ◽

Roisin O'Cearbhaill

Keyword(s):

Risk Factors ◽

Endometrial Cancer ◽

Cancer Patients ◽

Phase Ii ◽

Phase Ii Trial ◽

Early Stage ◽

Intermediate Risk ◽

Vaginal Cuff ◽

Early Stage Endometrial Cancer

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Chemotherapy as Adjuvant Treatment for Early Stage Endometrial Cancer With High Intermediate Risk Factors

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000001295 ◽

2018 ◽

Vol 28 (7) ◽

pp. 1285-1289

Author(s):

Min Gao ◽

Naiyi Zhang ◽

Nan Song ◽

Hong Zheng ◽

Xin Yan ◽

...

Keyword(s):

Endometrial Cancer ◽

Adjuvant Chemotherapy ◽

Adjuvant Treatment ◽

Early Stage ◽

Disease Free Survival ◽

Intermediate Risk ◽

Free Survival ◽

Platinum Based Chemotherapy ◽

Disease Free ◽

Early Stage Endometrial Cancer

ObjectiveThe aim of this study was to explore the role of chemotherapy as adjuvant treatment for early-stage endometrial cancer (EC) with high-intermediate-risk (HIR) factors.MethodsA prospective study of patients with early-stage EC with HIR factors for recurrence was performed between 2006 and 2014. A total of 96 patients were enrolled, and 50 patients received 3 cycles of platinum-based chemotherapy after surgery. Five-year disease-free survival and overall survival were evaluated.ResultsA total of 11 (11.5%) of the 96 patients had recurrence, with a median recurrent time of 15.4 months. Of these 11 patients with recurrence, 2 received adjuvant chemotherapy after surgery, whereas 9 did not receive any treatment. Patients without adjuvant chemotherapy exhibited a significantly higher recurrence rate than those with adjuvant chemotherapy (19.6% vs 4%; P = 0.024). Meanwhile, patients with adjuvant chemotherapy had significantly higher 5-year disease-free survival compared with the control group (92.1% vs 70.0%, P = 0.024).ConclusionsChemotherapy is feasible and safe as adjuvant treatment for early-stage EC with HIR factors. Three cycles of platinum-based chemotherapy are sufficient for reducing the risk of recurrence. Further, large sample randomized studies are needed to confirm these results.

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