Pathological Stage I Endometrial Carcinoma: The Role for Adjuvant Radiotherapy

1993 ◽  
Vol 79 (6) ◽  
pp. 405-409 ◽  
Author(s):  
Massad Barhum ◽  
Moshe Stein ◽  
Eduardo Ronsenblatt ◽  
Janet Dale ◽  
Abraham Kuten
Keyword(s):  
Radiation Therapy ◽  
High Risk ◽  
Endometrial Carcinoma ◽  
Adjuvant Radiotherapy ◽  
Postoperative Radiotherapy ◽  
Disease Free Survival ◽  
Myometrial Invasion ◽  
Stage I ◽  
Pathological Stage ◽  
Postoperative Radiation Therapy

Background In order to assess the efficacy of adjuvant radiotherapy in the treatment of pathological stage I endometrial carcinoma, we performed a retrospective analysis of 158 patients with this diagnosis who after surgery were either treated with radiation therapy or only followed from January 1980 through December 1987. Methods Patients were divided into two prognostic categories, high and low risk, on the basis of three known predictors of survival: histology, differentiation, and depth of myometrial invasion. All patients underwent total abdominal hysterectomy and bilateral salpingooophorectomy but only the high risk group received radiotherapy as well. Results After a median follow up time of 59 months the survival rates of the two groups were similar. The 5-year disease-free survival of the surgery alone group was 92 % compared to 89 % for the postoperative radiotherapy group. Side effects of treatment were minimal. Conclusions Postoperative radiation therapy for high risk pathological stage I endometrial carcinoma is an effective adjuvant therapy and confers an excellent prognosis.

Outcome of High-Risk Stage IC, Grade 3, Compared With Stage I Endometrial Carcinoma Patients: The Postoperative Radiation Therapy in Endometrial Carcinoma Trial

2004 ◽  
Vol 22 (7) ◽  
pp. 1234-1241 ◽  
Author(s):  
Carien L. Creutzberg ◽  
Wim L.J. van Putten ◽  
Carla C. Wárlám-Rodenhuis ◽  
Alfons C.M. van den Bergh ◽  
Karin A.J. De Winter ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Endometrial Cancer ◽  
High Risk ◽  
Endometrial Carcinoma ◽  
Postoperative Radiotherapy ◽  
Risk Category ◽  
Postoperative Radiation ◽  
Postoperative Radiation Therapy ◽  
Stage Ib ◽  
Grade 3

Purpose Stage IC, grade 3 endometrial cancer is regarded as a high-risk category. Stage IC, grade 3 patients were not eligible for the randomized Postoperative Radiation Therapy in Endometrial Carcinoma (PORTEC) trial, but were registered and received postoperative radiotherapy. Patients and Methods The PORTEC trial included 715 patients with stage IC, grade 1 or 2, and stage IB, grade 2 or 3 endometrial cancer. Patients were randomly assigned after surgery to receive pelvic radiotherapy (RT) or no further treatment. A total of 104 patients with stage IC, grade 3 endometrial cancer were registered, of whom 99 could be evaluated. Patterns of relapse and survival were compared with PORTEC patients receiving RT. Median follow-up was 83 months. Results The actuarial 5-year rates of locoregional relapse were 1% to 3% for PORTEC patients who received RT, compared with 14% for stage IC, grade 3 patients. Five-year distant metastases rates were 3% to 8% for grade 1 and 2 tumors; 20% for stage IB, grade 3 tumors; and 31% for stage IC, grade 3 tumors. Overall survival rates were 83% to 85% for grades 1 and 2; 74% for stage IB, grade 3; and 58% for stage IC, grade 3 patients (P < .001). In multivariate analysis grade 3 was the most important adverse prognostic factor for relapse and death as a result of endometrial cancer (hazard ratios, 5.4 and 5.5; P < .0001). Conclusion Patients with stage IC, grade 3 endometrial carcinoma are at high risk of early distant spread and endometrial carcinoma-related death. Novel strategies for adjuvant therapy should be explored to improve survival for this patient group.

scholarly journals Atypical meningiomas: is postoperative radiotherapy indicated?

2013 ◽  
Vol 35 (6) ◽  
pp. E15 ◽  
Author(s):  
Kangmin D. Lee ◽  
John J. DePowell ◽  
Ellen L. Air ◽  
Alok K. Dwivedi ◽  
Ady Kendler ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Adjuvant Radiotherapy ◽  
Tumor Recurrence ◽  
Postoperative Radiotherapy ◽  
Recurrence Free Survival ◽  
Postoperative Radiation ◽  
Recurrence Rates ◽  
Postoperative Radiation Therapy ◽  
Free Survival ◽  
Atypical Meningiomas

Object The role of postoperative radiation therapy after surgery for atypical meningiomas remains controversial. In this retrospective cohort study, the authors examine the recurrence rates for atypical meningiomas after resection (with or without adjuvant radiotherapy) and identify which factors were associated with recurrence. Methods Of 90 patients with atypical meningiomas who underwent surgery between 1999 and 2009, 71 (79%) underwent gross-total resection (GTR) and 19 (21%) underwent subtotal resection (STR); 31 patients received adjuvant radiotherapy. All tumors were pathology-confirmed WHO Grade II atypical meningiomas. Univariate and multivariate analyses were performed to identify factors associated with recurrence-free survival. Results Among 90 patients, 17 developed tumor recurrence (81% recurrence-free survival at 5 years). In the overall group, adjuvant radiotherapy reduced the recurrence rate to 9% from 19% at 5 years (p = 0.048). After STR, adjuvant radiotherapy significantly reduced recurrence from 91% to 20% (p = 0.0016). However, after GTR, adjuvant radiotherapy did not significantly reduce the recurrence rate (16.7% without radiation therapy vs 11.8% with radiation therapy) (p = 1.00). Five factors independently predictive of tumor recurrence included mitotic index, sheeting, necrosis, nonuse of radiation therapy, and STR. Further recursive partitioning analysis showed significant increases in risk for patients older than 55 years with mitoses and sheeting. Conclusions Adjuvant radiotherapy was effective at lowering recurrence rates in patients after STR but delivered no significant improvement in patients after GTR. Given that rates after GTR were similar with or without adjuvant radiotherapy, close observation without postoperative radiation therapy may be a viable option for these patients. Patients older than 55 years and those with mitoses noted during pathological examination had a significant risk of recurrence after GTR; for these patients, postoperative radiotherapy is recommended.

Location of recurrences in high-risk stage Iendometrial cancer patients not given postoperative radiotherapy: A Danish gynecological cancer group study

2019 ◽  
Vol 29 (3) ◽  
pp. 497-504 ◽  
Author(s):  
Gitte Ørtoft ◽  
Claus Høgdall ◽  
Caroline Juhl ◽  
Lone K Petersen ◽  
Estrid S Hansen ◽  
...  
Keyword(s):  
High Risk ◽  
Postoperative Radiotherapy ◽  
Gynecological Cancer ◽  
Abdominal Cavity ◽  
Myometrial Invasion ◽  
Stage I ◽  
Not Given ◽  
Recurrence Rates ◽  
Cancer Group ◽  
Grade 3

ObjectivesTo study recurrence rates in Danish high-risk stage I endometrial cancers not given radiotherapy in accordance with the decision of the Danish Gynecological Cancer Group.MethodsThis prospective national cohort study includes all 4707 endometrial carcinomas diagnosed from 2005 to 2012. Of these, 623 patients had grade 3 endometroid adenocarcinoma with >50% myometrial invasion or serous/clear/undifferentiated carcinoma (with any depth of invasion). In 305 patients with high-risk stage I on final pathology, 14.1% received adjuvant external beam radiotherapy and 9.6% adjuvant chemotherapy. No patients received brachytherapy. 5-year Kaplan-Meier survival estimates and actuarial recurrence rates were calculated, and adjusted Cox regression analysis used for comparison. Recurrence rates were compared with historical Danish population data (DEMCA 98–99).ResultsFor non-irradiated patients, 5-year overall survival, cancer-specific survival, and progression-free survival rates in high-risk stage I patients were 65%, 78%, and 73%, respectively. For non-irradiated patients, isolated local recurrences were uncommon (vaginal 3.1%, pelvic 0.4%). Death was mainly due to a high occurrence of non-local recurrences, with 8.8% experiencing a first recurrence in the abdominal cavity (outside the field where radiation traditionally have been given) and 13.0% a distant metastasis outside the abdominal cavity. Grade 3 tumors with >50% myometrial invasion seem to be characterized by a different pattern of recurrences, with significantly more isolated vaginal recurrences (7.9% vs 2.2%) and fewer total number of abdominal recurrences (7.9% vs 15.3%) as compared with unfavorable tumor types.ConclusionIsolated vaginal and pelvic recurrences were rare (3–5%) in patients with a final pathologic diagnosis of high-risk stage I endometrial cancer even after the Danish Gynecological Cancer Group decided to omit all types of postoperative radiotherapy and introduce lymph node staging.

Evaluation of Unusual and Highly Aggressive Variant of Endometrium Cancer: Nonendometrioid Endometrium Carcinoma of the Uterus

2015 ◽  
Vol 103 (6) ◽  
pp. 551-556 ◽  
Author(s):  
Fatma Sert ◽  
Ugur Yılmaz ◽  
Senem Alanyalı ◽  
Arif Aras ◽  
Zeynep Ozsaran
Keyword(s):  
Prognostic Factors ◽  
Postoperative Radiotherapy ◽  
Disease Free Survival ◽  
Myometrial Invasion ◽  
Stage Iv ◽  
Stage I ◽  
Factors Affecting ◽  
Endometrium Carcinoma ◽  
Grade 3

Aims To evaluate the survival and treatment outcomes of patients with nonendometrioid endometrium carcinoma after postoperative radiotherapy. Methods The records of 94 patients treated with postoperative radiotherapy (RT) between January 2005 and December 2011 were retrospectively reviewed. Postoperative RT was delivered with a dose of 45-50.4 Gy with 1.8 Gy daily fractions and brachytherapy was added to external RT for 62 patients with a dose of 3 × 6 Gy. Median follow-up time was 35 months (range 6-95 months). Results Median age was 63 years (range 43-83 years) and lymph node metastasis (LNM) was positive in 15 (16.0%) patients. The stage distribution of the patients was as follows: stage I, 58 (61.7%); stage II, 16 (17.0%); stage III, 18 (19.1%); stage IV, 2 (2.2%). Five-year locoregional control (LRC), disease-free survival (DFS), and overall survival (OS) rates were 92.3%, 68.2%, and 78.6%, respectively. In univariable analysis, it was determined that the factors affecting OS rates were stage (p = 0.003), presence of LNM (p = 0.003), and presence of lymphovascular space invasion (LVSI) (p = 0.007); factors affecting DFS rates were stage (p = 0.019), presence of LVSI (p = 0.002), and having LNM (p = 0.049); and the factor affecting LRC rates was tumor size (>5 cm) (p = 0.011). In subgroup analyses, among all stage I patients, the DFS rates were lower for those with histologic grade 3 tumors and more than ½ myometrial invasion. Conclusions Due to its rarity, the prognostic factors and outcomes of nonendometioid endometrium carcinoma are not fully understood. In our analysis, stage, LNM, and presence of LVSI were found to be the most important prognostic factors. In order to tailor the optimal treatment strategy, prospective studies are needed.

scholarly journals Adjuvant Radiotherapy Improved Survival in Stage I to II Low-Grade Endometrial Stromal Sarcoma: A Retrospective Study of 152 Cases

2021 ◽  
Vol 10 ◽  
Author(s):  
Wenhui Wang ◽  
Shuai Sun ◽  
Zheng Miao ◽  
Xiaorong Hou ◽  
Fuquan Zhang ◽  
...  
Keyword(s):  
Adjuvant Radiotherapy ◽  
Early Stage ◽  
Postoperative Radiotherapy ◽  
Disease Free Survival ◽  
Endometrial Stromal Sarcoma ◽  
Stage I ◽  
Low Grade ◽  
Free Survival ◽  
Stage Ib ◽  
Stromal Sarcoma

ObjectiveLow-grade endometrial stromal sarcoma (LG-ESS) is a rare gynecological tumor. Whether adjuvant radiotherapy benefits survival in patients with resected early-stage ESS remains controversial. This study was designed to explore the role of adjuvant radiotherapy in stage I to II LG-ESS.MethodsWe retrospectively reviewed patients with stage I to II LG-ESS in our center from Jan. 1998 to Feb. 2018. All patients underwent a total hysterectomy and postoperative radiotherapy was administrated based on clinical and pathological characteristics.ResultsA total of 152 patients with stage I to II resected LG-ESS were included. Forty patients received adjuvant radiotherapy (RT group) while 112 patients did not receive adjuvant radiotherapy (no RT group). The baseline characteristics of the two groups were comparable, except that the proportion of stage II patients in the RT group was higher than that in the no RT group (32.5% vs. 11.6%, in RT vs. no RT groups, respectively; p = 0.003). For both patient groups, median overall survival was not reached. The median disease-free survival (DFS) was 144 months. Radiotherapy was associated with significantly improved DFS (92 months vs. not reached in RT vs. no RT groups, respectively; p = 0.008) and pelvic failure-free survival (PFFS) (92 months vs. not reached in RT vs. no RT groups, respectively; p=0.004). Subgroup analysis revealed that RT benefited survival most among patients with stage IB to IIB disease. Adjuvant radiotherapy significantly reduced the pelvic recurrence rate (10.0%, 4/40 vs. 28.6%, 32/112, p = 0.018). No radiotherapy-induced grade 4 to 5 toxicity was observed.ConclusionFor patients with stage I to II LG-ESS, adjuvant radiotherapy showed significant improvement in DFS and PFFS with tolerable adverse effects, especially in patients with stage IB to IIB disease.

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