Long-Term Outcomes After Pelvic Radiation for Early-Stage Endometrial Cancer

2013 ◽  
Vol 31 (31) ◽  
pp. 3951-3956 ◽  
Author(s):  
Mathias Onsrud ◽  
Milada Cvancarova ◽  
Taran P. Hellebust ◽  
Claes G. Tropé ◽  
Gunnar B. Kristensen ◽  
...  
Keyword(s):  
Overall Survival ◽  
Endometrial Cancer ◽  
Early Stage ◽  
External Beam Radiation ◽  
Secondary Cancer ◽  
Pelvic Radiation ◽  
Significant Difference ◽  
Early Stage Endometrial Cancer

Purpose This follow-up of a randomized study was conducted to assess the long-term effects of external beam radiation therapy (EBRT) in the adjuvant treatment of early-stage endometrial cancer. Patients and Methods Between 1968 and 1974, 568 patients with stage I endometrial cancer were included. After primary surgery, patients were randomly assigned to either vaginal radium brachytherapy followed by EBRT (n = 288) or brachytherapy alone (n = 280). Overall survival was analyzed by using the Kaplan-Meier method. A Cox proportional hazards model was used to estimate hazard ratios (HRs) with 95% CIs. We also conducted analyses stratified by age groups. Results After median 20.5 years (range, 0 to 43.4 years) of follow-up, no statistically significant difference was revealed in overall survival (P = .186) between treatment groups. However, women younger than age 60 years had significantly higher mortality rates after EBRT (HR, 1.36; 95% CI, 1.06 to 1.76) than the control group. The risk of secondary cancer increased after EBRT, especially in women younger than age 60 years (HR, 2.02; 95% CI, 1.30 to 3.15). Conclusion We observed no survival benefit of external pelvic radiation in early-stage endometrial carcinoma. In women younger than age 60 years, pelvic radiation decreased survival and increased the risk of secondary cancer. Adjuvant EBRT should be used with caution, especially in women with a long life expectancy.

Survival after radiation therapy for early-stage endometrial carcinoma: The Oslo study revisited after up to 43 years of follow-up.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 5008-5008 ◽  
Author(s):  
Kristina Lindemann ◽  
Mathias Onsrud ◽  
Gunnar Kristensen ◽  
Claes Trope
Keyword(s):  
Endometrial Carcinoma ◽  
Patient Group ◽  
Early Stage ◽  
Secondary Cancer ◽  
External Radiation ◽  
Pelvic Radiation ◽  
Secondary Cancers ◽  
Increased Risk ◽  
Significant Difference

5008 Background: There is an ongoing debate regarding the benefit of radiation in patients with early stage endometrial carcinoma. Data on long time risk conferred by radiation is scarce. This study is a long-term follow-up on survival and secondary cancers of a previously published randomized study (Aalders J. et al., Obstet Gynecol 1980; 56: 419-27). Methods: Between 1968 and 1974, 568 patients with endometrial cancer FIGO stage I primarily treated with abdominal hysterectomy and bilateral salpingo-oophorectomy were included in the study. Patients were postoperatively randomized to receive either vaginal radium brachytherapy followed by external pelvic radiation 40 Gy (N=288) or brachytherapy alone (N=280). Survival data and data on incident secondary cancers were obtained by individual linkage to the Registry of Statistics Norway and Cancer Registry of Norway. By the end of follow-up at 1 November 2011, 45 (7.9%) patients were still alive. We used Cox proportional hazards model to estimate hazard ratios (HR) with 95% confidence intervals (95% CI). We also conducted analyses stratified by age groups. Results: After median 21 (range 0-43.4) years of follow-up there was no significant difference in overall survival or relapse free survival between treatment arms with HR of 1.12 (95% CI: 0.95-1.33) and HR 0.88 (95% CI: 0.55-1.40), respectively. Patients treated with external radiation had significantly lower risk of developing locoregional relapse (p<0.001). However, women younger than 60 years had a significant poorer survival after external radiation (HR 1.36; 95% Cl: 1.06-1.76). In this patient group the risk of secondary cancer was significantly increased (HR 1.9; 95% CI: 1.23-3.03). Conclusions: We observed no survival benefit of external pelvic radiation in early stage endometrial carcinoma. In women younger than 60 years, pelvic radiation decreased survival, probably due to increased risk of subsequent second neoplasms. Adjuvant external radiotherapy cannot be recommended to this patient group. Those who have received such treatment might eventually benefit from prolonged post treatment surveillance with respect to secondary cancer.

Laparoscopic Versus Laparotomic Approach for Early Stage Endometrial Cancer: A Long-Term Follow-Up Study

2008 ◽  
Vol 15 (6) ◽  
pp. 42S-43S
Author(s):  
S. Palomba ◽  
A. Falbo ◽  
T. Russo ◽  
R. Oppedisano ◽  
R. Mocciaro ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Early Stage ◽  
Follow Up Study ◽  
Long Term Follow Up ◽  
Early Stage Endometrial Cancer

Long Term Follow-Up after Laparoscopic Management of Early Stage Endometrial Cancer

2009 ◽  
Vol 16 (6) ◽  
pp. S81-S82
Author(s):  
G. Siesto ◽  
A. Cromi ◽  
M. Serati ◽  
N. Piazza ◽  
F. Zefiro ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Early Stage ◽  
Laparoscopic Management ◽  
Long Term Follow Up ◽  
Early Stage Endometrial Cancer

Association of delayed adjuvant therapy and overall survival in early stage endometrial cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 5590-5590 ◽  
Author(s):  
Leo Luo ◽  
Weiji Shi ◽  
Zhigang Zhang ◽  
C. Jillian Tsai
Keyword(s):  
Overall Survival ◽  
Endometrial Cancer ◽  
Adjuvant Therapy ◽  
Cancer Patients ◽  
Median Time ◽  
Early Stage ◽  
Interquartile Range ◽  
External Beam Radiation ◽  
Interval Time ◽  
Early Stage Endometrial Cancer

5590 Background: The primary treatment for early stage endometrial cancer includes definitive surgical staging procedure followed by adjuvant therapy in women with high risk of recurrence. The optimal interval time between surgery and adjuvant therapy is unclear. Methods: 349,404 patients with primary uterine carcinoma diagnosed from 2004 and 2012 were extracted from National Cancer Database (NCDB). Study population was limited to patients with FIGO 2009 stage I and II endometrial cancer with endometroid, mucinous, clear cell, or serous histology. Adjuvant therapy included radiation therapy, chemotherapy, or a combination. A binary variable of interval time between surgery and adjuvant therapy (“early” vs. “delayed”) was created by using the median time as a cutoff. Analysis of relationship between the interval time and overall survival was performed. Results: Final analysis included 118,373 early stage endometrial cancer patients who had definitive surgical treatment. Median age was 61 (interquartile range 55-69). 87,189 patients (74%) had stage IA disease, 21,573 (18%) patients had stage IB disease, and 9,611 (8%) patients had stage II disease. 28,824 (24%) patients received adjuvant therapy after surgery. The median time from surgery to adjuvant therapy was 1.6 months (interquartile range 1.3-2.2 months). Of the patients that received adjuvant therapy, 48% received intra-vaginal brachytherapy alone, 31% received pelvic external beam radiation, and 7% received a combination of chemotherapy and brachytherapy. There was a significant difference in overall survival in patients who received adjuvant therapy within 1.6 months from surgery and 1.6 months after surgery (Log-rank test, p = 0.04). Patients with advanced age, African-American or Hispanic race, and uninsured status or government-sponsored insurance were associated with delayed treatments. Conclusions: In this large retrospective review of early stage endometrial cancer patients, delayed time between surgery and adjuvant therapy is associated with worse overall survival. Further analysis will be performed to determine an optimal timing between surgery and adjuvant therapy.

Adjuvant treatment improves overall survival in women with high-intermediate risk early-stage endometrial cancer with lymphovascular space invasion

2020 ◽  
Vol 30 (11) ◽  
pp. 1738-1747
Author(s):  
Ji Son ◽  
Laura M Chambers ◽  
Caitlin Carr ◽  
Chad M Michener ◽  
Meng Yao ◽  
...  
Keyword(s):  
Overall Survival ◽  
Endometrial Cancer ◽  
Early Stage ◽  
Progression Free Survival ◽  
External Beam Radiation ◽  
Intermediate Risk ◽  
Beam Radiation ◽  
Free Survival ◽  
Early Stage Endometrial Cancer ◽  
Lymphovascular Space Invasion

BackgroundAdjuvant therapy in early-stage endometrial cancer has not shown a clear overall survival benefit, and hence, patient selection remains crucial.ObjectiveTo determine whether women with high-intermediate risk, early-stage endometrial cancer with lymphovascular space invasion particularly benefit from adjuvant treatment in improving oncologic outcomes.MethodsA multi-center retrospective study was conducted in women with stage IA, IB, and II endometrial cancer with lymphovascular space invasion who met criteria for high-intermediate risk by Gynecologic Oncology Group (GOG) 99. Patients were stratified by the type of adjuvant treatment received. Clinical and pathologic features were abstracted. Progression-free and overall survival were evaluated using multivariable analysis.Results405 patients were included with the median age of 67 years (range 27–92, IQR 59–73). 75.0% of the patients had full staging with lymphadenectomy, and 8.6% had sentinel lymph node biopsy (total 83.6%). After surgery, 24.9% of the patients underwent observation and 75.1% received adjuvant therapy, which included external beam radiation therapy (15.1%), vaginal brachytherapy (45.4%), and combined brachytherapy + chemotherapy (19.1%). Overall, adjuvant treatment resulted in improved oncologic outcomes for both 5-year progression-free survival (77.2% vs 69.6%, HR 0.55, p=0.01) and overall survival (81.5% vs 60.2%, HR 0.42, p<0.001). After adjusting for stage, grade 2/3, and age, improved progression-free survival and overall survival were observed for the following adjuvant subgroups compared with observation: external beam radiation (overall survival HR 0.47, p=0.047, progression-free survival not significant), vaginal brachytherapy (overall survival HR 0.35, p<0.001; progression-free survival HR 0.42, p=0.003), and brachytherapy + chemotherapy (overall survival HR 0.30 p=0.002; progression-free survival HR 0.35, p=0.006). Compared with vaginal brachytherapy alone, external beam radiation or the addition of chemotherapy did not further improve progression-free survival (p=0.80, p=0.65, respectively) or overall survival (p=0.47, p=0.74, respectively).ConclusionAdjuvant therapy improves both progression-free survival and overall survival in women with early-stage endometrial cancer meeting high-intermediate risk criteria with lymphovascular space invasion. External beam radiation or adding chemotherapy did not confer additional survival advantage compared with vaginal brachytherapy alone.

Why Routine Clinical Follow-up for Patients With Early-Stage Endometrial Cancer Is Not Always Necessary

2014 ◽  
Vol 69 (8) ◽  
pp. 470-471
Author(s):  
Lilly Aung ◽  
Robert E. J. Howells ◽  
Kenneth C. K. Lim ◽  
Emma Hudson ◽  
Peter W. Jones
Keyword(s):  
Endometrial Cancer ◽  
Early Stage ◽  
Early Stage Endometrial Cancer

Survival Impact of Ovarian Preservation on Women With Early-Stage Endometrial Cancer: A Systematic Review and Meta-analysis

2016 ◽  
Vol 27 (1) ◽  
pp. 77-84 ◽  
Author(s):  
Haifeng Gu ◽  
Jundong Li ◽  
Yangkui Gu ◽  
Hua Tu ◽  
Yun Zhou ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Early Stage ◽  
Meta Analysis ◽  
Grey Literature ◽  
Disease Free Survival ◽  
Premenopausal Women ◽  
Cochrane Library ◽  
Ovarian Preservation ◽  
Significant Difference ◽  
Early Stage Endometrial Cancer

ObjectiveThe aim of this article was to investigate the survival impact of ovarian preservation in surgically treated patients with early-stage endometrial cancer using a meta-analysis.MethodsMajor online databases, including PubMed, EMBASE, Web of Science, the Cochrane Library, as well as Grey Literature database, were searched to collect studies on the effects of ovarian preservation compared with bilateral salpingo-oophorectomy (BSO) for surgical treatment in endometrial cancer patients. The literature search was performed up to April 2016. The results were analyzed using RevMan 5.0 software and Stata/SE 12.0 software.ResultsTotally, 7 retrospective cohort studies including 1419 patients in ovarian preservation group and 15,826 patients in BSO group were enrolled. Meta-analysis showed that there was no significant difference in overall survival between the patients treated with ovarian preservation and BSO (hazards ratio [HR], 1.00; 95% confidence interval [CI], 0.72–1.39; P = 1.00). Similar result was achieved in the young and premenopausal women (HR, 0.99; 95% CI, 0.70–1.39; P = 0.39). Furthermore, the disease-free survival of patients whose ovaries were preserved was slightly compromised but with no statistical significance (HR, 1.49; 95% CI, 0.56–3.93; P = 0.42).ConclusionsOvarian preservation may be safe in patients with early-stage endometrial cancer, and it could be cautiously considered in treating young and premenopausal women because it is not associated with an adverse impact on the patients’ survival. Given the inherent limitations of the included studies, further well-designed randomized controlled trial are needed to confirm and update this analysis.

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