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Akdöner A, Kurt S, Yavuz O, Bayram E, Üresin M, Ulukuş EÇ. Effect of low uterine segment involvement on prognosis of early stage endometrial cancer. J Obstet Gynaecol Res 2024. [PMID: 38575743 DOI: 10.1111/jog.15933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/14/2024] [Indexed: 04/06/2024]
Abstract
AIM Our aim is to investigate the effect of uterine lower segment involvement on prognosis of early-stage endometrial cancer cases diagnosed and treated in our clinic. MATERIALS AND METHODS The file records of 316 cases reviewed retrospectively.Only stage I (a and b, n=209) cases were investigated, because they were more homogeneous group. RESULTS The lymphovascular invasion rate was found to be higher in patients with stage Ia and uterine lower segment involvement (p < 0.001). Adjuvant treatment requirement was higher in patients with stage Ia and uterine lower segment involvement (p < 0.001). Among stage Ia cases, the recurrence rate between 1 and 3 years was found to be higher in cases with uterine lower segment involvement (p = 0.001). Among the stage Ib cases, lymphovascular invasion was found to be higher in cases with uterine lower segment involvement (p < 0.001). The recurrence rate between 1 and 3 years was found to be higher in stage Ib compared to Ia (p = 0.01). Uterine lower segment involvement was found to be associated with high lymphovascular invasion rate in all stage I cases (p < 0.001). It was determined that the need for adjuvant treatment was higher in cases with uterine lower segment involvement (p < 0.001). It was determined that the probability of recurrence between 1 and 3 years was higher in cases with uterine lower segment involvement (p = 0.007). CONCLUSION Uterine lower segment involvement is associated with increased lymphovascular invasion even in the early stages. It is an important risk factor for systemic spread such as lymphovascular invasion, myometrial invasion, and lymph node involvement.
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Affiliation(s)
- Aslı Akdöner
- Gynecology and Obstetrics Department, Medical School, Dokuz Eylül University, İzmir, Turkey
| | - Sefa Kurt
- Gynecology and Obstetrics Department, Medical School, Dokuz Eylül University, İzmir, Turkey
| | - Onur Yavuz
- Gynecology and Obstetrics Department, Medical School, Dokuz Eylül University, İzmir, Turkey
| | - Emre Bayram
- Gynecology and Obstetrics Department, Medical School, Dokuz Eylül University, İzmir, Turkey
| | - Merve Üresin
- Gynecology and Obstetrics Department, Medical School, Dokuz Eylül University, İzmir, Turkey
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Faria SL, Ferrigno R. Câncer do Endométrio: Tratamento Adjuvante Pélvico apenas com Radioterapia Externa após Cirurgia sem Linfadenectomia. REVISTA BRASILEIRA DE CANCEROLOGIA 2022. [DOI: 10.32635/2176-9745.rbc.1999v45n3.2778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A incidência mediana de câncer endometrial no Brasil é de 6 casos novos/cem mil mulheres/ ano. A radioterapia tem sido usada como tratamento adjuvante pré ou pós cirurgia, com ou sem braquiterapia. Há consenso de que os casos estadiados como II e III pela FIGO recebam irradiação pélvica, com ou sem braquiterapia. Entretanto, 75% dos casos são estádios I. Por isso há subgrupos prognósticos que dependem da profundidade de invasão do miométrio e do grau histológico do tumor. Tumores em estádio I com invasão profunda do miométrio e/ou alto grau têm também sido tratados com irradiação. A adição de braquiterapia vaginal após a radioterapia externa resulta em melhor controle de falha pélvica? Esta é uma pergunta não resolvida. Desde 1990 temos feito apenas radioterapia externa nos casos de câncer do endométrio que têm indicação de irradiação adjuvante, sem braquiterapia. A cirurgia básica destes casos têm sido histerectomia abdominal total + salpingo-ooforectomia bilateral sem dissecção de rotina dos linfonodos pélvicos. Foram revistas retrospectivamente 61 destes casos tratados no nosso serviço, com 4 campos pélvicos. Cobalto, dose total entre 45Gy-50,4Gy em 25 a 28 frações. Seguimento mediano de 33 meses mostrou um único caso de falha em vagina, 6/61 casos de pacientes que morreram e apenas um caso de complicação intestinal moderada. Estes resultados se assemelham com outros da literatura que não usam a braquiterapia de rotina após a irradiação externa na pelve.
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The role for vaginal cuff brachytherapy boost after external beam radiation therapy in endometrial cancer. Brachytherapy 2022; 21:177-185. [PMID: 35210017 DOI: 10.1016/j.brachy.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/10/2021] [Accepted: 10/19/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the role and technique of a vaginal cuff brachytherapy (VB) boost to adjuvant external beam (EB) radiation for endometrial cancer through a systematic review. METHODS AND MATERIALS Relevant trials were identified through a systematic search of the literature. RESULTS A total of 21 prospective and retrospective studies which had a patient cohort undergoing EB + VB was identified to evaluate for rates of vaginal and pelvic recurrences, overall survival, and toxicity. Additional database studies were utilized to demonstrate differences in local control and overall survival between EB and EB + VB. CONCLUSIONS While there is limited prospective evidence to guide the use of a VB boost after EB, the evidence suggests that patients with a higher risk of a vaginal recurrence such as those with cervical stromal involvement in select Stage III patients may derive local control and survival benefits from a VB boost. Additional individual risk factors such as grade, histology, extent of invasion, margin status, age, and the use of lower doses of EB should be considered when deciding when to add a VB boost.
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Popovic V, Milosavljevic N, Radojevic MZ, Vojinovic RH, Nedovic N, Mitrovic S, Nedovic J, Tomasevic A. Analysis of postoperative radiotherapy effects within risk groups in patients with FIGO I, II, and III endometrial cancer. Indian J Cancer 2019; 56:341-347. [PMID: 31607704 DOI: 10.4103/ijc.ijc_370_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION To define indications for adjuvant radiotherapy in patients with endometrial cancer, the risk groups have been established according to clinical and pathological prognostic factors. The purpose was to determine precise criteria for adjuvant radiotherapy and identify patients with increased risk for disease relapse who may benefit from postoperative radiotherapy, with an acceptable level of toxicity. MATERIALS AND METHODS A retrospective study was conducted at the Department of Oncology and Radiology, Kragujevac, during a 5-year period. A group of 80 patients with endometrial cancer treated with adjuvant radiotherapy were included in the study. Patients were divided into four risk groups according to ESMO-ESGO-ESTRO Consensus Conference classification. The Kaplan-Meier method was used for overall and progression-free survival. A statistical analysis was performed using SPSS 20.0 statistical software. RESULTS The 5-year survival rate was 80%, and 66.3% patients were progression-free during this period. Fatal outcome occurred in 20% of patients. The results showed survival was shortest in patients from the high-risk group. Factors that had impact on the 5-year survival were comorbidities, FIGO stage, postoperative radiotherapy, organ site of late toxicity, and localization of metastases. The analysis of postoperative radiotherapy effects showed that 72.5% of patients had no complications. The most common symptoms of late irradiation toxicity arose from the gastrointestinal tract. Toxicity was usually moderate. CONCLUSIONS Adjuvant radiotherapy can potentially prolong survival and prevent recurrence, with acceptable level of toxicity, to preserve patient's quality of life. Patient classification into appropriate risk groups allows for adjuvant treatment individualization.
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Affiliation(s)
- Vladan Popovic
- Center for Oncology and Radiology, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Neda Milosavljevic
- Center for Oncology and Radiology, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Marija Zivkovic Radojevic
- Center for Oncology and Radiology, Clinical Center Kragujevac; University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
| | - Radisa H Vojinovic
- University of Kragujevac, Faculty of Medical Sciences; Department for Radiology, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Nikola Nedovic
- University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
| | - Slobodanka Mitrovic
- University of Kragujevac, Faculty of Medical Sciences; Department for Pathology, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Jasmina Nedovic
- Center for Oncology and Radiology, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Aleksandar Tomasevic
- Department of Brachyterapy, Institute for Oncology and Radiology, Belgrade, Serbia
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Martell K, Doll C, Barnes EA, Phan T, Leung E, Taggar A. Radiotherapy practices in postoperative endometrial cancer: A survey of the ABS membership. Brachytherapy 2019; 18:741-746. [PMID: 31521546 DOI: 10.1016/j.brachy.2019.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/05/2019] [Accepted: 07/22/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE This survey aimed to document the current practice patterns of postoperative radiotherapy (RT), including vaginal vault brachytherapy (VVB) and external beam radiotherapy (EBRT), in the management of patients with endometrial cancer. METHODS AND MATERIALS A 30-item, multiple choice survey querying RT prescribing practices and planning techniques was distributed electronically to American Brachytherapy Society members in December 2018. RESULTS Seventy-five surveys from 62 centers were completed. Eighty-nine percent of respondents practiced within the USA or Canada. Most (79%) respondents indicated a preference for recommending adjuvant VVB alone in FIGO Stage IB, Grade 2 margin and lymphovascular space invasion (LVSI) negative disease. For FIGO Stage IB, Grade 3, LVSI-positive disease, most respondents preferred incorporating EBRT either alone (33%) or with VVB (28%). For IIIC1, margin positive disease, VVB in addition to EBRT was most commonly recommended (75%). When planning adjuvant EBRT, 49% utilized CT simulation with both bladder full and empty. Internal target volume was utilized by 53%. Volumetric modulated arc therapy (53%) or intensity-modulated radiotherapy (19%) were commonly used planning techniques. The most common dose prescription was 45 Gy in 25 fractions (57%). When treating with VVB, 49% determined applicator size at the time of brachytherapy. Sixty-four percent planned treatments based on CT imaging with the applicator in situ and 33% repeated CT imaging before each subsequent fraction. The most common prescription was 21 Gy in three fractions prescribed to 0.5 cm depth (43%). CONCLUSIONS This study identified variability in treatment recommendations and in both EBRT and VVB simulation and planning processes in postoperative endometrial cancer.
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Affiliation(s)
- Kevin Martell
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Oncology, University of Calgary, Calgary, Alberta, Canada; Tom Baker Cancer Centre, Calgary, Alberta, Canada.
| | - Corinne Doll
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada; Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Elizabeth A Barnes
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Tien Phan
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada; Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Eric Leung
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Amandeep Taggar
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Ogane N, Hori SI, Yano M, Katoh T, Kamoshida S, Kato H, Kameda Y, Yasuda M. Preponderance of endometrial carcinoma in elderly patients. Mol Clin Oncol 2018; 9:269-273. [PMID: 30155248 PMCID: PMC6109667 DOI: 10.3892/mco.2018.1680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 07/16/2018] [Indexed: 11/05/2022] Open
Abstract
Elderly patients with endometrial carcinoma (EMC) are considered to have a poor clinical outcome. The present study included 79 patients aged ≥70 years with EMC stage I or II according to the International Federation of Gynecology and Obstetrics classification, and it was conducted to analyse the clinicopathological significance of histological type (I or II), depth of myometrial invasion (<1/2 or ≥1/2), lymphovascular invasion (+ or -) and immunohistochemical profile. The aim of these analyses was to determine whether these factors may adversely affect the patient outcome and the underlying mechanisms. The immunohistochemical markers used were estrogen receptor (ER), Ki-67 and p53. The expression of these markers was evaluated as high (+) or low (-). Accordingly, the patients were divided into groups as follows: 54 cases type I vs. 25 cases type II; 48 cases with myometrial invasion <1/2 vs. 31 cases without myometrial invasion ≥1/2; 63 cases with lymphovascular invasion vs. 16 cases without lymphovascular invasion; 57 cases with ER (+) vs. 22 cases with ER (-); 24 cases with Ki-67 (+) vs. 55 cases with Ki-67 (-); and 29 cases with p53 (+) vs. 50 cases with p53 (-). In conclusion, close attention must be paid to elderly patients with EMC due to the tumor's intrinsic aggressiveness, which may include the ER (-) and p53 (+) pattern as an independent poor prognostic factor.
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Affiliation(s)
- Naoki Ogane
- Department of Pathology, Kanagawa Prefectural Ashigarakami Hospital, Matsuda, Kanagawa 258-0003, Japan
| | - Shin-Ichi Hori
- Department of Gynecology and Obstetrics, Seto Hospital, Tokorozawa, Saitama 359-1128, Japan
| | - Mitsutake Yano
- Department of Pathology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Tomomi Katoh
- Department of Pathology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Shingo Kamoshida
- Laboratory of Pathology, Department of Medical Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Hyogo 654-0142, Japan
| | - Hisamori Kato
- Department of Gynecology, Kanagawa Cancer Center, Yokohama, Kanagawa 241-8515, Japan
| | - Yoichi Kameda
- Department of Pathology, Kanagawa Prefectural Ashigarakami Hospital, Matsuda, Kanagawa 258-0003, Japan
| | - Masanori Yasuda
- Department of Pathology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
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Is Older Age a Real Adverse Prognostic Factor in Women With Early-Stage Endometrial Carcinoma? A Matched Analysis. Int J Gynecol Cancer 2017; 27:479-485. [DOI: 10.1097/igc.0000000000000890] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Isrow D, Burmeister C, Hanna RK, Elshaikh MA. Survival endpoints for young women with early stage uterine endometrioid carcinoma: a matched analysis. Eur J Obstet Gynecol Reprod Biol 2016; 207:115-120. [PMID: 27838535 DOI: 10.1016/j.ejogrb.2016.10.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/03/2016] [Accepted: 10/21/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Younger age is thought to be a favorable prognostic factor in women with endometrial carcinoma (EC). Survival endpoints were compared between two matched groups of patients with early stage EC: women 45 years or younger and women older than 45 years. METHODS AND MATERIALS Two matched groups of patients were created based on stage, grade, lymph node dissection and adjuvant management. Recurrence-free (RFS), disease-specific (DSS) and overall survival (OS) were calculated. RESULTS A total of 525 patients (88 younger patients and 437 older patients, matched 1:5) were included in this study. The two groups were well balanced except for less myometrial invasion in the younger patients. There were no significant differences between younger and older patients in regards to 5-year RFS (94% vs. 91%, p=0.6902). Similarly, there was no significant difference in regards to DSS (96% vs. 97%, p=0.9000). While 5-year OS was similar for both groups (89% vs. 89%, p=0.9942), 10-year OS was longer in the younger group (83% vs. 68% with p=0.13). On multivariate analysis for RFS, the presence of lymphovascular space invasion was the only predictor of shorter RFS (p=0.0007). Tumor grade (p=0.0002) and lower uterine segment involvement (p=0.0141) were independent predictors of shorter DSS. Older age (p<0.001) and stage II (p=0.01) were the only predictors of shorter OS. CONCLUSIONS When matched based on tumor stage, grade and adjuvant management, our study suggests that there is no difference in survival endpoints between younger and older patients with early stage endometrial carcinoma.
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Affiliation(s)
- Derek Isrow
- Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Charlotte Burmeister
- Department of Public Health Science, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Rabbie K Hanna
- Division of Gynecologic Oncology, Department of Women's Health Services, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Mohamed A Elshaikh
- Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI 48202, USA.
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Should the Optimal Adjuvant Treatment for Patients With Early-Stage Endometrial Cancer With High-Intermediate Risk Factors Depend on Tumor Grade? Int J Gynecol Cancer 2016; 25:1445-52. [PMID: 26397067 PMCID: PMC5106082 DOI: 10.1097/igc.0000000000000572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objectives To explore whether the optimal adjuvant treatments for patients with early-stage endometrial cancer with high-intermediate risk (HIR) factors should depend on tumor grade. Methods A retrospective analysis of patients with HIR endometrial cancer from 1999 to 2012 was conducted. The adjuvant treatments and survival were evaluated. Results A total of 129 patients with HIR were identified, of which 71 had grade 1–2 tumor and 58 had grade 3 tumor. The adjuvant treatment chosen differed significantly between patients with grade 1–2 and grade 3 tumors (P < 0.001). Most of the patients (76.1%) with grade 1–2 tumors received no adjuvant treatment; however, chemotherapy alone was the most frequent (75.9%) adjuvant treatment for patients with grade 3 tumors. In the grade 1–2 group, no significant differences in the 5-year progression-free survival (94.1% vs 96.3%; P = 0.857) and overall survival (OS) rates (94.1% vs 98.1%; P = 0.401), respectively, were observed between patients who received adjuvant treatment (radiation and chemotherapy with or without radiation) and those who did not. For grade 3 disease, patients undergoing adjuvant chemotherapy alone had a favorable outcome with the 5-year progression-free survival rate of 84.4% and the OS rate of 95.5%. Conclusion It is logical to speculate that surgery followed by observation might be sufficient for patients with HIR with grade 1–2 tumor. Further prospective trials are required to confirm the issue owing to the limited number of this population. More studies are warranted to clarify the feasibility and efficacy of adjuvant chemotherapy alone in patients with HIR with grade 3 tumor.
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Pros and cons of vaginal brachytherapy after external beam radiation therapy in endometrial cancer. Gynecol Oncol 2016; 140:167-75. [DOI: 10.1016/j.ygyno.2015.09.084] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 09/25/2015] [Accepted: 09/28/2015] [Indexed: 11/23/2022]
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Lee JH, Lee HC, Kim SH, Chung MJ, Jeong SM, Lee SJ, Yoon JH, Park DC. Postoperative Radiotherapy Alone Versus Chemoradiotherapy in Stage I-II Endometrial Carcinoma: An Investigational and Propensity Score Matching Analysis. Cancer Res Treat 2014; 47:298-305. [PMID: 25544573 PMCID: PMC4398106 DOI: 10.4143/crt.2014.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 03/19/2014] [Indexed: 11/21/2022] Open
Abstract
Purpose The purpose of this study was to compare the results of postoperative adjuvant radiotherapy (RT) and concurrent chemoradiotherapy (CRT) in stage I-II endometrial carcinoma. Materials and Methods We analyzed a total of 64 patients with surgically staged I-II endometrial carcinoma who were treated with postoperative adjuvant RT or concurrent CRT between March 1999 and July 2013. Thirty-two patients who received postoperative RT alone were matched with those who received postoperative CRT (n=32) in accordance to age, stage, and tumor histology. Overall survival and relapse-free survival, as well as toxicity of the RT and CRT arms were evaluated and compared. Results The 5-year overall survival rate was 90.0% for the RT arm and 91.6% for the CRT arm. There was no significant difference in overall survival between the two treatment arms (p=0.798). The 5-year relapse-free survival rate was 87.2% in the RT arm and 88.0% in the CRT arm. Again, no significant difference in relapse-free survival was seen between the two arms (p=0.913). In a multivariate analysis, tumor histology was an independent prognostic factor for relapse-free survival (hazard ratio, 3.67; 95% of CI, 2.34 to 7.65; p=0.045). Acute grade 3 or 4 hematologic toxicities in the CRT arm were significantly higher than in the RT alone arm (6.2% vs. 31.2%, p=0.010). Conclusion Adjuvant pelvic concurrent chemoradioherapy did not show superior results in overall survival and relapse-free survival compared to RT alone in stage I-II endometrial carcinoma.
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Affiliation(s)
- Jong Hoon Lee
- Departments of Radiation Oncology, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Hyo Chun Lee
- Departments of Radiation Oncology, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sung Hwan Kim
- Departments of Radiation Oncology, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Mi Joo Chung
- Departments of Radiation Oncology, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Song Mi Jeong
- Departments of Radiation Oncology, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sung Jong Lee
- Departments of Obstetrics and Gynecology, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Joo Hee Yoon
- Departments of Obstetrics and Gynecology, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Dong Choon Park
- Departments of Obstetrics and Gynecology, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
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Arenas M, Gascón M, Rovirosa À, Hernández V, Riu F, López I, Montero A, Sabater S. The effect of lymphadenectomy and radiotherapy on recurrence and survival in endometrial carcinoma. Experience in a population reference centre. Rep Pract Oncol Radiother 2014; 20:50-6. [PMID: 25535585 DOI: 10.1016/j.rpor.2014.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 06/18/2014] [Accepted: 09/16/2014] [Indexed: 11/17/2022] Open
Abstract
AIM To evaluate the effect of lymphadenectomy and/or radiotherapy on recurrence and survival patterns in endometrial carcinoma (EC) in a radiotherapy reference centre population. MATERIAL AND METHODS A retrospective population-based review was conducted on 261 patients with stages I-III EC. Univariate and multivariate analyses were carried out. Both recurrence and survival were analysed according to patient age, FIGO stage, tumour size, myometrial invasion, tumour grade, lymphadenectomy, external beam irradiation (EBI), and brachytherapy (BT). RESULTS Median age: 64.8 years. Median follow-up: 151 months. The following treatments were administered: surgery, 97.32%; lymph-node dissection, 54.4%; radiotherapy, 162 patients (62%) (EBI and BT: 64.1%, BT alone: 30.2%, EBI alone: 5.6%). Twenty-six patients (9.96%) suffered loco-regional recurrence, whilst 27 (10.34%) suffered distant failure. The 5-year overall survival (OS) for all stages was 80.1%. The 5-year disease free survival (DFS) was 92.1% for all patients. The 10-year DFS was 89.9%. The independent significant prognostic factors for a good outcome identified through the multivariate analysis were: age <75 years (p = 0.001); tumour size ≤2 cm (p = 0.003); myometrial invasion ≤50% (p = 0.011); lymphadenectomy (p = 0.02); EBI (p = 0.001); and BT (p = 0.031). Toxicity occurred in 114 of the 162 patients who received radiotherapy (70.5%). The toxicity was mainly acute, and late in only 28.3% (n = 45) of cases. The majority experienced G1-2 toxicity, and only 3% of patients experienced G3 late toxicity (5/162). CONCLUSIONS Our results suggest that age <75 years, tumour size ≤2 cm, myometrial invasion ≤50%, lymphadenectomy, EBI, and BT, are predictors of a good outcome in EC.
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Affiliation(s)
- Meritxell Arenas
- Radiation Oncology Department, Hospital Universitari Sant Joan de Reus, Institut d'Investigacions Sanitàries Pere Virgili (IISPV), Universitat Rovira i Virgili (URV), Tarragona, Spain
| | - Marina Gascón
- Radiation Oncology Department, Hospital Universitari Sant Joan de Reus, Institut d'Investigacions Sanitàries Pere Virgili (IISPV), Universitat Rovira i Virgili (URV), Tarragona, Spain
| | - Àngels Rovirosa
- Gynaecologic Cancer Unit, Radiation Oncology Department, Institut Clínic de Malalties Hematològiques i Oncològiques (ICMHO), Hospital Clinic, Barcelona, Spain
| | - Víctor Hernández
- Medical Physics and Radiation Protection Department, Hospital Universitari Sant Joan de Reus, IISPV, Spain
| | - Francesc Riu
- Pathology Department, Hospital Universitari Sant Joan de Reus, IISPV, Spain
| | - Iolanda López
- Radiation Oncology Department, Hospital Universitari Sant Joan de Reus, Institut d'Investigacions Sanitàries Pere Virgili (IISPV), Universitat Rovira i Virgili (URV), Tarragona, Spain
| | - Angel Montero
- Radiation Oncology Department, Hospital Ramon y Cajal, Madrid, Spain
| | - Sebastià Sabater
- Radiation Oncology Department, Complejo Hospitalario Universitario Albacete (CHUA), Spain
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Herrera FG, Cruz OS, Achtari C, Bourhis J, Ozsahin M. Long-term outcome and late side effects in endometrial cancer patients treated with surgery and postoperative radiation therapy. Ann Surg Oncol 2014; 21:2390-7. [PMID: 24604587 DOI: 10.1245/s10434-014-3622-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND We retrospectively reviewed the long-term outcome and late side effects of endometrial cancer (EC) patients treated with different techniques of postoperative radiotherapy (PORT). METHODS Between 1999 and 2012, 237 patients with EC were treated with PORT. Two-dimensional external beam radiotherapy (2D-EBRT) was used in 69 patients (30 %), three-dimensional EBRT (3D-EBRT) in 51 (21 %), and intensity-modulated RT (IMRT) with helical Tomotherapy in 47 (20 %). All patients received a vaginal brachytherapy (VB) boost. Seventy patients (29 %) received VB alone. RESULTS After a median of 68 months (range, 6-154) of follow-up, overall survival was 75 % [95 % confidence interval (CI), 69-81], disease-free survival was 72 % (95% CI, 66-78), cancer-specific survival was 85 % (95 % CI, 80-89), and locoregional control was 86 % (95 % CI, 81-91). The 5-year estimates of grade 3 or more toxicity and second cancer rates were 0 and 7 % (95 % CI, 1-13) for VB alone, 6 % (95 % CI, 1-11) and 0 % for IMRT + VB, 9 % (95 % CI, 1-17) and 5 % (95 % CI, 1-9) for 3D-EBRT + VB, and 22 % (95 % CI, 12-32) and 12 % (95 % CI, 4-20) for 2D-EBRT + VB (P = 0.002 and P = 0.01), respectively. CONCLUSIONS Pelvic EBRT should be tailored to patients with high-risk EC because the severe late toxicity observed might outweigh the benefits. When EBRT is prescribed for EC, IMRT should be considered, because it was associated with a significant reduction of severe late side effects.
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Affiliation(s)
- Fernanda G Herrera
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
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Santin AD, Bellone S, O'Brien TJ, Pecorelli S, Cannon MJ, Roman JJ. Current treatment options for endometrial cancer. Expert Rev Anticancer Ther 2014; 4:679-89. [PMID: 15270671 DOI: 10.1586/14737140.4.4.679] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In North America, endometrial cancer is the most prevalent cancer of the female genital tract. On the basis of clinical and histologic variables, two main types of endometrial cancer have been described: Type I tumors, which are usually well differentiated and endometrioid in histology and account for the majority of cases; and Type II, which are poorly differentiated tumors, often with serous papillary or clear cell histology. Due to the early declaration of the disease by vaginal bleeding, approximately 80% of endometrial cancers are diagnosed at an early stage. Total abdominal hysterectomy and bilateral salpingo-oophorectomy with or without lymph node dissection remains the cornerstone of treatment. Tumor stage, histologic grade and depth of myometrial invasion are the most important prognostic factors. If myometrial invasion to 50% or more of the myometrial width and/or grade 2 or 3 histology is present, pelvic radiotherapy is indicated to reduce the risk of pelvic recurrence. Postoperative radiation therapy may improve local control but does not affect survival for Stage I endometrial cancer patients. Systemic chemotherapy is typically reserved for women with disseminated primary disease or extrapelvic recurrence. Although the combination of cisplatin plus doxorubicin is commonly used, carboplatin plus paclitaxel represents an efficacious, low-toxicity regimen for managing advanced or recurrent endometrial cancer. Recently, a significant percentage of Type II uterine tumors have been found to overexpress the epidermal growth factor Type II receptor. Anti-HER-2/neu-targeted therapy might be a novel and attractive therapeutic strategy in patients harboring this biologically aggressive variant of endometrial cancer.
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Affiliation(s)
- Alessandro D Santin
- University of Arkansas for Medical Sciences, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, 4301 West Markham Street, Slot 518, Little Rock, AR 72205, USA.
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High-grade endometrial cancer: Revisiting the impact of tumor size and location on outcomes. Gynecol Oncol 2014; 132:44-9. [DOI: 10.1016/j.ygyno.2013.10.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 10/10/2013] [Accepted: 10/22/2013] [Indexed: 11/17/2022]
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16
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Comparative outcomes assessment of uterine grade 3 endometrioid, serous, and clear cell carcinomas. Gynecol Oncol 2013; 129:478-85. [DOI: 10.1016/j.ygyno.2013.03.011] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 03/13/2013] [Accepted: 03/14/2013] [Indexed: 11/30/2022]
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Choi EC, Kim JH, Kim OB, Byun SJ, Park SG, Kwon SH. Postoperative radiotherapy for endometrial cancer. Radiat Oncol J 2012; 30:108-16. [PMID: 23170289 PMCID: PMC3496844 DOI: 10.3857/roj.2012.30.3.108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 08/06/2012] [Accepted: 09/11/2012] [Indexed: 11/18/2022] Open
Abstract
Purpose To investigate the prognostic factors and effectiveness of postoperative radiotherapy alone for endometrial carcinoma. Materials and Methods Sixty four patients with stage I-III endometrial cancer (EC) treated with postoperative radiotherapy alone between January 1989 and December 2008 at the Keimyung University Dongsan Medical Center were chosen for the present study. Typically, total hysterectomy, salpingo-oophorectomy and lymphadenectomy were performed on the patient's pelvis. Total dose from 50.4 Gy to 63 Gy was irradiated at pelvis or extended field. Thirteen patients were treated with Co-60 or Ir-192 intracavitary radiotherapy. Follow-up periods were from 7 to 270 months, with a median of 56 months. Results Five year overall survival (OS) rate was 58.7%, respectively. Five year disease-free survival (DFS) rate was 59.2%, respectively. In univariate analysis for OS and DFS, stage, menopausal age, type of operation, serosal invasion, and lymph node involvement were found to be statistically significant. Histologic type was marginally significant. In multivariate analysis for OS and DFS, stage, types of operation, histologic type were also found to be statistically significant. Treatment failure occurred in 14 patients. The main pattern of failure was found to be distant metastasis. Time to distant metastasis was from 3 to 86 months (median, 12 months). There were no grade 3 or 4 complications. Conclusion Stage, types of operation, and histologic type could be the predictive prognostic factors in patients. We contemplated postoperative radiation as effective and safe treatment method for EC. Additional treatment would be needed to reduce distant metastasis.
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Affiliation(s)
- Eun Cheol Choi
- Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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Samper-Ternent R, Asem H, Zhang DD, Kuo YF, Hatch SS, Freeman JL, Berenson AB. The effect of postoperative beam, implant, and combination radiation therapy on GI and bladder toxicities in female Medicare beneficiaries with stage I uterine cancer. J Geriatr Oncol 2012; 3:344-350. [DOI: 10.1016/j.jgo.2012.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bahng AY, Chu C, Wileyto P, Rubin S, Lin LL. Risk factors for recurrence amongst high intermediate risk patients with endometrioid adenocarcinoma. J Gynecol Oncol 2012; 23:257-64. [PMID: 23094129 PMCID: PMC3469861 DOI: 10.3802/jgo.2012.23.4.257] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 05/31/2012] [Accepted: 06/04/2012] [Indexed: 01/23/2023] Open
Abstract
Objective To determine risk factors associated with recurrence in patients with high intermediate risk (HIR) endometrioid adenocarcinoma. Methods A retrospective analysis of patients with HIR endometrioid adenocarcinoma who underwent hysterectomy, bilateral salpingo-oophorectomy, with or without pelvic/para-aortic lymphadenectomy at the University of Pennsylvania between 1990 and 2009 was performed. Results A total of 103 women with HIR endometrial cancer were identified. Multivariable analysis revealed that ≥2/3 myometrial invasion (HR, 4.79; p=0.010) and grade 3 disease (HR, 3.04; p=0.045) were independently predictive of distant metastases. The 5-year distant metastases free survival (DMFS) for patients with neither or one of these risk factors was 89%, and the 5-year DMFS for patients with both risk factors was 48% (p<0.001). Conclusion Patients with both grade 3 disease and deep third myometrial invasion have a high risk of distant metastases. Identifying these patients may be important in rationally selecting patients for systemic therapy.
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Affiliation(s)
- Agnes Y Bahng
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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De Ieso PB, Mullassery V, Shrimali R, Lowe G, Bryant L, Hoskin PJ. Image-guided vulvovaginal interstitial brachytherapy in the treatment of primary and recurrent gynecological malignancies. Brachytherapy 2012; 11:306-10. [DOI: 10.1016/j.brachy.2011.08.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 05/12/2011] [Accepted: 08/09/2011] [Indexed: 11/17/2022]
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Comparison of prognosis in patients with endometrioid endometrial cancer staged IB in FIGO 1988 and 2009 classifications. Arch Gynecol Obstet 2012; 286:995-1000. [PMID: 22627994 DOI: 10.1007/s00404-012-2378-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2011] [Accepted: 05/08/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Since 2009 the new FIGO Staging System of endometrial cancer, which changed the previous FIGO 1988 Staging System, has been in use. The aim of the study was to compare prognosis in patients with endometrioid endometrial cancer at stage IB of the 2009 FIGO Staging System and of the 1988 FIGO Staging System. METHODS We analyzed 173 patients: 108 patients (group A) at stage IB in FIGO 1988 Staging System, and 68 patients (group B) at stage IB in FIGO 2009 Staging System from 262 consecutive endometrioid endometrial cancer patients. The disease-free survival (DFS) and overall survival (OS) were compared between these groups. RESULTS The DFS rate was 96.3 % in group A and it was 87.7 % in group B (p = 0.029). Relapses were observed in 12 patients (6.4 %) from 6 to 57 months (mean 28.1; SD = 14.6) after initial surgery, and occurred in four patients from group A (3.7 %) and eight patients from group B (12.3 %) (p = 0.032). The OS rate was 94.4 % in group A and it was 83.1 % in group B (p = 0.018). During follow-up, 17 patients (9.8 %) died: six patients from group A (5.6 %), and 11 patients from group B (16.9 %). CONCLUSIONS Stage IB in FIGO 2009 Staging System is associated with worse prognosis compared to stage IB according to FIGO 1988 classification. There seems to be a need to use exclusively the new FIGO 2009 classification worldwide to avoid therapeutic mistakes, which can be caused by diverse nomenclature.
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Carcinoma endometrial: tratamento. Rev Assoc Med Bras (1992) 2012. [DOI: 10.1590/s0104-42302012000300005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Endometrial carcinoma: treatment. Rev Assoc Med Bras (1992) 2012. [DOI: 10.1016/s0104-4230(12)70195-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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The prognostic significance of age in surgically staged patients with Type II endometrial carcinoma. Gynecol Oncol 2012; 126:16-9. [PMID: 22507535 DOI: 10.1016/j.ygyno.2012.04.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 04/06/2012] [Accepted: 04/08/2012] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Many studies have examined the impact of older age on tumor recurrence and survival after hysterectomy for patients with endometrioid carcinoma. However, there is paucity of data examining the prognostic significance of age in patients with Type II endometrial carcinoma. The study was conducted to determine the prognostic impact of age in this patient population. MATERIALS AND METHODS In this Institutional Review Board (IRB)-approved study, our prospectively-maintained database of 1305 patients with endometrial cancer was reviewed. Seventy-two consecutive patients with serous and clear carcinoma 2009 FIGO stages I-II were identified with at least one year follow-up after surgical staging. Patients with mixed histology and those who received preoperative therapy were excluded. All the patients underwent surgical staging from 1989 to 2009. Their medical records were reviewed. The study cohort was divided into two groups based on their age at hysterectomy (≤ 65 vs. >65). Patient's demographics, pathologic features and treatment-related factors were compared. The impact of age on recurrence-free survival (RFS), disease-specific survival (DSS) and overall survival (OS) were calculated. Following univariate analysis, multivariate modeling was done using step-wise Cox proportional hazards analysis to assess the impact of age on clinical outcomes after adjusting for various clinical variables. RESULTS Median follow-up for the study cohort was 45 months (range 13-246). Fifty percent of patients received adjuvant platinum-based chemotherapy and/or adjuvant radiation treatment (RT). Thirty-five patients were older than 65 years (49%) and 37 were ≤ 65 (51%). There were no significant differences between the two groups in regard to race (African American vs Caucasian), FIGO stage, number of lymph nodes dissected, lymphovascular space involvement (LVSI), or adjuvant therapy received. There were more clear cell histology in the younger age group (p=0.035). Patients >65 years old developed more recurrences with a 5-year RFS of 59% compared to 84% for younger patients (p=0.036). The five-year DSS was not statistically different between the two groups (68% vs. 79%, respectively with p=0.313). 5-year OS was significantly shorter in the elderly patients (58% vs. 78% with p=0.014). On multivariate analysis, the presence of LVSI, not receiving RT and age >65 were independent predictors of worse RFS (p=<0.001, 0.005, and 0.040 respectively). CONCLUSION In this study for surgically staged FIGO I-II patients with Type II endometrial carcinoma, age more than 65 years is a significant adverse prognostic factor for tumor recurrence.
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Bahng AY, Dagan A, Bruner DW, Lin LL. Determination of Prognostic Factors for Vaginal Mucosal Toxicity Associated With Intravaginal High-Dose Rate Brachytherapy in Patients With Endometrial Cancer. Int J Radiat Oncol Biol Phys 2012; 82:667-73. [DOI: 10.1016/j.ijrobp.2010.10.071] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 10/02/2010] [Accepted: 10/29/2010] [Indexed: 10/18/2022]
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Gayar OH, Robbins JR, Parikh K, Lu M, Buekers T, Munkarah A, Elshaikh MA. Hysterectomy for uterine adenocarcinoma in the elderly: Tumor characteristics, and long-term outcome. Gynecol Oncol 2011; 123:71-5. [DOI: 10.1016/j.ygyno.2011.06.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 06/17/2011] [Accepted: 06/25/2011] [Indexed: 10/17/2022]
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Does postoperative radiotherapy provide any survival advantage over observation in stage IC endometrial cancer after comprehensive surgical staging? Eur J Obstet Gynecol Reprod Biol 2010; 154:200-4. [PMID: 20965641 DOI: 10.1016/j.ejogrb.2010.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Revised: 08/10/2010] [Accepted: 09/25/2010] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare postoperative radiotherapy and observation for survival and recurrence rates in stage IC endometrial carcinoma patients who underwent comprehensive surgical staging. STUDY DESIGN Fifty-seven stage IC endometrial cancer patients who underwent surgical staging were included in this study. Twenty cases (35%) received postoperative radiotherapy and 37 (65%) were observed without additional therapy. The two groups were compared for survival and recurrence rates. RESULTS Mean follow-up times for the radiotherapy and observation groups were 52.05 and 38.71 months, respectively. Five-year disease-free survival rates for the radiotherapy and observation groups were 91% and 63%, respectively, and 5-year overall survival rates for the radiotherapy and observation groups were 90.0% and 80.8%, respectively. Both the disease-free and overall survival rates were similar between the two groups (p > 0.05). One (5%) of the 20 patients in the radiotherapy group, and four (10.8%) of the 37 patients in the observation group had recurrences and there was no statistical difference for the recurrence rates (p > 0.05). Disease grade had no prognostic significance in terms of survival after surgical staging. CONCLUSIONS Comprehensive surgical staging might minimize the unfavorable role of deep myometrial invasion and grade. After surgical staging, postoperative observation without radiotherapy may be an appropriate approach in stage IC, all grades, endometrial carcinoma.
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Long-term urinary adverse effects of pelvic radiotherapy. World J Urol 2010; 29:35-41. [PMID: 20959990 DOI: 10.1007/s00345-010-0603-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Accepted: 09/28/2010] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Radiation for tumors arising in the pelvis has been utilized for over a 100 years. Adverse effects (AEs) of radiotherapy (RT) continue to accumulate with time and are reported to show decades after treatment. The benefit of RT for pelvic tumors is well described as is their acute AEs. Late AEs are less well described. The burden of treatment for the late AEs is large given the high utilization of RT. REVIEW For prostate cancer, 37% of patients will receive radiation during the first 6 months after diagnosis. Low-and high-grade AEs are reported to occur in 20-43 and 5-13%, respectively, with a median follow-up of ~60 months. For bladder cancer, the grade 2 and grade 3 late AEs occur in 18-27 and 6-17% with a median follow-up of 29-76 months. For cervical cancer, the risk of low-grade AEs following radiation can be as high as 28%. High-grade AEs occur in about 8% at 3 years and 14.4% at 20 years or ~0.34% per year. Radiation AEs appear to be less common or at least less well studied after radiation for rectal and endometrial cancers. CONCLUSION Properly delineating the rate of long-term AEs after pelvic RT is instrumental to counseling patients about their options for cancer treatment. Further studies are needed that are powered to specifically evaluate long-term AEs.
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Does Brachytherapy Improve Survival in Addition to External Beam Radiation Therapy in Patients With High Risk Stage I and II Endometrial Carcinoma? Am J Clin Oncol 2010; 33:364-9. [DOI: 10.1097/coc.0b013e3181b0c266] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Okuma K, Yamashita H, Kawana K, Nakagawa S, Oda K, Nakagawa K. Advanced age is a significant determinant of poor prognosis in patients treated with surgery plus postoperative radiotherapy for endometrial cancer. J Obstet Gynaecol Res 2010; 36:757-63. [DOI: 10.1111/j.1447-0756.2010.01202.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gemer O, Gdalevich M, Voldarsky M, Barak F, Ben Arie A, Schneider D, Levy T, Anteby E, Lavie O. Lower uterine segment involvement is associated with adverse outcome in patients with stage I endometroid endometrial cancer: Results of a multicenter study. Eur J Surg Oncol 2009; 35:865-9. [DOI: 10.1016/j.ejso.2008.10.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Revised: 08/03/2008] [Accepted: 10/14/2008] [Indexed: 11/30/2022] Open
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Koukourakis MI, Tsoutsou PG, Abatzoglou I, Soulimioti G, Sismanidou K, Liberis V, Giatromanolaki A, Sivridis E, Galazios G. Postoperative Accelerated Radiotherapy with Cytoprotection Followed by Three-Dimensional Conformal Boost in Patients with Early Endometrial/Cervical Cancer. TUMORI JOURNAL 2009; 95:455-60. [DOI: 10.1177/030089160909500408] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background Adjuvant external beam radiotherapy is highly recommended for uterine carcinomas invading beyond the inner half of the myometrium or cervical stage IIa carcinomas. The addition of a booster intracavitary dose is widely used. Methods We assessed the feasibility and toxicity of a hypofractionated accelerated conformal radiotherapy scheme (2.7 Gy per fraction, for 14 consecutive fractions to the pelvis) supported with the cytoprotective agent amifostine (HypoARC). The amifostine dose was individualized (500–1000 mg daily subcutaneously). A booster dose of radiation was given to the vagina and stump using a 6-field 3D-conformal technique (3 × 4 Gy or 4 × 3 Gy) instead of intracavitary radiotherapy. Results Grade 2 diarrhea appeared in 9/25 (36%) and grade 1 cystitis in 7/25 (28%) cases. Analysis according to the amifostine dose level clearly showed reduced toxicity in patients receiving a daily dose of 750–1000 mg (P <0.009). Within a median follow-up of 31 months (range, 11–52), there was only one case with grade 2 colitis (the patient had received no amifostine). None of the patients treated has relapsed locally or to distant organs within a median of 31 months of follow-up. Conclusions It is concluded that HypoARC followed by 3D-conformal booster dose to the vagina is feasible and convenient for patients and for busy radiotherapy departments, as it reduces the overall time by 50%. When supported by high-dose daily amifostine, it has an impressively low rate of early and late radiation toxicity.
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Affiliation(s)
- Michael I Koukourakis
- Department of Radiotherapy and Oncology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Pelagia G Tsoutsou
- Department of Radiotherapy and Oncology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Ioannis Abatzoglou
- Department of Radiotherapy and Oncology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Georgia Soulimioti
- Department of Radiotherapy and Oncology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Kyriaki Sismanidou
- Department of Radiotherapy and Oncology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Vassilios Liberis
- Department of Obstetrics and Gynecology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Alexandra Giatromanolaki
- Department of Pathology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Efthimios Sivridis
- Department of Pathology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - George Galazios
- Department of Pathology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
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Estimation of Optimal Brachytherapy Utilization Rate in the Treatment of Malignancies of the Uterine Corpus by a Review of Clinical Practice Guidelines and the Primary Evidence. Int J Radiat Oncol Biol Phys 2008; 72:849-58. [DOI: 10.1016/j.ijrobp.2008.01.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Revised: 01/09/2008] [Accepted: 01/09/2008] [Indexed: 11/23/2022]
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Kuoppala T, Mäenpää J, Tomas E, Puistola U, Salmi T, Grenman S, Lehtovirta P, Fors M, Luukkaala T, Sipilä P. Surgically staged high-risk endometrial cancer: Randomized study of adjuvant radiotherapy alone vs. sequential chemo-radiotherapy. Gynecol Oncol 2008; 110:190-5. [DOI: 10.1016/j.ygyno.2008.03.020] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Revised: 03/14/2008] [Accepted: 03/29/2008] [Indexed: 10/22/2022]
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Lavie O, Uriev L, Gdalevich M, Barak F, Peer G, Auslender R, Anteby E, Gemer O. The outcome of patients with stage I endometrial cancer involving the lower uterine segment. Int J Gynecol Cancer 2008; 18:1079-83. [DOI: 10.1111/j.1525-1438.2007.01150.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The objective of this study was to evaluate whether lower uterine segment involvement (LUSI) correlates with recurrence and survival in women with stage I endometrial adenocarcinoma and whether it is associated with poor prognostic histopathologic features. Three hundred seventy-five consecutive patients with endometrial carcinoma stage I compromised the study population. The patients were divided into two groups according to the presence of LUSI with endometrial carcinoma. The two groups were compared with regard to prognostic factors and outcome measures by using the Pearson χ2 test, log-rank test, and Cox proportional hazards model. LUSI was present in 89 (24%) patients with stage I endometrial carcinoma. LUSI was significantly associated with grade 3 tumor (P= 0.022), deep myometrial invasion (P< 0.0001), and the presence of capillary space-like involvement (CSLI) (P= 0.003). Kaplan–Meier survival curves demonstrated that patients with LUSI had a lower recurrence-free survival (log-rank test; P= 0.009) and a worse overall survival (log-rank test; P= 0.0008). In the Cox proportional hazards model, only a trend toward higher recurrence rate (HR = 2.4, 95% CI 0.7, 8.2; P= 0.16) and a trend toward poorer overall survival (HR = 1.54, 95% CI 0.82, 2.91; P= 0.18) were noted when LUSI was present. In patients with stage I endometrial cancer, the presence of LUSI is associated with grade 3 tumor, deep myometrial invasion, and the presence of CSLI. A larger group of patients is necessary to conclude whether higher recurrence rate and poorer overall survival are associated with the presence of LUSI.
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Desrosiers L, Fadare O, Xiao ZF, Dresser K, Wang SA. Lymphovascular space invasion does not predict vaginal relapses in stage I endometrioid adenocarcinoma of the endometrium. Ann Diagn Pathol 2008; 12:112-7. [DOI: 10.1016/j.anndiagpath.2007.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lachance JA, Stukenborg GJ, Schneider BF, Rice LW, Jazaeri AA. A cost-effective analysis of adjuvant therapies for the treatment of stage I endometrial adenocarcinoma. Gynecol Oncol 2008; 108:77-83. [DOI: 10.1016/j.ygyno.2007.08.072] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Revised: 08/20/2007] [Accepted: 08/20/2007] [Indexed: 10/22/2022]
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Barney BM, MacDonald OK, Lee CM, Rankin J, Gaffney DK. An analysis of simulation for adjuvant intracavitary high-dose-rate brachytherapy in early-stage endometrial cancer. Brachytherapy 2007; 6:201-6. [PMID: 17681241 DOI: 10.1016/j.brachy.2007.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Revised: 02/23/2007] [Accepted: 03/20/2007] [Indexed: 11/26/2022]
Abstract
PURPOSE The utility of serial simulations in vaginal vault irradiation is controversial. Our primary endpoint was to assess the significance of simulation in women who received adjuvant intracavitary high-dose-rate brachytherapy (HDR-BT) for early-stage endometrial adenocarcinoma. Secondary endpoints included assessment of acute and late treatment toxicity, medication requirements, and charges related to the HDR-BT simulation and procedure. METHODS AND MATERIALS Twenty-four consecutive women with early-stage endometrial cancer treated with adjuvant HDR-BT were evaluated. Descriptive statistical analyses were performed on the ratio of calculated to prescription BT dose at predefined dosimetric points. Data on acute and late toxicities, medication usage, and simulation charges were evaluated and compared. RESULTS The intravaginal cylinder was placed three times over 10-14 days (median 6.5Gy prescribed to 5mm). No substantial deviation in the means of the calculated ratios was observed except at the bladder point (mean 0.77+/-0.23). Early toxicity was found to be no greater than Grade 1 (n=5). Serious late toxicities were uncommon; one woman developed a Grade 3 gastrointestinal toxicity. Half of the women required prescription medication incident to simulation. The average simulation charge was $1252.80. CONCLUSIONS Despite the broad range of doses calculated at the bladder point, genitourinary toxicity was minimal. Simulation proved useful in recording dose and represented a small, yet important portion of the total treatment charge but did not alter treatment in this series. The necessity of simulation for intracavitary high-dose-rate vaginal brachytherapy remains unclear.
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Affiliation(s)
- Brandon M Barney
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, 1950 Circle of Hope, Salt Lake City, UT 84112, USA
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Fleming GF, Montag AC, Mundt AJ, Yamada S. Uterine Malignancies. Oncology 2007. [DOI: 10.1007/0-387-31056-8_53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lopes LAF, Nicolau SM, Baracat FF, Baracat EC, Gonçalves WJ, Santos HVB, Lopes RG, Lippi UG. Sentinel lymph node in endometrial cancer. Int J Gynecol Cancer 2007; 17:1113-7. [PMID: 17386045 DOI: 10.1111/j.1525-1438.2007.00909.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The aim of this study was to evaluate the possibility of identifying the sentinel lymph node and involvement of neoplastic cells in patients with endometrial carcinoma limited to the uterus, and also its correlation with the conditions of other pelvic and para-aortic lymph nodes. Forty patients with endometrial carcinoma, clinical staging I and II, were submitted to complete surgical staging through laparotomy, as recommended by FIGO in 1988. The sentinel node was investigated using patent blue dye in the myometrial subserosa. The sentinel node was excised and submitted to frozen section examination of specimen, stained with hematoxylin and eosin (H&E). Afterward, selective bilateral para-aortic and pelvic lymphadenectomy, total hysterectomy with bilateral salpingo-oophorectomy were performed. The lymph nodes excised were examined by means of paraffin-embedded slices stained with H&E and of imunohistochemistry with antikeratin antibody AE1/AE3. The sentinel lymph node was identified in 77.5% of patients (31/40), and 16.1% (5/31) presented neoplastic involvement in the node. In 25 cases of negative sentinel node, 96% (24/25) had no neoplastic involvement, and 4% (1/25) had other lymph node affected (false negative). In nine cases with no sentinel node identified, 55.5% (5/9) had lymph node involvement. The results of this study allow us to conclude that it is possible to identify the sentinel node using the methods described, and the pathologic examination significantly represents the same conditions of other pelvic and para-aortic lymph nodes.
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Affiliation(s)
- L A F Lopes
- Department of Obstetrics and Gynecology, Hospital do Servidor Público Estadual de São Paulo-Francisco Morato Oliveira, São Paulo, SP, Brazil.
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Lee CM, Szabo A, Shrieve DC, Macdonald OK, Tward JD, Skidmore TB, Gaffney DK. Descriptive nomograms of adjuvant radiotherapy use and patterns of care analysis for stage I and II endometrial adenocarcinoma: A surveillance, epidemiology, and end results population study. Cancer 2007; 110:2092-100. [PMID: 17849468 DOI: 10.1002/cncr.22997] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although endometrial cancer remains the most common gynecologic malignancy in the United States, differing approaches to adjuvant radiotherapy treatment for early disease exist within the medical community because of the lack of a national consensus. METHODS The authors studied patterns of adjuvant care for stage I and II endometrial adenocarcinoma using a large United States population database. A retrospective analysis was conducted from the Surveillance, Epidemiology, and End Results (SEER) Program of the U.S. National Cancer Institute from 1988 to 2002, and 26,923 women with American Joint Committee on Cancer stage I and II endometrial adenocarcinoma were selected. The following prognostic factors were analyzed: age, race, stage, grade, year of diagnosis, SEER registry location, and use and type of postoperative radiotherapy (RT). Adjuvant RT was coded as none, external-beam RT (EBRT), brachytherapy (BR), or a combination of the 2 (EBRT + BR). RESULTS Higher tumor grade and stage led to greater use of RT. The odds ratio (OR) for adjuvant RT was 3.4 for stage IB versus stage IA and 51.8 for stage IC/II versus stage IA. The effect of grade depended on stage: for stages IA and IB, the OR was 2.9 for grade 2 versus grade 1 and 11.7 for grade 3/4 versus grade 1; whereas, for stage IC/II, the OR was 1.5 for grade 2 versus grade 1 and 2.0 for grade 3/4 versus grade 1. Within stage I, increasing substage and grade increased the odds of EBRT with or without BR compared with BR alone. Race did not effect the choice of therapy (all P > .1). Geographic location had a significant effect on overall RT use and therapy choice. CONCLUSIONS To the authors' knowledge, this was the largest patterns of care analysis to date of adjuvant RT in patients with stage I and II endometrial adenocarcinoma. The current study revealed that there is significant diversity in the use of adjuvant RT across the United States, and the results reflected the absence of a national consensus on adjuvant treatment for early-stage disease.
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Affiliation(s)
- Christopher M Lee
- Department of Radiation Oncology, Huntsman Cancer Hospital and University of Utah Medical Center, Salt Lake City, Utah 99202, USA.
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Pecorelli S, Angioli R, Pasinetti B, Tisi G, Odicino F. Systemic therapy for gynecological neoplasms: Ovary, cervix and endometrium. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.uct.2006.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Macdonald OK, Sause WT, Lee RJ, Lee CM, Dodson MK, Zempolich K, Gaffney DK. Adjuvant radiotherapy and survival outcomes in early-stage endometrial cancer: A multi-institutional analysis of 608 women. Gynecol Oncol 2006; 103:661-6. [PMID: 16797682 DOI: 10.1016/j.ygyno.2006.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2006] [Revised: 04/24/2006] [Accepted: 05/02/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The role of post-operative radiotherapy (RT) in women with early-stage, low to intermediate risk cancer of the uterine corpus remains controversial. The primary objective of this analysis was to evaluate the survival outcomes of women with early-stage endometrial cancer treated with surgery alone or surgery followed by RT. METHODS Data from two institutions were collected from 1990 to 2003. The 608 eligible women had FIGO stage IA to IIA endometrial cancer and underwent primary surgery +/-RT. Univariate and multivariate analyses of pertinent variables were performed for the end points of disease-free survival (DFS) and overall survival (OS). RESULTS The median age for all women was 64 years. RT was delivered to 133 women (22%). Unfavorable histologic grade (P < 0.0001) and stage (P < 0.0001) were significantly more prevalent in the adjuvant RT group. At a median follow-up of 5.2 years, 26 pelvic (11 vaginal) and 16 distant failures occurred along with 110 deaths (with no significant differences between women undergoing surgery alone or followed by RT). Adjuvant RT, younger age, and lower stage predicted for improved DFS and OS on multivariate analysis. Stratified analysis revealed that adjuvant RT conferred a survival benefit in women with stage IC or IIA disease. CONCLUSIONS Adjuvant RT was associated with improved disease-free and overall survival in women with higher risk disease. Despite significantly worse disease characteristics among women in the adjuvant RT group, the analyzed end points were equivalent among the two groups. These findings suggest that adjuvant radiotherapy has a significant benefit in reducing mortality and disease progression in early-stage carcinoma of the uterine corpus.
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Affiliation(s)
- O Kenneth Macdonald
- Department of Radiation Oncology, Huntsman Cancer Hospital at the University of Utah, Salt Lake City, UT 84112-5560, USA
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Viani GA, Patia BF, Pellizzon AC, De Melo MD, Novaes PE, Fogaroli RC, Conte MA, Salvajoli JV. High-risk surgical stage 1 endometrial cancer: analysis of treatment outcome. Radiat Oncol 2006; 1:24. [PMID: 16887018 PMCID: PMC1555589 DOI: 10.1186/1748-717x-1-24] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2006] [Accepted: 08/03/2006] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To report the relapse and survival rates associated to treatment for patients with stage IC, grade 2 or grade 3 and IB grade 3 diseases considered high risk patients group for relapse. MATERIALS AND METHODS From January 1993 to December 2003, 106 patients with endometrial cancer stage I were managed surgically in our institution. Based on data from the medical records, 106 patients with epithelial endometrial cancer met the following inclusion criteria: stage IC grade 2 or 3 and IB grade 3 with or without lymphovascular invasion. Staging was defined according to the FIGO surgical staging system. Postoperative adjuvant radiotherapy consisted of external beam pelvic radiation, vaginal brachytherapy alone or both. The median age was 65 years (range, 32-83 years), lymph node dissection was performed in 45 patients (42.5%) and 14 patients (13.2%) received vaginal brachytherapy only, and 92 (86.8%) received combined vaginal brachytherapy and external beam radiotherapy. The median dose of external beam radiotherapy administered to the pelvis was 4500 cGy (range 4000-5040). The median dose to vaginal surface was 2400 cGy (range 2000-3000). Predominant pathological stage and histological grade were IC (73.6%) and grade 3 (51.9%). The lymphovascular invasion was present in 33 patients (31.1%) and pathological stage IC grade 2 was most common (48. 1%) combination of risk factors in this group. RESULTS With a follow up median of 58.3 months (range 12.8-154), five year overall survival and event free survival were 78.5% and 72.4%, respectively. Locoregional control in five year was 92.4%. Prognostic factors related with survival in univariate analyses were: lymphadenectomy (p = 0.045), lymphovascular invasion (p = 0.047) and initial failure site (p < 0.0001). In multivariate analyses the initial failure in distant sites (p < 0.0001) was the only factor associated with poor survival. Acute and chronic gastrointestinal and genitourinary toxicity grades 3 were not observed. CONCLUSION In conclusion, our results showed that the stage IC, grade 2, 3 and IB grade 3 endometrial cancer was associated with significantly increased risk of distant relapse and endometrial carcinoma-related death independently of salvage treatment modality.
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Affiliation(s)
- Gustavo A Viani
- Department of Radiation Oncology Hospital do Cancer, Sao Paulo, Brazil
| | - Barbara F Patia
- Department of Radiation Oncology Hospital do Cancer, Sao Paulo, Brazil
| | | | - Marcel D De Melo
- Department of Radiation Oncology Hospital do Cancer, Sao Paulo, Brazil
| | - Paulo E Novaes
- Department of Radiation Oncology Hospital do Cancer, Sao Paulo, Brazil
| | | | - Maria A Conte
- Department of Radiation Oncology Hospital do Cancer, Sao Paulo, Brazil
| | - Joao V Salvajoli
- Department of Radiation Oncology Hospital do Cancer, Sao Paulo, Brazil
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Harrison JD, Carter J, Young JM, Solomon MJ. Difficult clinical decisions in gynecological oncology: identifying priorities for future clinical research. Int J Gynecol Cancer 2006; 16:1-7. [PMID: 16445602 DOI: 10.1111/j.1525-1438.2006.00424.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
This study investigates the acceptability and feasibility of conducting randomized controlled trials (RCTs) in gynecological oncology by ascertaining the views of the Australian Society of Gynaecologic Oncologists (ASGO) about important clinical questions in this field, current treatment preferences, and willingness to participate in trials to address these questions. Members of ASGO received a mailed survey. Thirty-one gyneoncologists participated in this study (79% response fraction). There was considerable support for an RCT (81%; 95% confidence interval [CI], 63-93%) to compare sentinel node biopsy with total groin dissection for women with vulval cancer. This clinical question was also rated as "extremely" or "very" important by 91% (95% CI, 74-98%) of respondents, who also indicated high levels of individual equipoise. Another priority for research involved the use of second-line chemotherapy for women who have rising CA125 titers. This clinical question was rated as extremely or very important by 71% (95% CI, 52-86%), exhibited high levels of individual equipoise, with 74% (95% CI, 55-88%) of respondents willing to participate in an RCT to address this issue. The conduct of surveys of representative groups of clinicians provides useful empirical data to focus clinical research efforts where they are most likely to be successful based on equipoise, feasibility, and clinical interest.
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Affiliation(s)
- J D Harrison
- Surgical Outcomes Research Centre, Sydney South West Area Health Service and the University of Sydney, Missenden Road, NSW 2050, Sydney, Australia.
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Alektiar KM, Venkatraman E, Chi DS, Barakat RR. Intravaginal brachytherapy alone for intermediate-risk endometrial cancer. Int J Radiat Oncol Biol Phys 2005; 62:111-7. [PMID: 15850910 DOI: 10.1016/j.ijrobp.2004.09.054] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2004] [Accepted: 09/16/2004] [Indexed: 11/24/2022]
Abstract
PURPOSE Despite the results of the Gynecologic Oncology Group trial No. 99 (GOG#99), some unanswered questions still remain about the role of adjuvant radiotherapy (RT) for intermediate-risk endometrial cancer. First, can intravaginal brachytherapy (IVRT) alone substitute for external beam RT but without added morbidity? Second, is the high-risk (HR) definition from GOG#99 a useful tool to predict pelvic recurrence specifically? The purpose of this study was to try to answer these questions in a group of patients with Stage IB-IIB endometrial carcinoma treated with high-dose-rate (HDR) IVRT alone. METHODS AND MATERIALS Between November 1987 and December 2002, 382 patients with Stage IB-IIB endometrial carcinoma were treated with simple hysterectomy followed by HDR-IVRT alone at our institution. Comprehensive surgical staging (CSS), defined as pelvic washings and pelvic/paraaortic lymph node sampling, was performed in 20% of patients. The mean age was 60 years (range, 29-92 years). Lymphovascular invasion (LVI) was present in 14% of patients. The median HDR-IVRT dose was 21 Gy (range, 6-21 Gy), given in three fractions. Complications were assessed in terms of late Radiation Therapy Oncology Group (Grade 3 or worse) toxicity of the GI tract, genitourinary GU tract, and vagina. RESULTS With a median follow-up of 48 months, the 5-year vaginal/pelvic control rate was 95% (95% confidence interval [CI], 93-98%). On multivariate analysis, a poor vaginal/pelvic control rate correlated with age > or =60 years old (relative risk [RR], 3, 95% CI, 1-12; p = 0.01), International Federation of Gynecology and Obstetrics (FIGO) Grade 3 (RR, 9, 95% CI, 2-35; p = 0.03), and LVI (RR, 4, 95% CI, 1-13; p = 0.051). The depth of myometrial invasion and CSS, however, were not significant. With regard to pelvic control specifically, the presence of GOG#99 HR features did not affect the pelvic control rate. The 5-year rate for HR patients was 96% (95% CI, 90-100%) vs. 96% (95% CI, 94-99%) for those without HR disease (p = 0.48). Even when the CSS effect was taken into account, the influence of HR features on pelvic control was still not significant (p = 0.51). In contrast, pelvic control was significantly influenced when patients were grouped according to CSS and stage/grade substages. For those with Stage IB Grade 3-IIB and no CSS, the 5-year pelvic control rate was 86% compared with 97% for those with Stage IB Grade 3-IIB and CSS, 97% for Stage IB, Grade 1-2 without CSS, and 100% for those with Stage IB, Grade 1-2 and CSS (p = 0.027). The 5-year disease-free survival rate was 93% (95% CI, 90-96%). On multivariate analysis, poor disease-free survival correlated with age > or =60 years (RR, 5; 95% CI, 1-18; p = 0.002), FIGO Grade 3 (RR 5, 95% CI 2-17; p = 0.013), and LVI (RR 3, 95% CI 1-8; p = 0.054). Unlike pelvic control, disease-free survival was significantly affected by GOG#99 HR features, with a 5-year rate of 87% (95% CI, 76-99%) vs. 94% (95% CI, 91-97%) for those without HR features (p = 0.027). The 5-year overall and disease-specific survival rate was 93% and 97%, respectively. The overall 5-year actuarial rate of Grade 3 or worse complications was 1% (95% CI, 0-2%). CONCLUSION Tumor grade, depth of invasion, and the use of CSS were better predictors of pelvic control than the GOG#99 HR factors. IVRT alone seemed to provide adequate tumor control with very low morbidity. Therefore, it seems prudent to consider it for intermediate-risk patients because of its superior therapeutic ratio compared with that for surgery alone or pelvic RT. Additional follow-up, however, with a larger number of patients is needed, especially for those with LVI.
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Affiliation(s)
- Kaled M Alektiar
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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Weitmann HD, Pötter R, Waldhäusl C, Nechvile E, Kirisits C, Knocke TH. Pilot study in the treatment of endometrial carcinoma with 3D image–based high-dose-rate brachytherapy using modified Heyman packing: Clinical experience and dose–volume histogram analysis. Int J Radiat Oncol Biol Phys 2005; 62:468-78. [PMID: 15890589 DOI: 10.1016/j.ijrobp.2004.10.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2004] [Revised: 10/04/2004] [Accepted: 10/08/2004] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to evaluate dose distribution within uterus (clinical target volume [CTV]) and tumor (gross tumor volume [GTV]) and the resulting clinical outcome based on systematic three-dimensional treatment planning with dose-volume adaptation. Dose-volume assessment and adaptation in organs at risk and its impact on side effects were investigated in parallel. METHODS AND MATERIALS Sixteen patients with either locally confined endometrial carcinoma (n = 15) or adenocarcinoma of uterus and ovaries after bilateral salpingo-oophorectomy (n = 1) were included. Heyman packing was performed with mean 11 Norman-Simon applicators (3-18). Three-dimensional treatment planning based on computed tomography (n = 29) or magnetic resonance imaging (n = 18) was done in all patients with contouring of CTV, GTV, and organs at risk. Dose-volume adaptation was achieved by dwell location and time variation (intensity modulation). Twelve patients treated with curative intent received five to seven fractions of high-dose-rate brachytherapy (7 Gy per fraction) corresponding to a total dose of 60 Gy (2 Gy per fraction and alpha/beta of 10 Gy) to the CTV. Four patients had additional external beam radiotherapy (range, 10-40 Gy). One patient had salvage brachytherapy and 3 patients were treated with palliative intent. A dose-volume histogram analysis was performed in all patients. On average, 68% of the CTV and 92% of the GTV were encompassed by the 60 Gy reference volume. Median minimum dose to 90% of CTV and GTV (D90) was 35.3 Gy and 74 Gy, respectively. RESULTS All patients treated with curative intent had complete remission (12/12). After a median follow-up of 47 months, 5 patients are alive without tumor. Seven patients died without tumor from intercurrent disease after median 22 months. The patient with salvage treatment had a second local recurrence after 27 months and died of endometrial carcinoma after 57 months. In patients treated with palliative intent, symptom relief was achieved. No severe acute and late side effects (Grade 3/4) were observed. CONCLUSIONS Sectional image-based three-dimensional treatment planning on computed tomography and magnetic resonance imaging is feasible in definitive brachytherapy of endometrial carcinoma and enables by the use of dwell time and location adaptation a sufficient coverage of GTV and major parts of CTV. Local control in this limited number of patients is excellent and rate of side effects minimal.
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Affiliation(s)
- Hajo Dirk Weitmann
- Department of Radiotherapy and Radiobiology, Medical University of Vienna, General Hospital of Vienna, Wien, Austria.
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Hoffstetter S, Brunaud C, Marchal C, Luporsi E, Guillemin F, Leroux A, Bey P, Peiffert D. [Preoperative brachytherapy for clinical stage I and II endometrial carcinoma: results from a series of 780 patients with a 10-year follow-up]. Cancer Radiother 2004; 8:178-87. [PMID: 15217585 DOI: 10.1016/j.canrad.2004.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2003] [Revised: 01/26/2004] [Accepted: 02/09/2004] [Indexed: 11/17/2022]
Abstract
AIMS OF THE STUDY Retrospective analysis of patients treated by preoperative brachytherapy for endometrial carcinoma. PATIENTS AND METHODS From 1973 to 1994, 780 consecutive patients with a clinical stage I-II endometrial carcinoma were treated with brachytherapy followed by surgery and pelvic irradiation if necessary. Tumour was staged according to 1979 UICC classification. There were 462 T1a, 257 T1b, and 61 T2, 62% were well differentiated. Brachytherapy consisted in one low dose rate endocavitary application. Sixty grays were delivered on the reference isodose. Surgery consisted in a TAH/BSO (Piver II) and was performed 6 weeks later. Nodal pelvic irradiation was indicated in case of unfavourable pathological prognostic factors. RESULTS Median follow up was 122 months. Five year survival rates were: 84% for overall survival, 86% for survival without recurrence, 92.8% for local control, and 3.8% for late complications. Pronostic factors were age, stage, differentiation, grade and postoperative extension. Multivariate analysis showed only age, differentiation and postoperative extension to be independent prognostic factors. CONCLUSION If for stage 1, initial surgery has now replaced preoperative brachytherapy in most cases because it allows to identify initial prognostic factors, preoperative brachytherapy remains the most interesting option for stage 2 endometrial carcinomas.
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Affiliation(s)
- S Hoffstetter
- Service de radiothérapie-curiethérapie, centre Alexis-Vautrin, avenue de Bourgogne, 54511 Vandoeuvre-les-Nancy, France.
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Is Adjuvant Radiotherapy Effective in Intermediate-risk Surgical Stage I Endometrial Cancer? Taiwan J Obstet Gynecol 2004. [DOI: 10.1016/s1028-4559(09)60064-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Creutzberg CL, van Putten WLJ, Wárlám-Rodenhuis CC, van den Bergh ACM, de Winter KAJ, Koper PCM, Lybeert MLM, Slot A, Lutgens LCHW, Stenfert Kroese MC, Beerman H, van Lent M. Outcome of High-Risk Stage IC, Grade 3, Compared With Stage I Endometrial Carcinoma Patients: The Postoperative Radiation Therapy in Endometrial Carcinoma Trial. J Clin Oncol 2004; 22:1234-41. [PMID: 15051771 DOI: 10.1200/jco.2004.08.159] [Citation(s) in RCA: 227] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
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.
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Affiliation(s)
- Carien L Creutzberg
- Department of Radiation Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam, the Netherlands.
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