The Role of Adjuvant Radiotherapy in Carcinoma of the Endometrium—Results in 550 Patients with Pathologic Stage I Disease (original) (raw)
Related papers
Radiotherapy and Oncology, 1999
Adjuvant radiotherapy is the standard treatment for endometrial carcinoma. However, until now there has been no clear indication that radiotherapy in that setting improves survival. This calls for critical assessment of the relation between the expected benefit and the number and severity of postradiotherapeutic side effects. In a retrospective study 159 consecutive patients with stage I and II endometrial carcinoma were treated with external radiotherapy and vaginal brachytherapy after hysterectomy and bilateral salpingoophorectomy (no surgical lymph node staging). Recurrence rates, survival and side effects were evaluated, in particular with regard to the relation of acute and late toxicity. Five percent of all patients developed a recurrence either in the abdomen or at distant locations. No pelvic relapses were diagnosed. Five-year relapse-free survival was 92% for stage IA + B, 84% for stage IC, and 79% for stage II disease. Acute toxicity was seen in 65.4% of patients, all grade 1 or 2, late toxicity grade 1 or 2 in 18.8%, grade 3 or 4 complications in 1.8%. The estimated 5-year freedom from late toxicity was 76.8%. Seventy-seven percent of all patients with treatment interruptions or premature end of therapy experienced late injury. In ten of 33 patients with late sequelae there was no free interval between early and late toxicity. No relation of radiation technique/fractionation and the rate of side effects was noticed. Adjuvant radiotherapy leads to excellent pelvic control, with few serious complications. Major acute toxicity shows significant correlation with the incidence of severe late injury, which we suggest to classify in part as consequential late effects.
Brachytherapy, 2015
OBJECTIVE: To evaluate recurrence patterns and overall survival in patients treated with adjuvant radiation after surgical staging for Stage II endometrial carcinoma. Secondary goals include identification of prognostic factors for recurrence and toxicity assessment. METHODS/MATERIALS: The medical records of 41 patients treated with adjuvant radiotherapy at Washington University School of Medicine after surgical staging for endometrial cancer (total abdominal hysterectomy and bilateral salpingo-oophorectomy, peritoneal cytology, lymph node dissection) were reviewed. Nineteen were treated with a combination of external beam radiotherapy and vaginal brachytherapy (VB), and 22 patients were treated with postoperative VB alone. Median followup for all patients was 41 months. RESULTS: Median patient age was 59 years (range, 42e87 years). All tumors were of endometrioid histology. There were 20 Grade 1 tumors, 13 Grade 2 tumors, and 8 Grade 3 tumors. For all patients, the 5-year overall survival was 69.8%, and the 5-year recurrence-free survival was 89.0%. There was no statistically significant difference in overall survival ( p 5 0.510) or freedom from vaginal ( p 5 0.840), distant ( p 5 0.133), or any recurrence ( p 5 0.275) with respect to modality of treatment (external beam radiotherapy and VB vs. VB alone). There were no pelvic lymph node recurrences. In the univariate analysis, there were no risk factors influencing overall survival or recurrences. One patient experienced a toxicity requiring hospital admission. She was treated with pelvic external beam radiation plus brachytherapy. CONCLUSIONS: VB alone results in excellent local control for patients with Stage II endometrial cancer after surgical staging. Long-term toxicities are rare and more common in the group of patients who were treated with pelvic external beam plus brachytherapy. Ó
Radiotherapy as local adjuvant treatment for endometrial carcinoma--a review of 45 patients
Annals of the Academy of Medicine, Singapore, 1998
Forty-five patients with endometrial carcinoma were treated with local postoperative adjuvant radiotherapy during the period 1992 to 1995. Radiotherapy technique comprised both external beam irradiation as well as high-dose-rate vaginal vault brachytherapy. The 5-year overall survival and relapse-free survival rates were 74% and 73%, respectively and poorly differentiated histology grade was associated with poorer prognosis. Only 1 patient developed an isolated vaginal vault recurrence and another 9 patients relapsed mainly at the distal anatomical sites. The main radiotherapy-related complications were vaginal adhesion and stenosis. Radiotherapy is therefore effective as local adjuvant treatment in reducing risk of local-regional relapse in endometrial carcinoma.
Long-term results of adjuvant radiotherapy in stage I endometrial cancer
2011
Two hundred sixty-three patients with stage I endometrial adenocarcinoma, who were treated with postoperative radiotherapy between 1978 and 1998, were analyzed retrospectively. According to the 1988-FIGO staging system, the disease was stage IA in 19, stage IB in 128, and stage IC in 116 patients. One hundred and ninety-seven patients were treated with external and intracavitary irradiation, 45 patients with external radiotherapy and 21 patients with vaginal brachytherapy.
International Journal of Radiation Oncology Biology Physics, 1998
Purpose: To retrospectively evaluate the outcome and risk factors in patients treated with radiation for endometrial cancer at time of recurrence. Materials and Methods: Three hundred ninety-nine women were treated with radiation therapy for endometrial cancer at KCI/WSU from January 1980 to December 1994. Of these, 26 patients treated primarily with surgery received radiation therapy at the time of recurrence. Median time to recurrence after surgery was 8 months, with all recurrences occurring within 24 months. Twenty-four patients had recurrences in the vaginal cuff, vagina, or pelvis. These patients received external-beam radiation to the pelvis (45.00 -50.40 Gy) and periaortic lymph nodes (45.00 -50.00 Gy), along with a boost given by external-beam radiation or brachytherapy (16.00 -30.00 Gy). Mean follow-up was 15 months (range 1-85 months).
The Lancet, 2010
Methods In this open-label, non-inferiority, randomised trial undertaken in 19 Dutch radiation oncology centres, 427 patients with stage I or IIA endometrial carcinoma with features of high-intermediate risk were randomly assigned by a computer-generated, biased coin minimisation procedure to pelvic EBRT (46 Gy in 23 fractions; n=214) or VBT (21 Gy high-dose rate in three fractions, or 30 Gy low-dose rate; n=213). All investigators were masked to the assignment of treatment group. The primary endpoint was vaginal recurrence. The predefi ned noninferiority margin was an absolute diff erence of 6% in vaginal recurrence. Analysis was by intention to treat, with competing risk methods. The study is registered, number ISRCTN16228756. Findings At median follow-up of 45 months (range 18-78), three vaginal recurrences had been diagnosed after VBT and four after EBRT. Estimated 5-year rates of vaginal recurrence were 1·8% (95% CI 0·6-5·9) for VBT and 1·6% (0·5-4·9) for EBRT (hazard ratio [HR] 0·78, 95% CI 0·17-3·49; p=0·74). 5-year rates of locoregional relapse (vaginal or pelvic recurrence, or both) were 5·1% (2·8-9·6) for VBT and 2·1% (0·8-5·8) for EBRT (HR 2·08, 0·71-6·09; p=0·17). 1·5% (0·5-4·5) versus 0·5% (0·1-3·4) of patients presented with isolated pelvic recurrence (HR 3·10, 0·32-29·9; p=0·30), and rates of distant metastases were similar (8·3% [5·1-13·4] vs 5·7% [3·3-9·9]; HR 1·32, 0·63-2·74; p=0·46). We recorded no diff erences in overall (84·8% [95% CI 79·3-90·3] vs 79·6% [71·2-88·0]; HR 1·17, 0·69-1·98; p=0·57) or disease-free survival (82·7% [76·9-88·6] vs 78·1% [69·7-86·5]; HR 1·09, 0·66-1·78; p=0·74). Rates of acute grade 1-2 gastrointestinal toxicity were signifi cantly lower in the VBT group than in the EBRT group at completion of radiotherapy (12·6% [27/215] vs 53·8% [112/208]).
Indications for Adjuvant Radiotherapy in Endometrial Carcinoma
Hematology/Oncology Clinics of North America, 1999
Stage for stage, endometrial cancer has about the same prognosis as cervical cancer.65 In general, this prognosis is good, because endometrial cancer is usually diagnosed at an early stage and has a low tendency for micrometastatic seeding. The survival rate is provided by the Swedish population-based Cancer Registry, which registered 23,970 patients with diagnoses of endometrial cancer between 1960 and 1989. During this time, a modest change was seen with a 5-year relative survival rate of 75% (95% confidence interval [CI] of 73% to 78) for patients (n = 1966) diagnosed between 1960 and 1962, and 82% (95% CI of 80% to 84%) for patients (n = 2605) diagnosed between 1987 and 1989 (unpublished data). Also, the 5-year cancer-specific survival rate of 13,040 patients diagnosed with endometrial cancer at 117 institutions between 1987 and 1989 was 77Y0.~~ The same report showed that about 15% of patients with stage I endometrial cancer die of disease within 5 years.
International Journal of Radiation Oncology*Biology*Physics, 2012
Materials/Methods: The charts of patients with pathologic stage III endometrial cancer treated in our institution from June 1997 to June 2007 were reviewed. All patients underwent comprehensive surgical staging, including nodal assessment, followed by adjuvant treatment with chemotherapy alone (CT), radiation therapy alone (RT), or both (CRT). The radiation therapy included pelvic external beam radiation, whole abdominal radiation, vaginal brachytherapy, or a combination. Overall and disease-free survival (OS and DFS) were calculated from the date of surgery using a Kaplan-Meier method. The rates of loco-regional recurrence (LRR) and distant recurrence (DR) as sites of first failure were also calculated. Results: We identified 46 patients with pathologic stage III endometrial cancer who received adjuvant treatment. The median age at diagnosis was 61.4 years (range: 44-88 years). Most patients had stage III-C disease (85%). The histologic types included endometrioid adenocarcinoma (59%), papillary serous/clear cell (35%), and other carcinomas (6%). Adjuvant treatment was 13% (nZ6) CT, 37% (nZ17) RT, and 50% (nZ23) CRT. Of these patients, 45% (nZ21) received pelvic radiation therapy (PRT) and 55% (nZ25) received no pelvic radiation therapy (NPRT). Most NPRT patients received chemotherapy AE vaginal brachytherapy. The median follow-up for all patients was 41.5 months (range: 1.7-149 months). The rates of 3-year OS, 3-year DFS, LRR, and DR for each patient group are shown in the table below. There were no statistically significant differences between the CT, RT, and CRT groups. However, there was a trend towards improved 3-year DFS (pZ0.07) in the RT group. The PRT group on univariate analysis had a significant improvement in 3-year DFS (pZ0.009) and reduction in LRR (pZ0.04) as well as a trend towards improved 3-year OS (pZ0.06) compared to the NPRT group. On multivariate analysis, only depth of invasion was predictive of LRR and DFS.
Gynecologic Oncology, 1997
Purpose. To evaluate the long-term disease control, survival and complication rates using high-dose-rate intracavitary brachyther-Cancer of the uterus remains the most common gynecoapy (HDRB) and external beam radiotherapy (EBRT) for patients logical malignancy in the 1990s with an estimated 34,000 found to have isolated vaginal recurrences from early-stage endocases in 1996 in the United States [1]. The cornerstone of metrial adenocarcinoma following total abdominal hysterectomy treatment for early-stage endometrial carcinoma (i.e., FIGO and bisalpingo-oophorectomy (TAH BSO).