A multicenter analysis of adjuvant therapy after surgery for stage IIIC endometrial adenocarcinoma: A Korean Radiation Oncology Group study (KROG 13-17)

Yoon, Myung Ha; Park, Won; Huh, Seung Jae; Kim, Hak Jae; Kim, Young Seok; Kim, Yong Bae; Kim, Joo Young; Lee, Jong Hoon; Kim, Hun Jung; Cha, Jae-Young; Kim, Jin Hee; Kim, Juree; Yoon, Won Sup; Choi, Jin Hwa; Chun, Mison; Choi, Youngmin; Chang, Soo-Ho; Lee, Kang Kyoo; Kim, Myung-Soo

doi:10.1016/j.ygyno.2015.06.030

Cited by 6 publications

(5 citation statements)

References 23 publications

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“…In our study, no particular subgroup of Stage III patients (IIIA/IIIB/IIIC) appeared to benefit from the addition of chemotherapy to radiation (Table 3). This is consistent with the results of the Korean KROG 13-17 study by Yoon et al, which concluded that there was no survival benefit in Stage IIIC1 and IIIC2 cancers with either treatment modality [17]. Conflicting results from Lum et al suggests survival benefit from use of adjuvant chemoradiation for Stage IIIA patients, however they included non-endometrioid histology subtypes in their retrospective study, which may account for the differing results [14].…”

Section: Discussionsupporting

confidence: 83%

“…The lack of statistically significant OS benefit is consistent with the findings of other large randomized studies. Combination chemotherapy and radiation treatment in Stage III endometrial cancers at best only improved the DFS compared with radiotherapy [7,16,17]. The added toxicities of these additional treatment modalities to improve cancer control need to be weighed against the lack of OS improvements.…”

Section: Discussionmentioning

confidence: 99%

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Sequential Chemoradiation versus Radiation for the Adjuvant Treatment of Stage III Endometrioid Adenocarcinoma of the Uterus

Lim¹,

Lim²,

Lin³

et al. 2020

European Journal of Gynaecological Oncology

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Purpose of Investigation:The optimal adjuvant therapy for women with Stage III endometrial cancer following surgical staging is controversial. Post-operative sequential chemotherapy followed by external beam radiotherapy is the standard treatment for Stage III uterine cancer at our institution since 2006. We aim to analyse the survival outcomes in this group of patients comparing with the historical group of patients who received radiation only. Materials and Methods: This is a retrospective single-institution analysis of patients with surgical Stage III endometrioid adenocarcinoma of the uterus treated at KK Women's and Children's Hospital from 2000 to 2010. Results: Ninety-six patients with surgical Stage III endometrioid endometrial cancer who received postoperative adjuvant therapies were identified; 43% (n = 41) received chemotherapy followed by radiotherapy, 57% (n = 55) received radiotherapy only. The 2 groups were well balanced with regard to age, ECOG performance status, tumour size, myometrial invasion, lymphovascular invasion, peritoneal cytology status and debulking status. At a median follow up of 62.5 months (range: 4 -164), the 5-year overall survival (OS), cancer-specific survival (CSS) and disease-free survival (DFS) were not significantly different. Following adjustment for age, disease stage, tumour grade, residual disease, tumour size and nodal status, the adjusted hazard ratios for DFS, CSS and OS for those treated with chemoradiation were not significantly better than those treated with radiation only. Conclusion: In this single institution retrospective analysis of Asian patients with surgical Stage III endometrioid endometrial cancer, there was a trend towards sequential chemotherapy followed by radiation having better OS and CSS over radiation alone but this did not reach statistical significance.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Sequential Chemoradiation versus Radiation for the Adjuvant Treatment of Stage III Endometrioid Adenocarcinoma of the Uterus

Lim¹,

Lim²,

Lin³

et al. 2020

European Journal of Gynaecological Oncology

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“…The optimal treatment for patients with metastatic uterine cancer remains an area of uncertainty. 14,15 In 2006, Gynecologic Oncology Group (GOG) protocol 122 established that chemotherapy was superior to whole abdominal radiation for women with stage III-IV endometrial cancer. 16 This protocol led to the increased uptake of chemotherapy for women with advanced stage endometrial cancer.…”

Section: Discussionmentioning

confidence: 99%

Chemotherapy, Radiation, or Combination Therapy for Stage III Uterine Cancer

Syeda

Chen

Hou

et al. 2019

Obstetrics &Amp; Gynecology

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Objective-To compare the outcomes of women with stage III uterine cancer treated with chemotherapy alone, external beam radiation alone, and combination chemotherapy and radiation. Methods-The National Cancer Database was used to identify women with stage III endometrioid, serous, and clear cell uterine cancer treated with either chemotherapy (with or without vaginal brachytherapy) alone, external beam radiation (with or without brachytherapy) or combination chemotherapy and external beam radiation (with or without vaginal brachytherapy) from 2004-2015. Survival was estimated using Cox proportional hazards models and adjusted survival curves after propensity score analysis using inverse probability of treatment weighting to balance the clinical and demographic characteristics between the cohorts. Results-Of the 20,873 patients identified, 9,456 (45.3%) received chemotherapy alone, 2,417 (11.6%) were treated with radiation alone, and 9,000 (43.1%) received chemotherapy in combination with external beam radiation. Use of combination therapy was 33.0% in 2004, and then rose to 50.5% in 2015. The mortality of the cohort was 33.1% and median survival was 115 months. Within the cohort, combination therapy was associated with a 23% reduction in mortality (HR=0.77; 95% CI, 0.73-0.80) compared to chemotherapy alone. Similar findings of decreased mortality were noted in subgroup analyses for both stage IIIA (HR=0.81; 95% CI, 0.68-0.98) and stage IIIC (HR=0.79; 95% CI, 0.75-0.84) tumors. Similarly, when compared to radiation alone, combination therapy was accompanied by a 19% decrease in mortality (HR=0.

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“…Predictors of OS were parametrial invasion (HR 4.43; 95% CI, 2.01-9.76, p<0.001), older age (HR 3.82; 95% CI, 1.93-7.56; p<0.001) and >3 positive pelvic nodes (HR 2.62; 95% CI 1.35-5.06; p=0.004) but LVSI had no effect on 5 year-DFS (p=0.38) and 5 year-OS (p=0.55). (12). In the current study, for the entire cohort, advanced age (≥58 years) (HR 3.73; 95% CI, 1.19-11.69, p=0.02), grade 3 tumors (HR 2.57; 95% CI, 1.002-6.62, p=0.04) and presence of cervical involvement (HR 2.62; 95% CI, 1.03-6.67, p= 0.04) were found as independent predictors of decreased OS.…”

Section: Figure 2: Comparison Of Overall Survival Between Lvsi-negatimentioning

confidence: 99%

“…There is solid evidence in the literature about the prognostic significance of LVSI on survival and recurrence patterns in early stage EC (9)(10)(11). However, there are limited data about the prognostic significance of LVSI in advanced stage disease because of the heterogeneity of patients in advanced stages particularly in regards to adjuvant therapy, which varies across the institutions (4,12,13). In this case-control study, we aimed to investigate the effect of LVSI on survival and recurrence patterns in patients with stage IIIC endometrioid type EC diagnosed by complete surgical staging including systematic pelvic and paraaortic lymphadenectomy.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Survival Outcomes of Lymphovascular Space Invasion-Negative and Lymphovascular Space Invasion - Positive Women with Stage IIIC Endometrioid Endometrial Cancer: A Case - Control Study

Cüylan

Meydanlı

Öz

et al. 2020

Gynecol Obstet Reprod Med

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Objective: The purpose of this case-control study was to investigate the effect of lymphovascular space invasion on recurrence patterns and survival in patients with stage IIIC endometrioid type endometrial cancer.Study Design: A multicenter, retrospective, department database review was performed to identify lymphovascular space invasion-negative and lymphovascular space invasion-positive stage IIIC endometrioid endometrial cancer at five gynecological oncology centers in Turkey. Demographic, clinicopathological and survival data were collected. Cases and controls were matched in terms of age at diagnosis, grade of tumor, depth of myometrial invasion, sub-stage and adjuvant treatment.Results: Forty-one patients in the case group and 82 patients in the control group were eligible for the study. The 5-year OS rates were 94.4% in the lymphovascular space invasion-negative group and 77.2% in the LVSI-positive group (p=0.058). Advanced age (58 years) (HR 3.73; 95% CI: 1.19-11.69, p=0.02), grade 3 tumor (HR 2.57; 95% CI: 1.002-6.62, p=0.048) and cervical involvement (HR 2.62; 95% CI: 1.03-6.67, p= 0.04) appeared to be as independent predictors of decreased overall survival (OS). There was a trend towards statistical significance between the presence of lymphovascular space invasion and OS in regression analysis (HR 3.10; 95% CI 0.90-10.67, p=0.05). Recurrence rates were 17.0% (7/41) and 24.4% (20/82) in lymphovascular space invasion-negative and lymphovascular space invasion-positive groups, respectively (p=0.48). There were 5 cases of retroperitoneal recurrences in the lymphovascular space invasion-positive group and no retroperitoneal recurrence among lymphovascular space invasion-negative women.Conclusion: Lymphovascular space invasion status seems to be of borderline significance for OS in stage IIIC endometrioid endometrial cancer and impacts recurrence patterns as retroperitoneal recurrences are strongly related to positive lymphovascular space invasion status.

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A multicenter analysis of adjuvant therapy after surgery for stage IIIC endometrial adenocarcinoma: A Korean Radiation Oncology Group study (KROG 13-17)

Cited by 6 publications

References 23 publications

Sequential Chemoradiation versus Radiation for the Adjuvant Treatment of Stage III Endometrioid Adenocarcinoma of the Uterus

Sequential Chemoradiation versus Radiation for the Adjuvant Treatment of Stage III Endometrioid Adenocarcinoma of the Uterus

Chemotherapy, Radiation, or Combination Therapy for Stage III Uterine Cancer

Comparison of Survival Outcomes of Lymphovascular Space Invasion-Negative and Lymphovascular Space Invasion - Positive Women with Stage IIIC Endometrioid Endometrial Cancer: A Case - Control Study

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