A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study

Keys, Henry; Roberts, James A.; Brunetto, Virginia L.; Zaino, Richard J.; Spirtos, Nick M.; Bloss, Jeffrey D.; Pearlman, Andrew; Maiman, Mitchell; Bell, Jeffrey G.

doi:10.1016/j.ygyno.2003.11.048

Cited by 1,490 publications

(904 citation statements)

References 15 publications

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“…Our proportion of women receiving adjuvant pelvic radiation (35%) was higher than other contemporary studies (~20%) 7,8 because GOG protocol 0099 11 and the Post-Operative Radiation Therapy in Endometrial Carcinoma (PORTEC) 12 results were unpublished when many women in this retrospective study underwent treatment..…”

Section: Commentmentioning

confidence: 63%

“…Four-year endpoints were arbitrary, and used to contrast with prior randomized clinical trials. 11,12 Progression-free survival was measured to the date of disease progression or death, or to date of last contact for patients alive and progressionfree. Endometrial cancer-related survival was measured to the date of death associated with documented endometrial disease progression.…”

Section: Discussionmentioning

confidence: 99%

“…Randomized clinical trials show a significant and substantial reduction in pelvic relapse with radiation as compared to observation. 11,12 However, since pelvic irradiation does increase the risk of complications, the controversial suggestion that pelvic radiation can be omitted in favor of local intravaginal brachytherapy has been made. Often, the argument for intravaginal brachytherapy substituting for pelvic radiation is predicated on nodal yield at laparotomy and pathological confirmation of no occult nodal disease.…”

Section: Commentmentioning

confidence: 99%

“…16,17 Data suggests that women whose tumors are moderate to high grade or invade the outer one-half of the myometrium are at sufficient risk for relapse and likely to benefit from radiation. 11,12,19 Whether the same radiotherapeutic benefit can be realized with pelvic radiation or intravaginal brachytherapy remains controversial. 20 Whether obese women who often have low grade, early stage endometrial cancer need to undergo surgical staging lymphadenectomy remains controversial.…”

Section: Commentmentioning

confidence: 99%

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Adjuvant treatment and survival in obese women with endometrial cancer: An international collaborative study

Martra

Kunos

Gibbons

et al. 2008

American Journal of Obstetrics and Gynecology

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Objective-To determine the impact of patient weight on frequency of surgical staging lymphadenectomy and pelvic radiation. Adverse effects, disease relapse, and survival outcomes were investigated.Study Design-Records of 766 women undergoing surgery for presumed corpus-confined endometrial cancer were reviewed. Body mass index (BMI) was calculated categorizing women as obese (BMI ≥ 30) or nonobese (BMI < 30). Radiation-related toxicity was retrospectively scored. Median duration of follow-up was 38 months. Chi-square, logistic regression, correlation, KaplanMeier and Cox multivariate proportional hazards were used for analysis.Results-Lymphadenectomy was completed as often in nonobese as obese women (p=0.24). Adjuvant pelvic radiation treatment was administered more often in nonobese women (p=0.01). Among 681 women with endometrioid histopathology, four-year cancer-related survival in obese women was 10 percent higher than all cause mortality, compared to 6 percent in nonobese women.Conclusion-Obesity was not a barrier to lymphadenectomy, but did influence adjuvant pelvic radiation use.CORRESPONDING AUTHOR and REPRINT REQUESTS: Vivian von Gruenigen, MD,

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Section: Commentmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

See 2 more Smart Citations

Adjuvant treatment and survival in obese women with endometrial cancer: An international collaborative study

Martra

Kunos

Gibbons

et al. 2008

American Journal of Obstetrics and Gynecology

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“…Over the past decade, some clinical trials have incorporated UPSC, and CC while others have excluded these poor histologic subtypes (Keys et al, 2004;Randell et al, 2006). This dichotomy stems from the conflicting data in the current literature regarding prognosis of high-risk endometrial tumours.…”

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confidence: 99%

Uterine papillary serous and clear cell carcinomas predict for poorer survival compared to grade 3 endometrioid corpus cancers

Cheung²,

et al. 2006

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To compare the survival of women with uterine papillary serous carcinoma (UPSC) and clear cell carcinoma (CC) to those with grade 3 endometrioid uterine carcinoma (G3EC). Demographic, pathologic, treatment, and survival information were obtained from the Surveillance, Epidemiology, and End Results Program from 1988 to 2001. Data were analysed using Kaplan -Meier and Cox proportional hazards regression methods. Of 4180 women, 1473 had UPSC, 391 had CC, and 2316 had G3EC cancers. Uterine papillary serous carcinoma and CC patients were older (median age: 70 years and 68 vs 66 years, respectively; Po0.0001) and more likely to be black compared to G3EC (15 and 12% vs 7%; Po0.0001). A higher proportion of UPSC and CC patients had stage III -IV disease compared to G3EC patients (52 and 36% vs 29%; Po0.0001). Uterine papillary serous carcinoma, CC and G3EC patients represent 10, 3, and 15% of endometrial cancers but account for 39, 8, and 27% of cancer deaths, respectively. The 5-year disease-specific survivals for women with UPSC, CC and G3EC were 55, 68, and 77%, respectively (Po0.0001). The survival differences between UPSC, CC and G3EC persist after controlling for stage I -II (74, 82, and 86%; Po0.0001) and stage III -IV disease (33, 40, and 54; Po0.0001). On multivariate analysis, more favourable histology (G3EC), younger age, and earlier stage were independent predictors of improved survival. Women with UPSC and CC of the uterus have a significantly poorer prognosis compared to those with G3EC. These findings should be considered in the counselling, treating and designing of future trials for these high-risk patients.

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Frequency and Effect of Adjuvant Radiation Therapy Among Women With Stage I Endometrial Adenocarcinoma

Lee¹

2006

JAMA

119

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A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study

Cited by 1,490 publications

References 15 publications

Adjuvant treatment and survival in obese women with endometrial cancer: An international collaborative study

Adjuvant treatment and survival in obese women with endometrial cancer: An international collaborative study

Uterine papillary serous and clear cell carcinomas predict for poorer survival compared to grade 3 endometrioid corpus cancers

Frequency and Effect of Adjuvant Radiation Therapy Among Women With Stage I Endometrial Adenocarcinoma

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