Adjuvant Carboplatin, Paclitaxel, and Vaginal Cuff Brachytherapy for Stage III Endometrial Cancer

Abstract

Objective To evaluate outcomes of patients with stage III endometrial adenocarcinoma treated with surgery followed by adjuvant chemotherapy and vaginal cuff brachytherapy. Methods We retrospectively identified 83 patients treated for 1988 FIGO stage III endometrial adenocarcinoma at our institution between 2003 and 2010. All patients underwent comprehensive surgical staging. Adjuvant therapy was carboplatin and paclitaxel for 6 cycles and vaginal cuff brachytherapy. For analysis, patients were grouped into type 1 (FIGO grade 1–2 endometrioid histology, n=41) or type 2 (FIGO grade 3, clear cell or papillary serous histology, n=42) disease. Forty-three patients (52%) had node positive disease, with similar node positive rates for type I (n=21, 51.2%) and type II (n=22, 52.4%). Results Median follow up was 38.6 months. There were no isolated vaginal failures. Estimated 3-year disease-free (DFS) and overall survival (OS) for type I versus type II were 92.4% vs 58.0% (p = 0.001) and 97.2% vs 65.8% (p = 0.002), respectively. The 3-year DFS and OS for node negative versus node positive were 85.0% vs 63.6 % (p = 0.02) and 84.2% vs 78.0% (p = 0.02), respectively. Associations between type I histology and node negative disease with improved DFS and OS persisted on multivariate analysis. Conclusions Our institutional approach of adjuvant chemotherapy and vaginal cuff brachytherapy for stage III endometrial cancer appeared acceptable for patients with low risk histology or node negative disease. In contrast, higher rates of failure among those with high risk histology and/or node positive disease support intensification of therapy in these subsets.

Predictors of Survival in Women with High-Risk Endometrial Cancer and Comparisons of Sandwich versus Concurrent Adjuvant Chemotherapy and Radiotherapy

“…In this study, paraaortic lymph node metastasis was a predictor for PFS (HR = 11.11, Table 3 ) and OS (HR = 32.74, Table 4 ). Similarly, Young et al reported that positive lymph node metastasis was associated with worse PFS (HR = 3.37, p = 0.03) and OS (HR = 2.96, p = 0.04) in FIGO 1988 stage III EC patients [ 12 ]. Onal et al also found that paraaortic lymph node metastasis was a predictor for worse OS (HR = 2.01, 95% CI = 1.15–3.53, p = 0.02) compared with pelvic lymph node metastasis [ 9 ].…”

MR- versus CT-based high-dose-rate interstitial brachytherapy for vaginal recurrence of endometrial cancer

“…Pelvic relapse occurs in 10 – 15% of intermediate-risk and 20 – 26% of high-risk patients (1, 5, 10–15). Approximately 75 – 80% of these relapses are confined to the vagina (16–20). Salvage radiation therapy (SRT) in the form of combined external beam treatment (EBRT) and brachytherapy (BT) is the recommended treatment for vaginal recurrence of endometrial cancer (21–23).…”

Value of combined adjuvant chemotherapy and radiation on survival for stage III uterine cancer: is less radiation equal to more?

“…In a recent institutional series from Yale, adjuvant carboplatin and paclitaxel followed by VBT for stage III EC achieved excellent overall and disease free survival in lower grade, node-negative patients. There were no cases of isolated vaginal recurrence in this series, suggesting the benefit of focal vaginal therapy in selected surgically-staged locally advanced patients [ 29 ]. Our results indicated that using VBT with CT was also associated with improved survival over monotherapy even after correcting for other factors in a multivariate analysis, and there was no statistical survival difference between EBRT with or without VBT with CT and VBT alone with CT in low-risk stage III patients.…”