Adjuvant Radiotherapy for Stage I Endometrial Cancer: An Updated Cochrane Systematic Review and Meta-analysis

Kong, Anthony; Johnson, Nick; Kitchener, Henry C; Lawrie, Theresa A

doi:10.1093/jnci/djs374

Cited by 174 publications

(118 citation statements)

References 16 publications

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“…Observation, whole pelvic radiotherapy, brachytherapy and chemotherapy are all treatment options recommended for stage IB disease in NCCN guidelines but which treatment for which particular patient is not clear. Adjuvant radiotherapy was previously shown to reduce local recurrence but no effect was found on overall survival in a number of randomized studies as well as a recent Cochrane meta-analysis (Kong et al, 2012;Setakornnukul et al, 2014). However these studies had limitations including no or low rate of pelvic/ paraaortic lymph node dissection (Creutzberg et al, 2000), combination of patients at different disease stages and non-uniform high risk criteria.…”

Section: Discussionmentioning

confidence: 99%

Good Outcomes of Patients with Stage IB Endometrial Cancer with Surgery Alone

Rahatli

Dizdar²,

Küçüköztaş³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Section: Discussionmentioning

confidence: 99%

Good Outcomes of Patients with Stage IB Endometrial Cancer with Surgery Alone

Rahatli

Dizdar²,

Küçüköztaş³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…[21]. EBRT was associated with an increased risk of severe acute toxicity, severe late toxicity, and reduced quality of life.…”

Section: Discussionmentioning

confidence: 99%

“…External beam pelvic irradiation [EBRT] significantly reduces the risk loco-regional recurrence, without any significant impact on cancer-related deaths or overall survival [14][15][16][17][18][19][20][21]. Although recurrent disease occurs in less than 20% of patients with clinically early endometrial cancer, most of these failures involve distant sites.…”

Section: Introductionmentioning

confidence: 99%

Adjuvant treatment and analysis of failures in patients with high-risk FIGO Stage Ib–II endometrial cancer: An Italian multicenter retrospective study (CTF study)

Gadducci

Cosio

Landoni

et al. 2014

Gynecologic Oncology

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• Adjuvant chemotherapy reduces the risk of distant recurrences in patients with high-risk, early-stage endometrial cancer with negative pelvic nodes.• The sequential administration of adjuvant chemotherapy and radiotherapy achieves excellent local and distant control of disease in this clinical settings. Objectives. The purpose of this retrospective study was to assess the clinical outcome of patients with highrisk, early-stage endometrioid endometrial cancer (stage Ib or II with myometrial invasion N 50%, grade 2-3). a b s t r a c t a r t i c l e i n f oMethods. We assessed 192 patients who underwent hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy, had histologically negative pelvic nodes, and had negative CT findings for aortic node involvement.Results. Tumor relapsed in 36 patients after a median time of 21.2 months. The recurrence was vaginal in 7 (19.4%), distant in 16 (44.4%), aortic in 8 (22.2%), and involved multiple sites in 5 (13.9%). There was a trend to a lower vaginal recurrence rate in the 143 patients who received adjuvant radiotherapy (+chemotherapy) compared with the 46 who did not (2.1% versus 8.7%). Distant or aortic recurrences were lower in the 37 patients who received adjuvant chemotherapy (+radiotherapy) than in the 152 who did not (2.7% versus 18.4%, p = 0.02). Of the 29 patients who received sequential adjuvant chemotherapy and radiotherapy, none developed local recurrence and only one had distant recurrence. There was a trend for a better 5-year progression-free survival and overall survival for the patients who received chemotherapy (+ radiotherapy) compared with those who did not (86.0% versus 71.3%, and 92.3% versus 75.6%, respectively).Conclusions. Our data appear to suggest that adjuvant chemotherapy reduces the risk of distant or aortic recurrences and that sequential adjuvant chemotherapy and radiotherapy achieve an excellent local and distant control of disease in these clinical settings.

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“…Adjuvant therapy recommendations are based on the individual patient's risk of disease recurrence using clinicopathologic factors such as age, stage, histologic subtype, tumor grade, and lymphovascular space invasion (LVSI; ref. 3). Endometrial carcinoma patients are generally stratified in three risk groups; however, various definitions exist (4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

Improved Risk Assessment by Integrating Molecular and Clinicopathological Factors in Early-stage Endometrial Cancer—Combined Analysis of the PORTEC Cohorts

Stelloo

Nout

Osse

et al. 2016

Clinical Cancer Research

607

733

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Purpose: Recommendations for adjuvant treatment for women with early-stage endometrial carcinoma are based on clinicopathologic features. Comprehensive genomic characterization defined four subgroups: p53-mutant, microsatellite instability (MSI), POLE-mutant, and no specific molecular profile (NSMP). We aimed to confirm the prognostic capacity of these subgroups in large randomized trial populations, investigate potential other prognostic classifiers, and integrate these into an integrated molecular risk assessment guiding adjuvant therapy.Experimental Design: Analysis of MSI, hotspot mutations in 14 genes including POLE, protein expression of p53, ARID1a, b-catenin, L1CAM, PTEN, ER, and PR was undertaken on 947 available early-stage endometrioid endometrial carcinomas from the PORTEC-1 and -2 trials, mostly high-intermediate risk (n ¼ 614). Prognostic value was determined using univariable and multivariable Cox proportional hazard models. AUCs of different risk stratification models were compared.Results: Molecular analyses were feasible in >96% of the patients and confirmed the four molecular subgroups: p53-mutant (9%), MSI (26%), POLE-mutant (6%), and NSMP (59%). Integration of prognostic molecular alterations with established clinicopathologic factors resulted in a stronger model with improved risk prognostication. Approximately 15% of highintermediate risk patients had unfavorable features (substantial lymphovascular space invasion, p53-mutant, and/or >10% L1CAM), 50% favorable features (POLE-mutant, NSMP being microsatellite stable, and CTNNB1 wild-type), and 35% intermediate features (MSI or CTNNB1-mutant).Conclusions: Integrating clinicopathologic and molecular factors improves the risk assessment of patients with early-stage endometrial carcinoma. Assessment of this integrated risk profile is feasible in daily practice, and holds promise to reduce both overtreatment and undertreatment.

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Adjuvant Radiotherapy for Stage I Endometrial Cancer: An Updated Cochrane Systematic Review and Meta-analysis

Abstract: EBRT reduces the risk of locoregional recurrence but has no statistically significant impact on cancer-related deaths or OS. However, EBRT is associated with clinically and statistically significant morbidity and a reduction in quality of life.

Cited by 174 publications

References 16 publications

Good Outcomes of Patients with Stage IB Endometrial Cancer with Surgery Alone

Good Outcomes of Patients with Stage IB Endometrial Cancer with Surgery Alone

Adjuvant treatment and analysis of failures in patients with high-risk FIGO Stage Ib–II endometrial cancer: An Italian multicenter retrospective study (CTF study)

Improved Risk Assessment by Integrating Molecular and Clinicopathological Factors in Early-stage Endometrial Cancer—Combined Analysis of the PORTEC Cohorts

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