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.