Long-Term Survival in Patients With Para-Aortic Lymph Node Metastasis With Systematic Retroperitoneal Lymphadenectomy Followed by Adjuvant Chemotherapy in Endometrial Carcinoma

Hiura, Masamichi; Nogawa, Takayoshi; Matsumoto, Takashi; Yokoyama, Takashi; Shiroyama, Yuko; Wroblewski, Junko

doi:10.1111/igc.0b013e3181d80aff

Cited by 17 publications

(6 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…5,7–9,11 The reported 5-year survival rates for patients with systemic pelvic and para-aortic lymphadnectomy treated with adjuvant chemotherapy range from 48–76%. 12–14 …”

Section: Discussionmentioning

confidence: 99%

Combined chemotherapy and radiation improves survival for node-positive endometrial cancer

Lee

Viswanathan

2012

Gynecologic Oncology

View full text Add to dashboard Cite

Objective To evaluate the clinical outcomes for women with node-positive endometrioid adenocarcinoma of the uterus Methods Records were reviewed for 66 patients with Stage IIIC endometrioid adenocarcinoma diagnosed between 1/1995 and 12/2009. Study inclusion required TAH, BSO and negative chest imaging. Papillary serous and clear cell histologies were excluded. Adjuvant treatment was external beam radiation (RT) alone in 18 patients (27%), combined chemotherapy and RT in 44 (67%), chemotherapy alone in 1 (2%), and no adjuvant therapy in 3 (5%). The median follow-up was 48 months. Results Of 66 patients, 56 (85%) had positive pelvic nodes only, 5 (8%) had positive para-aortic nodes only, and 5 (8%) had both. Of the 62 patients who received adjuvant RT, only 4 (6%) had an in-field recurrence, including 2 with residual disease after surgery. Disease-free (DFS) and overall (OS) survival rates at 5 years were 71% and 81%, respectively. By adjuvant treatment modality, 5-year DFS and OS rates were 63% and 67% for RT alone and 79% and 90% for combined modality therapy (p=0.15 and p<0.01). On multivariate analysis, combined modality therapy significantly improved DFS (HR 0.12, 95% CI 0.03–0.49, p<0.01) and OS (HR 0.20, 95% CI 0.05–0.75, p=0.02) compared to adjuvant RT alone. Conclusions Compared to RT alone, combined modality therapy decreased recurrence and improved survival in patients with node-positive endometrioid adenocarcinoma of the uterus. In addition, external beam RT resulted in excellent local and regional control. Future studies are needed to define the optimal chemotherapy regimen, sequencing, and radiation fields.

show abstract

“…5,7–9,11 The reported 5-year survival rates for patients with systemic pelvic and para-aortic lymphadnectomy treated with adjuvant chemotherapy range from 48–76%. 12–14 …”

Section: Discussionmentioning

confidence: 99%

Combined chemotherapy and radiation improves survival for node-positive endometrial cancer

Lee

Viswanathan

2012

Gynecologic Oncology

View full text Add to dashboard Cite

show abstract

“…Although more than 50% of patients with lymphatic dissemination have paraaortic metastasis [9,23,24], the impact of extended-field radiotherapy on lymphatic recurrences beyond the pelvis remains uncertain [2,4,11,12,25,26]. Similarly, the efficacy of contemporary systemic therapy in effectively managing lymphatic and occult distant metastatic disease in EC has not been elucidated [10,15,16,18,19,21,27–31]. Furthermore, emerging reports suggest marked differences in the therapeutic indices comparing endometrioid to type II EC; the latter shows relative recalcitrance to contemporary chemotherapy [10,15,27,30].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of contemporary chemotherapy in stage IIIC endometrial cancer: A histologic dichotomy

Bakkum-Gamez

Mariani

Dowdy

et al. 2014

Gynecologic Oncology

View full text Add to dashboard Cite

Background Treatment failures in stage IIIC endometrial carcinoma (EC) are predominantly due to occult extrapelvic metastases (EPM). The impact of chemotherapy on occult EPM was investigated according to grade (G), G1/2EC vs G3EC. Methods All surgical-stage IIIC EC cases from January 1, 1999, through December 31, 2008, from Mayo Clinic were included. Patient-, disease-, and treatment-specific risk factors were assessed for association with overall survival, cause-specific survival, and extrapelvic disease-free survival (DFS) using Cox proportional hazards regression. Results 109 cases met criteria, with 92 (84%) having systematic lymphadenectomy (>10 pelvic and >5 paraaortic lymph nodes resected). In patients with documented recurrence sites, occult EPM accounted for 88%. Among G1/2EC cases (n = 48), the sole independent predictor of extrapelvic DFS was grade 2 histology (hazard ratio [HR], 0.28; 95% CI, 0.08–0.91; P = .03) while receipt of adjuvant chemotherapy approached significance (HR 0.13; 95% CI, 0.02, 1.01; P = .0511). The 5-year extrapelvic DFS with and without adjuvant chemotherapy was 93% and 54%, respectively (log-rank, P = .02). Among G3EC (n = 61), the sole independent predictor of extrapelvic DFS was lymphovascular space involvement (HR, 2.63; 95% CI, 1.16–5.97; P = .02). Adjuvant chemotherapy did not affect occult EPM in G3EC; the 5-year extrapelvic DFS for G3EC with and without adjuvant chemotherapy was 43% and 42%, respectively (log-rank, P = .91). Conclusions Chemotherapy improves extrapelvic DFS for stage IIIC G1/2EC but not stage IIIC G3EC. Future efforts should focus on prospectively assessing the impact of chemotherapy on DFS in G3EC and developing innovative phase I and II trials of novel systemic therapies for advanced G3EC.

show abstract

“…Postoperative adjuvant CEP chemotherapy was performed in 58 patients with a tumor confined to the uterus (Stages IC and II) in 3 courses 3-4 weeks apart and in 43 patients with extrauterine lesions involving adnexa and/or PLN in 5 courses, and also in 21 patients with PAN metastasis in 10 courses. No patient required major modification of the treatment modality of the postoperative adjuvant chemotherapy because of acute myelosuppression or gastrointestinal disorder (Hiura et al, 2010). Gynecologic Oncology Group (GOG) randomized trial (Randall et al, 2006) showed that AP (doxorubicin and cisplatin) chemotherapy significantly improved progression-free and overall survival compared with WAI (whole-abdominal irradiation) in patients with Stages III or IV endometrial carcinoma with a maximum of 2cm of postoperative residual disease.…”

Section: Resultsmentioning

confidence: 99%

The Role of Modified Radical Hysterectomy in Endometrial Carcinoma

Hiura¹,

Nogawa²

2012

Hysterectomy

Self Cite

View full text Add to dashboard Cite

Long-Term Survival in Patients With Para-Aortic Lymph Node Metastasis With Systematic Retroperitoneal Lymphadenectomy Followed by Adjuvant Chemotherapy in Endometrial Carcinoma

Abstract: It is suggested that surgery with systematic pelvic and para-aortic lymphadenectomy followed by adjuvant chemotherapy could improve long-term survival in patients with PAN metastasis, although there are only 21 patients with PAN metastasis.

Cited by 17 publications

References 25 publications

Combined chemotherapy and radiation improves survival for node-positive endometrial cancer

Combined chemotherapy and radiation improves survival for node-positive endometrial cancer

Efficacy of contemporary chemotherapy in stage IIIC endometrial cancer: A histologic dichotomy

The Role of Modified Radical Hysterectomy in Endometrial Carcinoma

Contact Info

Product

Resources

About