Low-dose adjuvant vaginal cylinder brachytherapy for early-stage non-endometrioid endometrial cancer: recurrence risk and survival outcomes

Abstract

ObjectiveThe aim of this study was to evaluate recurrence patterns and survival outcomes for patients with early-stage non-endometrioid endometrial adenocarcinoma treated with adjuvant high-dose rate vaginal brachytherapy with a low-dose scheme.MethodsA retrospective review was performed of patients with International Federation of Gynecology and Obstetrics (FIGO) stage I–II non-endometrioid endometrial cancer who received adjuvant vaginal brachytherapy with a low-dose regimen of 24 Gy in six fractions from November 2005 to May 2017. All patients had >6 months of follow-up. Rates of recurrence-free survival, overall survival, vaginal, pelvic, and distant recurrence were calculated by the Kaplan–Meier method. Prognostic factors for recurrence and survival were evaluated by Cox proportional hazards modeling.ResultsA total of 106 patients were analyzed. Median follow-up was 49 months (range 9–119). Histologic subtypes were serous (47%, n=50), clear cell (10%, n=11), mixed (27%, n=29), and carcinosarcoma (15%, n=16). Most patients (79%) had stage IA disease, 94% had surgical nodal assessment, and 13% had lymphovascular invasion. Adjuvant chemotherapy was delivered to 75%. The 5-year recurrence-free and overall survival rates were 74% and 83%, respectively. By histology, 5-year recurrence-free/overall survival rates were: serous 73%/78%, clear cell 68%/88%, mixed 88%/100%, and carcinosarcoma 56%/60% (p=0.046 and p<0.01). On multivariate analysis, lymphovascular invasion was significantly associated with recurrence (HR 3.3, p<0.01). The 5-year vaginal, pelvic, and distant recurrence rates were 7%, 8%, and 21%, respectively. Vaginal and pelvic recurrence rates were highest for patients with carcinosarcoma, lymphovascular invasion and/or FIGO stage IB/II disease. At 5 years, vaginal and pelvic recurrence rates for patients with lymphovascular invasion were 33% and 40%, respectively. Patients with stage IA disease or no lymphovascular invasion had 5-year vaginal recurrence rates of 4% and pelvic recurrence rates of 6% and 3%, respectively.ConclusionsAdjuvant high-dose rate brachytherapy with a low-dose scheme is effective for most patients with early-stage non-endometrioid endometrial cancer, particularly stage IA disease and no lymphovascular invasion. Pelvic radiation therapy should be considered for those with carcinosarcoma, lymphovascular invasion and/or stage IB/II disease.

Development and external validation of a nomogram for predicting overall survival of patients with non-endometrioid endometrial cancer: A population-based analysis

“…As depicted in the nomogram, serous carcinoma has the lowest score of all the histological subtypes. Previous studies have confirmed that NEEC has no significant correlation with estrogen compared with EEC, and it is more commonly occurred in menopausal and postmenopausal women [ 12 , 13 ]. Therefore as shown in this study, older patients (66-) are more possible developed NEEC, and the prognosis were worse than that of younger patients.…”

Survival outcomes and the prognostic significance of clinicopathological features in patients with endometrial clear cell carcinoma: a 35-year single-center retrospective study

“…Patients in the advanced stage had a higher recurrence rate (43.7% vs. 12%, p < 0.001) and overall death rate (31.2% vs. 13%, p = 0.006); the mean times to recurrence (11.57 ± 9.12 vs. 30.24 ± 30.33, p = 0.001) and death (26.50 ± 21.07 vs. 64.00 ± 68.84, p = 0.024) were also significantly shorter. We reviewed the current literature regarding prognostic factors for ECCC survival and found that LVSI [ 22 , 26 – 28 , 30 , 31 ], disease stage [ 31 – 33 ], age [ 33 ], PWC [ 13 , 27 , 34 ], and MI [ 22 , 31 , 32 , 35 ] were correlated with ECCC prognosis. Notably, both ECCC and serious uterine carcinoma have been analyzed in most of these studies.…”