Outcomes After Salvage Radiation Therapy for Recurrent Endometrial Cancer in Patients With No Prior Adjuvant Therapy: An Institutional Review

Abstract

Purpose After definitive surgery, women with early-stage, low-risk endometrial cancer are observed. However, some will require salvage radiation therapy for recurrence. The purpose of this study was to evaluate our experience using salvage radiation for recurrent endometrial cancer in patients who did not receive upfront adjuvant therapy. Methods and Materials Twenty-eight women with endometrial cancer who had undergone initial definitive hysterectomy without adjuvant therapy developed isolated local or regional recurrence and were treated with salvage radiation in our department from 2004 to 2018. Salvage radiation included whole pelvic radiation, vaginal brachytherapy, or both. Patient and tumor characteristics, treatment details, and toxicities were recorded and analyzed. Results The median time to first recurrence was 1.7 years. First recurrences consisted of local recurrence in 23 patients, regional recurrence in 4, and both in 1. The median times from hysterectomy to first recurrence, local and regional, were 1.2 and 4.0 years, respectively. All patients underwent salvage radiation for management of their first recurrence. The median total equivalent dose in 2 Gy fractions for this treatment was 67.6 Gy (37.5–81.8 Gy). Two second recurrences occurred following salvage treatment, both local recurrence, at 6.5 and 13.5 months after radiation. The 2-year rates of local control, disease-free survival, and overall survival were 93%, 80%, and 88%, respectively. Treatment was well-tolerated, with low rates of gastrointestinal and genitourinary toxicity. Conclusions In this group of patients, salvage radiation therapy for local or regional recurrence of endometrial cancer resulted in excellent control with low rates of acute and chronic toxicities.

Clinical outcomes after salvage external beam radiotherapy combined with interstitial brachytherapy for locally advanced, recurrent endometrial cancer

“…reported in other series. [20][21][22][23] Furthermore, it may appear better than the local control rates reported by Kotsuma et al and Vargo et al 24,25 The present study supports a recent American Brachytherapy Society literature review, which found 2-5-year local control rates of 83%-100% and low significant late-term morbidities with the use of imageguided brachytherapy in vaginal recurrences of endometrial cancer. 10 The EBRT doses used for microscopic disease (45 Gy) within the present study are within the current guideline recommendations (45-50 Gy).…”

Overall and cancer specific survival following radical or adjuvant (chemo)radiotherapy in a retrospective cohort of elderly patients with endometrial cancer

“…Almost 40% of our series had definitive radical (chemo)radiotherapy, either primary or salvage therapy. The OS results for women receiving salvage treatment are comparable to other series [18][19][20]. Conversely, 5-year OS was poor, at just 23.8%, in the medically inoperable patients.…”

Radiation therapy for pelvic recurrent colorectal or gynecological cancer: is whole pelvic irradiation necessary?

“…In-field second LR after RT was observed in 56.6% of patients, in one study (20). The RT field for postoperative LR of uterine endometrial cancer is also the whole pelvis, including the prophylactic LN regions, and in some patients, a vaginal BT boost is often combined with RT (22)(23)(24). Studies have reported that infield second LR after RT was observed in 7.1-15.1% of patients (23,24).…”

“…The RT field for postoperative LR of uterine endometrial cancer is also the whole pelvis, including the prophylactic LN regions, and in some patients, a vaginal BT boost is often combined with RT (22)(23)(24). Studies have reported that infield second LR after RT was observed in 7.1-15.1% of patients (23,24). In a study that included patients receiving vaginal BT with and without whole pelvic RT, pelvic progressive disease was observed in 52.1% of the patients after RT (22).…”