Salvage Versus Adjuvant Radiation Treatment for Women With Early-Stage Endometrial Carcinoma

Vance, Sean; Burmeister, Charlotte; Rasool, Nabila; Buekers, Thomas E.; Elshaikh, Mohamed A.

doi:10.1097/igc.0000000000000615

Cited by 7 publications

(11 citation statements)

References 35 publications

(9 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Among the few studies that have looked at HDR-BT for vaginal recurrent EC, Petignat et al (17), Vargo et al (4), Vance et al (23), Lin et al (2) and Fokdal (39) showed comparable local control, progression-free, and overall survival rates. Petignat et al reported 5-year LC and DFS rates of 100% and 96%, respectively; for patients treated with HDR-BT for isolated vaginal recurrence of FIGO stage I EC.…”

Section: Discussionmentioning

confidence: 99%

“…These rates are comparable to results of our study, despite the predominant utilization of IMRT (90%) and cylinder brachytherapy (73%) in this study. Vance et al (23) reported relatively better 2- and 5-year disease-specific (90%, 77%) and overall survival (84%, 72%) rates among women with early-stage EC (87% FIGO stage I and 13% FIGO stage II disease). Fokdal et al (38) showed 2-year LC of 92%, with disease-free survival and overall survival rates of 59% and 78% respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Approximately 75 – 80% of these relapses are confined to the vagina (16–20). Salvage radiation therapy (SRT) in the form of combined external beam treatment (EBRT) and brachytherapy (BT) is the recommended treatment for vaginal recurrence of endometrial cancer (21–23). BT can either be performed using an interstitial or intracavitary technique, depending on the size and location of the recurrence.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

MR- versus CT-based high-dose-rate interstitial brachytherapy for vaginal recurrence of endometrial cancer

et al. 2017

View full text Add to dashboard Cite

Purpose To compare clinical outcomes of MR-based versus CT-based high-dose-rate (HDR) interstitial brachytherapy (ISBT) for vaginal recurrence of endometrioid endometrial cancer (EC). Methods We reviewed 66 patients with vaginal recurrent EC; 18 had MR-based ISBT on a prospective clinical trial and 48 had CT-based treatment. Kaplan-Meier (K-M) survival modeling was used to generate estimates for local control (LC), disease-free interval (DFI), and overall survival (OS) and multivariate Cox modeling was used to assess prognostic factors. Toxicities were evaluated and compared. Results Median follow up was 33 months (CT 30 months, MR 35 months). Median cumulative EQD2 was 75.5 Gy for MR-ISBT and 73.8 Gy for CT-ISBT (p=0.58). MR patients were older (p=0.03) and had larger tumor size (>4cm vs ≤4cm) compared to CT patients (p=0.04). For MR- vs. CT-based ISBT, 3-year KM rate for LC was 100% vs. 78% (p = 0.04), DFI was 69% vs. 55% (p= 0.1), and OS was 63% vs. 75% (p= 0.81), respectively. On multivariate analysis, tumor grade 3 was associated with worse OS (HR 3.57, 95%CI 1.25,11.36) in a model with MR-ISBT (HR=0.56, 95%CI 0.16,1.89). Toxicities were not significantly different between the two modalities. Conclusion Despite worse patient prognostic features, MR-ISBT was associated with a significantly better (100%) 3-year local control, comparable survival, and improved DFI rates compared to CT. Toxicities did not differ compared to CT-ISBT patients. Tumor grade contributed as the most significant predictor for survival. Larger prospective studies are needed to assess the impact of MR-ISBT on survival outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

MR- versus CT-based high-dose-rate interstitial brachytherapy for vaginal recurrence of endometrial cancer

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Similarly, Nag et al and Huh et al revealed 85.8% and 83% 4.5-year DFS in patients administered with EBRT +/− BT [ 29 , 32 ]. In the analysis performed by Vance et al, 77% of patients were disease-free at 4–5 years and were also administered with EBRT +/− BT [ 35 ]. Lower DFS rates were detected at 4.5 years in the studies conducted by Wylie et al, Sears et al, and Kuten et al in 68%, 54%, and 40% of patients, respectively, who were administered with EBRT +/− BT [ 27 , 28 , 30 ].…”

Section: Resultsmentioning

confidence: 99%

“…Regarding OS, the highest 4.5-year rates were shown by Petignat et al with 96% OS [ 31 ]. Secondarily, Chapman et al, Huh et al, and Vance et al showed 4.5-year OS rates of 77%, 75%, and 72%, respectively, and their cohorts were treated with EBRT +/− BT [ 32 , 35 , 36 ]. Francis et al showed 65% OS at 4.5 years in patients administered with salvage EBRT [ 37 ].…”

Section: Resultsmentioning

confidence: 99%

Radiotherapy and Chemotherapy Features in the Treatment for Locoregional Recurrence of Endometrial Cancer: A Systematic Review

Ronsini

Iavarone

Reino

et al. 2023

JPM

View full text Add to dashboard Cite

Radiation therapy (RT) is the standard of care in patients with locoregional or isolated vaginal recurrence who never underwent irradiation. It is often associated with brachytherapy (BT), whereas chemotherapy (CT) is a rare treatment option. We systematically searched the PubMed and Scopus databases in February 2023. We included patients with relapsed endometrial cancer, describing the treatment of locoregional recurrence, and reporting at least one outcome of interest—disease-free survival (DFS), overall survival (OS), recurrence rate (RR), site of recurrence, and major complications. A total of 15 studies fulfilled the inclusion criteria. Overall, 11 evaluated RT only, 3 evaluated CT, and 1 analyzed oncological outcomes after administration with a combination of CT and RT. In total, 4.5-year OS ranged from 16% to 96%, and DFS ranged from 36.3% to 100% at 4.5 years. RR ranged from 3.7% to 98.2% during a median follow-up of 51.5 months. Overall, RT showed a 4.5-year DFS from 40% to 100%. CT revealed 36.3% DFS at 4.5 years. RT showed a 4.5-year OS ranging from 16% to 96%, whereas CT revealed a 27.7% OS rate. It would be appropriate to test multi-modality regimens to evaluate outcomes and toxicity. EBRT and BT are the most employed options to treat vaginal recurrences.

show abstract

Evolution of adjuvant treatment in endometrial cancer—no evidence and new questions?

et al. 2018

View full text Add to dashboard Cite

Surgery is the mainstay of treatment of EC patients. Well-differentiated tumors and early disease (FIGO IA) should be followed up without further treatment. In FIGO I stage without risk factors, VBT remains the standard treatment after surgery. FIGO I, II patients with one or more risk factors (MI ≥ 50%, Grading[G]3, age >60 years, LVSI) benefit from external beam radiotherapy (EBRT) in terms of survival. There are no data of acceptable quality demonstrating that chemotherapy is superior to radiation in locally advanced carcinomas. Therefore, even in locally advanced disease (FIGO III, IV), EBRT remains the standard of care after surgery. EBRT contributes to the very low rate of local relapses and better DFS in these patients and should not be replaced by chemotherapy only. Whether and which subgroups of patients benefit from an additional (concomitant and/or adjuvant) chemotherapy in terms of disease-free survival remains a controversial issue. The recently published PORTEC-3 trial could not create clear evidence. With a high rate of isolated tumors cells and micrometastases in the specimens, the increasing use of unvalidated sentinel concepts in endometrial cancer raises more questions with regard to indications for adjuvant treatment. In the future, integrated genomic characterization of tumors might be helpful for treatment individualization in the adjuvant setting.

show abstract

Salvage Versus Adjuvant Radiation Treatment for Women With Early-Stage Endometrial Carcinoma

Cited by 7 publications

References 35 publications

MR- versus CT-based high-dose-rate interstitial brachytherapy for vaginal recurrence of endometrial cancer

MR- versus CT-based high-dose-rate interstitial brachytherapy for vaginal recurrence of endometrial cancer

Radiotherapy and Chemotherapy Features in the Treatment for Locoregional Recurrence of Endometrial Cancer: A Systematic Review

Evolution of adjuvant treatment in endometrial cancer—no evidence and new questions?

Contact Info

Product

Resources

About