Improved Outcome of High-Grade, Early 1-Stage Endometrioid Endometrial Carcinoma With Adjuvant Chemotherapy and Radiotherapy

Reynaers, Eline Aem; Jutzi, Leah; Ezendam, Nicole P. M.; Kwon, Janice S.; Pijnenborg, Johanna M.A.

doi:10.1097/igc.0000000000000900

Cited by 7 publications

(6 citation statements)

References 30 publications

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“…Outside of prospective trials, there have been several studies examining recurrence in solely early-stage patients with EC ( 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ). However, some of these studies include a heterogenous group of women with non-endometrioid histologies, such as serous carcinoma, which are known to have a poor prognosis ( 8 , 10 , 11 , 21 , 22 ).…”

Section: Introductionmentioning

confidence: 99%

“…However, some of these studies include a heterogenous group of women with non-endometrioid histologies, such as serous carcinoma, which are known to have a poor prognosis ( 8 , 10 , 11 , 21 , 22 ). All of these studies also include women who received various adjuvant treatments ( 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ). Adjuvant therapy is known to significantly impact recurrence rates ( 3 , 23 ).…”

Section: Introductionmentioning

confidence: 99%

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Quantification of recurrence risk based on number of adverse prognostic factors in women with stage I uterine endometrioid carcinoma

Cook¹,

Aref²,

Burmeister³

et al. 2021

J Turkish German Gynecol Assoc

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Objective: The goal was to develop an updated model to predict the risk of recurrence, based on the number of adverse pathologic features in women with International Federation of Gynecology and Obstetrics stage I uterine endometrioid carcinoma, who did not undergo any adjuvant treatment. Material and Methods: Women at a single center who underwent surgical staging without adjuvant therapy between January 1990 and December 2019 were included. Cox proportional hazards model was used to identify independent predictors of relapse free survival (RFS). Prognostic groups were then created based on the number of independent predictors of recurrence that were identified (0, 1, or 2-3 risk factors). Overall survival (OS) and disease specific survival (DSS) were also calculated for each group. Results: In total 1133 women were eligible for inclusion. Median follow-up was 84 months. Independent prognostic factors of recurrence included: age ≥60; grade 2 or 3 differentiation; and presence of lymphovascular space invasion (LVSI). Due to the small number of patients with either 2 or 3 risk factors, these groups were combined into one (group 2/3). Isolated vaginal cuff recurrence was the most common site of recurrence in all study groups (2%, 7%, and 17% for groups 0, 1, and 2/3, respectively). Five-year RFS rates were 96%, 85%, and 57% for groups 0, 1, and 2/3 (p<0.01), respectively. Five-year DSS rates were 99%, 96%, and 85% and 5-year OS rates were 94%, 85%, and 62% (p<0.01), respectively. Conclusion: We identified older age, high grade, and presence of LVSI as independent predictors of recurrence for women with stage I uterine endometrioid carcinoma. Using these prognostic factors, recurrence risk can be quantified for individual patients, and these factors can be used in deciding the appropriate adjuvant management course.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Quantification of recurrence risk based on number of adverse prognostic factors in women with stage I uterine endometrioid carcinoma

Cook¹,

Aref²,

Burmeister³

et al. 2021

J Turkish German Gynecol Assoc

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“…[ 2 , 3 ] Patients receiving radiation have a significantly reduced recurrence and metastasis rate, and disease-free survival is greater. [ 4 , 5 ] However, side effects of radiation have been widely reported, including impaired fertility, [ 6 ] secondary malignancy, [ 7 , 8 ] and lung metastasis. [ 9 ] Thus, accurate diagnosis of lymph invasion is critical to guide adjuvant therapy.…”

Section: Introductionmentioning

confidence: 99%

Stard

Mao

Zhao²,

Huang³

et al. 2018

Medicine

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“…Studies have been conducted to evaluate the efficacy of chemotherapy for HR stage I to II EC patients. Reynaers et al [ 25 ] retrospectively analyzed 116 patients with stage IB-II grade 3 disease and concluded that adjuvant chemotherapy and RT resulted in improved OS compared to RT alone. Smogeli et al [ 26 ] demonstrated that HR EC patients had acceptable vaginal/pelvic control rates after adjuvant chemotherapy alone.…”

Section: Discussionmentioning

confidence: 99%

Overview of adjuvant radiotherapy on survival, failure pattern and toxicity in stage I to II endometrial carcinoma: a long-term multi-institutional analysis in China

Wang

et al. 2022

BMC Cancer

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Background This research aimed to provide an overview of the impact of adjuvant vaginal brachytherapy (VBT) and external beam pelvic radiotherapy (EBRT) with or without VBT on survival in stage I to II EC patients in China from a long-term multi-institutional analysis. Methods We retrospectively analyzed stage I to II EC patients from 13 institutions treated between 2003 and 2015. All patients underwent surgical staging and received adjuvant RT. Patients were divided into groups of low-risk (LR), intermediate-risk (IR), high-intermediate-risk (HIR) and high-risk (HR). Survival statistics, failure pattern, and toxicity of different radiation modalities in different risk groups were analyzed. Results A total of 1048 patients were included. HR disease represented 27.6%, HIR 17.7%, IR 27.7% and LR 27.1%, respectively. Endometrioid adenocarcinoma (EAC) and non-endometrioid carcinoma (NEC) accounted for 92.8 and 7.2%. A total of 474 patients received VBT alone and 574 patients received EBRT with or without VBT. As for EAC patients, the 5-year overall survival (OS), disease-free survival (DFS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) rate was: 94.6, 90.4, 93.0 and 91.6%, respectively. For LR patients, EBRT (with or without VBT) seemed to be a risk factor. With the higher risk category, the survival benefit of EBRT gradually became remarkable. EBRT (with or without VBT) significantly increased DFS, LRFS and DMFS compared to VBT alone in the HR group (p < 0.05). Distant metastasis was the main failure pattern for all risk groups. As for NEC patients, the 5-year OS, DFS, LRFS and DMFS rate was: 93.4, 87.2, 91.7 and 89.3%, respectively. As for toxicity, EBRT (with or without VBT) significantly increased the incidence of grade 1–2 gastrointestinal, urinary, and hematological toxicity. Conclusions For stage I to II EC patients, EAC accounted for the majority and had better prognosis than NEC. For EAC patients, VBT alone resulted in comparable survival to EBRT in the LR, IR and HIR groups, while EBRT significantly increased survival in the HR group. EBRT had higher rate of toxicity than VBT.

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Improved Outcome of High-Grade, Early 1-Stage Endometrioid Endometrial Carcinoma With Adjuvant Chemotherapy and Radiotherapy

Cited by 7 publications

References 30 publications

Quantification of recurrence risk based on number of adverse prognostic factors in women with stage I uterine endometrioid carcinoma

Quantification of recurrence risk based on number of adverse prognostic factors in women with stage I uterine endometrioid carcinoma

Stard

Overview of adjuvant radiotherapy on survival, failure pattern and toxicity in stage I to II endometrial carcinoma: a long-term multi-institutional analysis in China

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