Location of recurrences in high-risk stage Iendometrial cancer patients not given postoperative radiotherapy: A Danish gynecological cancer group study

Abstract

ObjectivesTo study recurrence rates in Danish high-risk stage I endometrial cancers not given radiotherapy in accordance with the decision of the Danish Gynecological Cancer Group.MethodsThis prospective national cohort study includes all 4707 endometrial carcinomas diagnosed from 2005 to 2012. Of these, 623 patients had grade 3 endometroid adenocarcinoma with >50% myometrial invasion or serous/clear/undifferentiated carcinoma (with any depth of invasion). In 305 patients with high-risk stage I on final pathology, 14.1% received adjuvant external beam radiotherapy and 9.6% adjuvant chemotherapy. No patients received brachytherapy. 5-year Kaplan-Meier survival estimates and actuarial recurrence rates were calculated, and adjusted Cox regression analysis used for comparison. Recurrence rates were compared with historical Danish population data (DEMCA 98–99).ResultsFor non-irradiated patients, 5-year overall survival, cancer-specific survival, and progression-free survival rates in high-risk stage I patients were 65%, 78%, and 73%, respectively. For non-irradiated patients, isolated local recurrences were uncommon (vaginal 3.1%, pelvic 0.4%). Death was mainly due to a high occurrence of non-local recurrences, with 8.8% experiencing a first recurrence in the abdominal cavity (outside the field where radiation traditionally have been given) and 13.0% a distant metastasis outside the abdominal cavity. Grade 3 tumors with >50% myometrial invasion seem to be characterized by a different pattern of recurrences, with significantly more isolated vaginal recurrences (7.9% vs 2.2%) and fewer total number of abdominal recurrences (7.9% vs 15.3%) as compared with unfavorable tumor types.ConclusionIsolated vaginal and pelvic recurrences were rare (3–5%) in patients with a final pathologic diagnosis of high-risk stage I endometrial cancer even after the Danish Gynecological Cancer Group decided to omit all types of postoperative radiotherapy and introduce lymph node staging.

Lymph-vascular space invasion (LVSI) as a strong and independent predictor for non-locoregional recurrences in endometrial cancer: a Danish Gynecological Cancer Group Study

“…In the pioneer study of Alders et al [26] on EBRT for stage I patients, the authors found a decrease in locoregional recurrences, but also a marginal, but non-significant, increase in distant recurrences, which explains the unchanged recurrence-free survival in patients given compared with patients not given radiotherapy. A plausible explanation for this could be that vaginal recurrence occur sooner then distant recurrence [2129], and as many patients experience multiple sites of recurrences, the first recurrences may shift from vaginal to distant if the vaginal recurrence is prevented by radiotherapy.…”

Prognostic relevance of the molecular classification in high-grade endometrial cancer for patients staged by lymphadenectomy and without adjuvant treatment

“…Deaths were retrieved from the Danish Central Person Register and cause of death was checked from the patient's medical records [15]. Histologically-verified recurrences were retrieved from the Danish pathology database, while those not histologically verified were identified from the medical records collected for patients who had died from EC.…”

“…Histologically-verified recurrences were retrieved from the Danish pathology database, while those not histologically verified were identified from the medical records collected for patients who had died from EC. Medical records were reviewed to collect time and site of recurrence [15]. As previously described [15], patients underwent abdominal hysterectomy, bilateral salpingo-oophorectomy and intra-abdominal assessment.…”

“…Medical records were reviewed to collect time and site of recurrence [15]. As previously described [15], patients underwent abdominal hysterectomy, bilateral salpingo-oophorectomy and intra-abdominal assessment. Routine systematic pelvic lymphadenectomy (removal of external iliac, obturator, and common iliac nodes) was recommended for high-risk patients according to national Danish guidelines (http:// dgcg.dk/index.php/guidelines/corpuscancer), with some institutions also performing para-aortic lymphadenectomy (removal of precaval, laterocaval, interaortocal, preaortic and lateroaortic nodes).…”

Defining Substantial Lymphovascular Space Invasion in Endometrial Cancer

“…The second cohort in our study was derived from a Danish population-based study of patients with highrisk EC (6,17) and is described in detail in our companion paper by Peters and colleagues (IJGP21-4497). Cases were collected from the DGCD, a Danish nationwide database that includes nearly all 4707 patients diagnosed with EC from January 1, 2005 to December 31, 2012.…”