The Role of Adjuvant Radiotherapy in Carcinoma of the Endometrium—Results in 550 Patients with Pathologic Stage I Disease

Irwin, C.; Levin, W.; Fyles, Anthony; Pintilie, Melania; Manchul, L.; Kirkbride, Peter

doi:10.1006/gyno.1998.5064

Cited by 99 publications

(40 citation statements)

References 13 publications

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“…However, the rates of severe GI toxicity we observed are higher than previously reported. (4;18;19) In this study, 6.9% of patients who received implant radiation experienced severe GI toxicity. In contrast, a previous trial reported that less than 1% of patients receiving vaginal brachytherapy experienced grade 3 or 4 GI toxicity.…”

Section: Discussionmentioning

confidence: 69%

The effect of postoperative beam, implant, and combination radiation therapy on GI and bladder toxicities in female Medicare beneficiaries with stage I uterine cancer

Samper‐Ternent

Asem²,

Zhang

et al. 2012

Journal of Geriatric Oncology

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Objective Determine the risk of late gastrointestinal (GI) and bladder toxicities in women treated for Stage I uterine cancer with postoperative beam, implant, or combination radiation. Methods The Surveillance, Epidemiology, and End Results (SEER) tumor registry and Medicare claims were used to estimate the risk of developing late GI and bladder toxicities by type of radiation received. Bladder and GI diagnoses were identified 6–60 months after cancer diagnosis. Cox-proportional hazard models were used to estimate risk of any late GI or bladder toxicity due to type of radiation received. Results A total of 3,024 women with uterine cancer diagnosed from 1992–2005 were identified for analysis with a mean age of 73.9 (Standard Deviation (SD) ± 6.5). Bladder and GI toxicities occurred most frequently in the combination group, and least in the implant group. After controlling for demographic characteristics, tumor grade, diagnosis year, SEER region, comorbidities, prior GI and bladder diagnosis, and chemotherapy, women receiving implant radiation had a 21% absolute decrease in GI toxicities compared to women receiving combination radiation (Hazard Ratio (HR) 0.79, 95% confidence interval (CI) 0.68–0.92). No differences were observed between those receiving beam and combination in GI (HR 1.01 (0.89–1.14)) and bladder (HR 0.95 (0.80–1.11)) toxicities. Conclusions Older women receiving combined radiation had the highest rates of GI and bladder toxicities, while women receiving implant radiation alone had the lowest rates. When selecting type of radiation for a patient, these toxicities should be considered. Counseling older women surviving cancer on late toxicities due to radiation must be a priority for physicians caring for them.

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Section: Discussionmentioning

confidence: 69%

The effect of postoperative beam, implant, and combination radiation therapy on GI and bladder toxicities in female Medicare beneficiaries with stage I uterine cancer

Samper‐Ternent

Asem²,

Zhang

et al. 2012

Journal of Geriatric Oncology

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“…Adjuvant chemotherapy alone is thought to control distant recurrence better than radiotherapy; however, it may be inadequate to achieve local control. 20,21 Local recurrent rates of 4% to 7% were reported in patients with stage I disease and poor prognostic factors who were receiving surgery followed by radiotherapy, 12,22,23 and up to 4.3% local recurrences were observed in patients with HIR who were treated with radiation combined with chemotherapy. 6,8,11 The local recurrence rate for patients with grade 3 tumor who received adjuvant chemotherapy alone was 4.5% (2/44) in our study, which is comparable to historical data.…”

Section: Discussionmentioning

confidence: 99%

Should the Optimal Adjuvant Treatment for Patients With Early-Stage Endometrial Cancer With High-Intermediate Risk Factors Depend on Tumor Grade?

Lan

Huang

et al. 2015

International Journal of Gynecological Cancer

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ObjectivesTo explore whether the optimal adjuvant treatments for patients with early-stage endometrial cancer with high-intermediate risk (HIR) factors should depend on tumor grade.MethodsA retrospective analysis of patients with HIR endometrial cancer from 1999 to 2012 was conducted. The adjuvant treatments and survival were evaluated.ResultsA total of 129 patients with HIR were identified, of which 71 had grade 1–2 tumor and 58 had grade 3 tumor. The adjuvant treatment chosen differed significantly between patients with grade 1–2 and grade 3 tumors (P < 0.001). Most of the patients (76.1%) with grade 1–2 tumors received no adjuvant treatment; however, chemotherapy alone was the most frequent (75.9%) adjuvant treatment for patients with grade 3 tumors. In the grade 1–2 group, no significant differences in the 5-year progression-free survival (94.1% vs 96.3%; P = 0.857) and overall survival (OS) rates (94.1% vs 98.1%; P = 0.401), respectively, were observed between patients who received adjuvant treatment (radiation and chemotherapy with or without radiation) and those who did not. For grade 3 disease, patients undergoing adjuvant chemotherapy alone had a favorable outcome with the 5-year progression-free survival rate of 84.4% and the OS rate of 95.5%.ConclusionIt is logical to speculate that surgery followed by observation might be sufficient for patients with HIR with grade 1–2 tumor. Further prospective trials are required to confirm the issue owing to the limited number of this population. More studies are warranted to clarify the feasibility and efficacy of adjuvant chemotherapy alone in patients with HIR with grade 3 tumor.

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“…Several publications have suggested that the incidence of distant metastasis in early stage endometrial adenocarcinoma ranges between 4-12% [7,13-21]. Several prognostic factors have been analyzed for correlations with distant metastasis, and the most commonly reported risk factors for distant metastasis in this HIR group are: LVSI, deep myometrial invasion, and grade 3 histology [7,15,22-26].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for recurrence amongst high intermediate risk patients with endometrioid adenocarcinoma

et al. 2012

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ObjectiveTo determine risk factors associated with recurrence in patients with high intermediate risk (HIR) endometrioid adenocarcinoma.MethodsA retrospective analysis of patients with HIR endometrioid adenocarcinoma who underwent hysterectomy, bilateral salpingo-oophorectomy, with or without pelvic/para-aortic lymphadenectomy at the University of Pennsylvania between 1990 and 2009 was performed.ResultsA total of 103 women with HIR endometrial cancer were identified. Multivariable analysis revealed that ≥2/3 myometrial invasion (HR, 4.79; p=0.010) and grade 3 disease (HR, 3.04; p=0.045) were independently predictive of distant metastases. The 5-year distant metastases free survival (DMFS) for patients with neither or one of these risk factors was 89%, and the 5-year DMFS for patients with both risk factors was 48% (p<0.001).ConclusionPatients with both grade 3 disease and deep third myometrial invasion have a high risk of distant metastases. Identifying these patients may be important in rationally selecting patients for systemic therapy.

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The Role of Adjuvant Radiotherapy in Carcinoma of the Endometrium—Results in 550 Patients with Pathologic Stage I Disease

Cited by 99 publications

References 13 publications

The effect of postoperative beam, implant, and combination radiation therapy on GI and bladder toxicities in female Medicare beneficiaries with stage I uterine cancer

The effect of postoperative beam, implant, and combination radiation therapy on GI and bladder toxicities in female Medicare beneficiaries with stage I uterine cancer

Should the Optimal Adjuvant Treatment for Patients With Early-Stage Endometrial Cancer With High-Intermediate Risk Factors Depend on Tumor Grade?

Risk factors for recurrence amongst high intermediate risk patients with endometrioid adenocarcinoma

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