Treatment outcomes of endometrial cancer patients with paraaortic lymph node metastasis: a multi-institutional analysis

Abstract

ObjectiveTo analyze the prognostic factors and treatment outcomes in endometrial cancer patients with paraaortic lymph node metastasis.MethodsData from four centers were collected retrospectively for 92 patients with endometrial cancer treated with combined radiotherapy and chemotherapy or adjuvant radiotherapy alone postoperatively, delivered by either the sandwich or sequential method. Prognostic factors affecting overall survival and progression-free survival were analyzed.ResultsThe 5-year overall survival and progression-free survival rates were 35 % and 33 %, respectively, after a median follow-up time of 33 months. The 5-year overall survival and progression-free survival rates were significantly higher in patients receiving radiotherapy and chemotherapy postoperatively compared with patients treated with adjuvant radiotherapy alone (P < 0.001 and P < 0.001, respectively). In a subgroup analysis of patients treated with adjuvant combined chemotherapy and radiotherapy, the 5-year overall survival and progression-free survival rates were significantly higher in patients receiving chemotherapy and radiotherapy via the sandwich method compared with patients treated with sequential chemotherapy and radiotherapy (P = 0.02 and P = 0.03, respectively). In the univariate analysis, in addition to treatment strategy, pathology, depth of myometrial invasion, and tumor grade were significant prognostic factors for both overall survival and progression-free survival. In the multivariate analysis, grade III disease, myometrial invasion greater than or equal to 50%, and adjuvant radiotherapy alone were negative predictors for both overall survival and progression-free survival.ConclusionWe demonstrated that adjuvant combined treatment including radiotherapyand chemotherapy significantly increases overall survival and progression-free survival rates compared with postoperative pelvic and paraaortic radiotherapy.

Comparison of outcomes between the one-step and two-step sentinel lymph node mapping techniques in endometrial cancer

“…As the lymphatic spread may course from the upper paracervical pathway to the common iliac lymph nodes and then posteriorly to the para-aortic lymph nodes, and as the incidence of para-aortic lymph node metastasis is small,24 stage IIIC1 and stage IIIC2 patients are often treated similarly and outcomes are often analyzed altogether. However, recent studies suggest that prognosis among stage III patients differ; the 5-year overall and progression-free survival rates in stage IIIC2 patients were 35% and 33%, which were significantly lower than those in stage IIIC1 patients 25. In our retrospective study setting, where most of the patients received both SLN biopsy and validation lymphadenectomy, the prevalence of stage III disease was 12.1% and that of stage IIIC2 subset was 5.0%, which were comparable to the previously reported rates 26.…”

Predictors of Survival in Women with High-Risk Endometrial Cancer and Comparisons of Sandwich versus Concurrent Adjuvant Chemotherapy and Radiotherapy

“…To our knowledge, there was no article mentioned about the comparison between sandwich and concurrent CRTs. Similarly, Onal et al reported a superiority of sandwich CRT in PFS and OS, compared with sequential CRT or radiotherapy only [ 8 , 9 ]. The underlying mechanism explaining the finding about the superiority of sandwich CRT is unknown.…”

ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma

“…319 Multiple retrospective studies indicated a survival benefit in patients with advanced stage endometrial carcinoma treated with post-operative combined treatment including radiotherapy and chemotherapy, delivered by either the sandwich or sequential method, compared with radiotherapy alone or chemotherapy alone. [326][327][328][329][330][331][332][333][334][335][336][337][338][339][340][341][342][343][344] The benefit of added chemotherapy is unclear for patients with stage I-II clear cell carcinomas. These have often been included with serous as 'non-endometrioid carcinomas'.…”