J Gynecol Oncol.  2014 Apr;25(2):105-110. 10.3802/jgo.2014.25.2.105.

Survival analysis of endometrial cancer patients with cervical stromal involvement

• Frandsen J
• Sause WT
• Dodson MK
• Soisson AP
• Belnap TW
• Gaffney DK

• KMID: 1708332
• DOI: http://doi.org/10.3802/jgo.2014.25.2.105

Abstract

OBJECTIVE
Stage II endometrial cancer is relatively uncommon. There is no consensus for appropriate adjuvant therapy in endometrial cancer patients with cervical stromal involvement (International Federation of Gynecology and Obstetrics [FIGO] stage II). This study investigates how adjuvant treatments and tumor characteristics influence overall survival (OS) and disease-free survival (DFS) in stage II patients in order to establish better treatment guidelines.
METHODS
This multi-institution, Institutional Review Board approved, study is a retrospective review of 40 endometrial cancer patients with cervical stromal involvement treated from 1993 to 2009. Kaplan-Meier estimates were used to evaluate OS and DFS.
RESULTS
OS was 85% at three years and 67% at five years. There were no significant differences in age, histology, depth of invasion, comorbid conditions, surgical staging or recurrence between patients who received radiation therapy (RT) and those who did not. However, patients with FIGO grade 1 cancers were less likely to receive RT (p=0.007). Patients treated with RT had a similar 5 year OS (n=33, 69%) to those treated with surgery only (n=7, 60%, p=0.746). There were no OS differences when evaluating by grade, histology, or depth of invasion between patients who did and did not receive RT. Four patients recurred: three were locoregional failures only, and one failed locally and distant.
CONCLUSION
Patients receiving RT had higher grade tumors. Despite this, OS was comparable between the RT and the no RT cohorts. Local failure was the predominant pattern of failure. Endometrial cancer patients with cervical stromal involvement likely receive better locoregional control with the addition of adjuvant RT and we continue to advocate for RT in most cases.

Keyword

Adjuvant radiation therapy; Cervical involvement; Endometrial cancer; Survival outcome

MeSH Terms

Cohort Studies
Consensus
Disease-Free Survival
Endometrial Neoplasms*
Ethics Committees, Research
Female
Gynecology
Humans
Obstetrics
Recurrence
Retrospective Studies
Survival Analysis*

Figure

• 

  Fig. 1 Stage II endometrial cancer overall survival for all subjects.

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