J Gynecol Oncol.  2014 Oct;25(4):313-319. 10.3802/jgo.2014.25.4.313.

The survival outcome and patterns of failure in node positive endometrial cancer patients treated with surgery and adjuvant radiotherapy with curative intent

• Rajasooriyar C
• Bernshaw D
• Kondalsamy-Chennakesavan S
• Mileshkin
• Narayan K

• KMID: 2130120
• DOI: http://doi.org/10.3802/jgo.2014.25.4.313

Abstract

OBJECTIVE
The purpose of this study was to evaluate the patterns of failure, overall survival (OS), disease-free survival (DFS) and factors influencing outcome in endometrial cancer patients who presented with metastatic lymph nodes and were treated with curative intent.
METHODS
One hundred and twenty-six patients treated between January 1996 to December 2008 with surgery and adjuvant radiotherapy were identified from our service's prospective database. Radiotherapy consisted of 45 Gy in 1.8 Gy fractions to the whole pelvis. The involved nodal sites were boosted to a total dose of 50.4 to 54 Gy.
RESULTS
The 5-year OS rate was 61% and the 5-year DFS rate was 59%. Grade 3 endometrioid, serous, and clear cell histologies and involvement of upper para-aortic nodes had lower OS and DFS. The number of positive nodes did not influence survival. Among the histological groups, serous histology had the worst survival. Among the 54 patients relapsed, only three (6%) failed exclusively in the pelvis and the rest of the 94% failed in extrapelvic nodal or distant sites. Patients with grade 3 endometrioid, serous and clear cell histologies did not influence pelvic failure but had significant extrapelvic failures (p<0.001).
CONCLUSION
Majority of node positive endometrial cancer patients fail at extrapelvic sites. The most important factors influencing survival and extrapelvic failure are grade 3 endometrioid, clear cell and serous histologies and involvement of upper para-aortic nodes.

Keyword

Endometrial neoplasms; Lymph nodes; Prospective studies; Radiotherapy; Survival rate

MeSH Terms

Adenocarcinoma, Clear Cell/pathology/radiotherapy/*secondary/surgery
Adult
Aged
Aged, 80 and over
Carcinoma, Endometrioid/pathology/radiotherapy/*secondary/surgery
Cystadenocarcinoma, Papillary/pathology/radiotherapy/*secondary/surgery
Endometrial Neoplasms/pathology/radiotherapy/*surgery
Female
Humans
Lymphatic Metastasis
Middle Aged
Neoplasm Staging
Prognosis
Prospective Studies
Radiotherapy, Adjuvant
Salvage Therapy/methods
Survival Analysis
Treatment Failure
Treatment Outcome

Figure

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  Fig. 1 (A) Overall survival, (B) disease-specific survival, and (C) disease-free survival estimates of high risk and low risk node positive endometrial cancer patients. CI, confidence interval; HR, hazard ratios.

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  Fig. 2 (A) Overall survival, (B) disease-specific survival, and (C) disease-free survival estimates of grade 1 & 2 endometroid (group 1) vs. grade 3 endometroid (group 2) and clear cell (group 3) vs. serous histology (group 4). CI, confidence interval; HR, hazard ratios.

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