J Gynecol Oncol.  2020 Jul;31(4):e39. 10.3802/jgo.2020.31.e39.

Survival benefit of radiation in high-risk, early-stage endometrioid carcinoma

• Xiang M
• Kidd EA

• KMID: 2511952
• DOI: http://doi.org/10.3802/jgo.2020.31.e39

Abstract

Objective
To better delineate optimal management of high-risk, early-stage endometrial cancer, as national guidelines permit substantial practice variations.
Methods
Patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB grade 3 and stage II endometrioid carcinoma who underwent at least total hysterectomy were identified in SEER-Medicare. Adjuvant treatments were brachytherapy (BT), external beam radiation therapy (EBRT), and chemotherapy. Death from endometrial cancer (cancerspecific mortality [CSM]) and local recurrence were analyzed using Gray's test and FineGray regression.
Results
In total, 1,095 patients were identified: 52% received BT, 56% received EBRT, 16% received chemotherapy, and 29% received no adjuvant treatment. Survival outcomes were significantly worse for stage IB grade 3 and stage II grade 3 relative to stage II grades 1–2 (5-year CSM: 18% and 23% vs. 10%; p<0.001 and p=0.003, respectively), while there was no difference between stage IB grade 3 and stage II grade 3 (p=0.618). BT had a local control benefit across all patients (p<0.001) that translated into a survival benefit in stage IB grade 3 (adjusted hazard ratio [HR] for CSM=0.47, p=0.003). EBRT had a survival benefit in stage II grade 3 (adjusted HR for CSM=0.36; p=0.031), as did lymph node dissection (p=0.015). Chemotherapy was not significantly correlated with CSM.
Conclusions
High-risk, early-stage endometrioid carcinoma is a heterogeneous population. BT was associated with a survival benefit in stage IB grade 3, whereas regional treatment with EBRT and lymphadenectomy was associated with a survival benefit in stage II grade 3.

Keyword

Endometrial Neoplasms; Brachytherapy; Radiotherapy; Adjuvant; Chemotherapy; Adjuvant; Medicare