Adjuvant Pelvic Radiation Therapy±Vaginal Brachytherapy in Patients With High-risk Stage I or Stage II Uterine Papillary Serous, Clear Cell, and High-grade Endometrioid Carcinoma. (August 2016)

• Record Type: Journal Article
• Authors: Nagar, Himanshu; Yan, Weisi; Parashar, Bhupesh; Nori, Dattatreyudu; Chao, K.S.C.; Christos, Paul; Gupta, Divya; Holcomb, Kevin; Caputo, Thomas; Wernicke, A. Gabriella
• Is Part Of: American journal of clinical oncology. Volume 39:Number 4(2016)
• Publication Date: 2016-08
• Subjects: EBRT -- brachytherapy -- high-grade endometrial cancer; Cancer -- Treatment -- Periodicals; Oncology -- Periodicals; Tumors -- Periodicals; 616.994005
• DOI: 10.1097/COC.0000000000000065
• Languages: English
• ISSNs: 0277-3732

Abstract

Abstract : Purpose: Radiation therapy (RT) for stages I-II uterine papillary serous carcinoma (UPSC), clear cell (CC), and high-grade endometrioid (HGE) carcinoma present a treatment challenge. Regimens include external beam radiotherapy (EBRT) with or without brachytherapy. We examine the use of these radiation modalities in these endometrial cancers (EC) with respect to cause-specific survival (CSS). Methods: The Surveillance, Epidemiology, and End Results (SEER) database was queried for patients with AJCC stages I-II UPSC, CC, or HGE cancer treated with hysterectomy and RT between 1998 and 2008. Patients who did not receive adjuvant RT or received brachytherapy alone were excluded. CSS was evaluated by the Kaplan-Meier survival analysis and the log-rank test was used to compare CSS. Multivariate analysis was performed using the Cox proportional hazards regression model. Adjusted hazard ratios (HR) were calculated for risk of EC death. Results: There were 1653 patients included in this analysis. The overall 100-month CSS for the entire cohort was 81.0%. The 100-month CSS was 85.3% for EBRT alone and 86.5% for EBRT+brachytherapy ( P =0.72). Stage IC/IIA/IIB patients had a greater risk of EC death compared with stage IA/IB patients (adjusted HR=2.39; P <0.0001). Patients with UPSC and CC had a slightly higher risk of EC death compared with HGE (adjusted HR=1.01 [ P =0.97] and 1.42 [ P =0.02], respectively). On subset analysis, there was no difference in CSS with the addition of brachytherapy for UPSC ( P =0.37), CC ( P =0.27), or HGE cancer patients ( P =0.42). Patients treated with brachytherapy in addition to EBRT did not demonstrate a reduced adjusted risk of EC death compared with EBRT alone ( P =0.38). Conclusions: The addition of brachytherapy to adjuvant EBRT in stages I-II UPSC, CC, and HGE cancer did not demonstrate superior CSS. Thus, patients may not benefit from the addition of brachytherapy to EBRT.