TY - JOUR
T1 - Adjuvant therapy for grade 3, deeply invasive endometrioid adenocarcinoma of the uterus
AU - Onstad, Michaela
AU - Ducie, Jennifer
AU - Fellman, Bryan M.
AU - Abu-Rustum, Nadeem R.
AU - Leitao, Mario
AU - Mariani, Andrea
AU - Multinu, Francesco
AU - Lu, Karen H.
AU - Soliman, Pamela
N1 - Funding Information:
Grant P30 CA016672), the NCI SPORE in Uterine Cancer (2P50 CA098258-06), and a T32 training grant for gynecologic oncology (CA101642). ML and NRA-R are supported in part by the NIH/NCI MSK Cancer Center Support Grant P30CA008748.
Funding Information:
Funding This work was supported in part by Cancer Center Support Grant (NCI
Publisher Copyright:
© 2020 IGCS and ESGO. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2020/4/1
Y1 - 2020/4/1
N2 - Background Patients with grade 3, deeply invasive endometrioid adenocarcinoma are typically managed with primary surgery. The role and type of adjuvant therapy used is controversial. We sought to evaluate the role of adjuvant radiation and/or chemotherapy in women with deeply invasive grade 3 endometrioid tumors. Methods A multi-center retrospective chart review was performed at three large medical institutions in the United States. Patients with grade 3 endometrioid adenocarcinoma invading >50% of the myometrium were included. Medical records were queried to evaluate whether lymph node assessment was performed, the status of the lymph nodes, adjuvant treatment strategy used, and dates of death or recurrence. Results Between 1984 and 2013, 257 patients were identified with a median follow-up of 3.08 years. Most patients (84.7%) had evaluation of pelvic and/or para-aortic lymph nodes and 43% had positive lymph nodes. For node negative patients, there was no difference in overall survival (OS) between those who received adjuvant pelvic radiation +/-vaginal brachytherapy (n=52) vs brachytherapy alone (n=46) (5-year probabilities were 0.73 vs 0.70, P=0.729). Among patients with positive lymph nodes (n=92), the adjuvant treatment strategy utilized impacted OS, with women undergoing a combination of chemotherapy and external beam radiation having the best outcomes (P=0.003). Conclusions Among women with grade 3, deeply invasive endometrioid adenocarcinoma, vaginal cuff brachytherapy alone resulted in similar survival when compared with pelvic radiation in node negative patients. The combination of chemotherapy with external beam radiation was associated with improved OS for women with positive nodes.
AB - Background Patients with grade 3, deeply invasive endometrioid adenocarcinoma are typically managed with primary surgery. The role and type of adjuvant therapy used is controversial. We sought to evaluate the role of adjuvant radiation and/or chemotherapy in women with deeply invasive grade 3 endometrioid tumors. Methods A multi-center retrospective chart review was performed at three large medical institutions in the United States. Patients with grade 3 endometrioid adenocarcinoma invading >50% of the myometrium were included. Medical records were queried to evaluate whether lymph node assessment was performed, the status of the lymph nodes, adjuvant treatment strategy used, and dates of death or recurrence. Results Between 1984 and 2013, 257 patients were identified with a median follow-up of 3.08 years. Most patients (84.7%) had evaluation of pelvic and/or para-aortic lymph nodes and 43% had positive lymph nodes. For node negative patients, there was no difference in overall survival (OS) between those who received adjuvant pelvic radiation +/-vaginal brachytherapy (n=52) vs brachytherapy alone (n=46) (5-year probabilities were 0.73 vs 0.70, P=0.729). Among patients with positive lymph nodes (n=92), the adjuvant treatment strategy utilized impacted OS, with women undergoing a combination of chemotherapy and external beam radiation having the best outcomes (P=0.003). Conclusions Among women with grade 3, deeply invasive endometrioid adenocarcinoma, vaginal cuff brachytherapy alone resulted in similar survival when compared with pelvic radiation in node negative patients. The combination of chemotherapy with external beam radiation was associated with improved OS for women with positive nodes.
KW - endometrial neoplasms
KW - lymph nodes
KW - pathology
KW - radiotherapy
UR - http://www.scopus.com/inward/record.url?scp=85078406321&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85078406321&partnerID=8YFLogxK
U2 - 10.1136/ijgc-2019-000807
DO - 10.1136/ijgc-2019-000807
M3 - Article
C2 - 31980487
AN - SCOPUS:85078406321
SN - 1048-891X
VL - 30
SP - 480
EP - 484
JO - International Journal of Gynecological Cancer
JF - International Journal of Gynecological Cancer
IS - 4
ER -