TY - JOUR
T1 - Adjuvant external radiation impacts outcome of pelvis-limited stage III endometrial carcinoma
T2 - A multi-institutional study
AU - Albuquerque, Kevin
AU - Folkert, Michael
AU - Mayadev, Jyoti
AU - Christie, Alana
AU - Liotta, Margaret R.
AU - Nagel, Christa
AU - Sevak, Parag
AU - Harkenrider, Matthew M.
AU - Lea, Jayanthi S.
AU - Hanna, Rabbie K.
AU - Small, William C.
AU - Miller, David S.
AU - Xie, Xian Jin
AU - Potkul, Ronald K.
AU - Elshaikh, Mohamed A.
N1 - Publisher Copyright:
© 2018 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2018/8/1
Y1 - 2018/8/1
N2 - Background: Adjuvant therapy choice for women with FIGO stage III endometrial carcinoma (EC) is controversial. We investigate the comparative benefit of adjuvant chemotherapy (CT) alone, radiation therapy alone (RT) or in combination (chemotherapy and radiation therapy [CRT]) with respect to recurrence-free survival (RFS) and overall survival (OS) in women with pelvis-limited (PL) EC (stage IIIA, IIIB, and IIIC1). Materials and Methods: A multi-institutional database of 270 surgically staged women with PLEC was analyzed. Univariate log-rank analyses and Cox regression multivariate analyses (MVA) were performed to identify factors associated with RFS and OS. Results: Median RFS and OS were 112 and 130 months, respectively, for the full cohort. Adjuvant treatment was CT in 21%, RT in 27%, and CRT in 47%. Age, year of treatment, grade, histology, and adjuvant treatment were significantly associated with RFS and OS on univariate analysis. PLEC patients receiving CT alone fared worse in terms of RFS (P = 0.07 relative to RT and <0.01 relative to CRT). On MVA, CRT retained significantly improved RFS relative to CT (hazard ratio for recurrence 0.38, P < 0.01). PLEC patients receiving RT or CRT had improved OS compared with CT, P < 0.01 and 0.03, respectively. On MVA, both RT only and CRT retained association with improved OS relative to CT alone (hazard ratio for death, 0.43, P = 0.02 and 0.40, P < 0.01, respectively). Conclusions: For surgically staged PL stage III EC, treatment regimens incorporating RT were associated with improved survival endpoints relative to CT alone. As such, RT should be considered an important component in the adjuvant management of stage III PLEC.
AB - Background: Adjuvant therapy choice for women with FIGO stage III endometrial carcinoma (EC) is controversial. We investigate the comparative benefit of adjuvant chemotherapy (CT) alone, radiation therapy alone (RT) or in combination (chemotherapy and radiation therapy [CRT]) with respect to recurrence-free survival (RFS) and overall survival (OS) in women with pelvis-limited (PL) EC (stage IIIA, IIIB, and IIIC1). Materials and Methods: A multi-institutional database of 270 surgically staged women with PLEC was analyzed. Univariate log-rank analyses and Cox regression multivariate analyses (MVA) were performed to identify factors associated with RFS and OS. Results: Median RFS and OS were 112 and 130 months, respectively, for the full cohort. Adjuvant treatment was CT in 21%, RT in 27%, and CRT in 47%. Age, year of treatment, grade, histology, and adjuvant treatment were significantly associated with RFS and OS on univariate analysis. PLEC patients receiving CT alone fared worse in terms of RFS (P = 0.07 relative to RT and <0.01 relative to CRT). On MVA, CRT retained significantly improved RFS relative to CT (hazard ratio for recurrence 0.38, P < 0.01). PLEC patients receiving RT or CRT had improved OS compared with CT, P < 0.01 and 0.03, respectively. On MVA, both RT only and CRT retained association with improved OS relative to CT alone (hazard ratio for death, 0.43, P = 0.02 and 0.40, P < 0.01, respectively). Conclusions: For surgically staged PL stage III EC, treatment regimens incorporating RT were associated with improved survival endpoints relative to CT alone. As such, RT should be considered an important component in the adjuvant management of stage III PLEC.
KW - Combined adjuvant chemotherapy and radiation therapy
KW - endometrioid adenocarcinoma
KW - external radiation therapy
KW - monotherapy
KW - pelvis-limited stage III endometrial cancer
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UR - http://www.scopus.com/inward/citedby.url?scp=85013427563&partnerID=8YFLogxK
U2 - 10.1097/COC.0000000000000371
DO - 10.1097/COC.0000000000000371
M3 - Article
C2 - 28225446
AN - SCOPUS:85013427563
SN - 0277-3732
VL - 41
SP - 792
EP - 796
JO - American Journal of Clinical Oncology: Cancer Clinical Trials
JF - American Journal of Clinical Oncology: Cancer Clinical Trials
IS - 8
ER -