TY - JOUR
T1 - Adjuvant therapy for early stage, endometrial cancer with lymphovascular space invasion
T2 - Is there a role for chemotherapy?
AU - Beavis, Anna L.
AU - Yen, Ting Tai
AU - Stone, Rebecca L.
AU - Wethington, Stephanie L.
AU - Carr, Caitlin
AU - Son, Ji
AU - Chambers, Laura
AU - Michener, Chad M.
AU - Ricci, Stephanie
AU - Burkett, Wesley C.
AU - Richardson, Debra L.
AU - Staley, Allison Stuart
AU - Ahn, Susie
AU - Gehrig, Paola A.
AU - Torres, Diogo
AU - Dowdy, Sean C.
AU - Sullivan, Mackenzie W.
AU - Modesitt, Susan C.
AU - Watson, Catherine
AU - Veade, Ashely
AU - Ehrisman, Jessie
AU - Havrilesky, Laura
AU - Secord, Angeles Alvarez
AU - Loreen, Amy
AU - Griffin, Kaitlyn
AU - Jackson, Amanda
AU - Viswanathan, Akila N.
AU - Jager, Leah R.
AU - Fader, Amanda N.
N1 - Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/3
Y1 - 2020/3
N2 - Objectives: Lymphovascular space invasion (LVSI) is an independent risk factor for recurrence and poor survival in early-stage endometrioid endometrial cancer (EEC), but optimal adjuvant treatment is unknown. We aimed to compare the survival of women with early-stage EEC with LVSI treated postoperatively with observation (OBS), radiation (RAD, external beam and/or vaginal brachytherapy), or chemotherapy (CHEMO)+/−RAD. Methods: This was a multi-institutional, retrospective cohort study of women with stage I or II EEC with LVSI who underwent hysterectomy+/−lymphadenectomy from 2005 to 2015 and received OBS, RAD, or CHEMO+/−RAD postoperatively. Progression-free survival and overall survival were evaluated using Kaplan-Meier estimates and Cox proportional hazards models. Results: In total, 478 women were included; median age was 64 years, median follow-up was 50.3 months. After surgery, 143 (30%) underwent OBS, 232 (48.5%) received RAD, and 103(21.5%) received CHEMO+/−RAD (95% of whom received RAD). Demographics were similar among groups, but those undergoing OBS had lower stage and grade. A total of 101 (21%) women recurred. Progression-free survival (PFS) was improved in both CHEMO+/−RAD (HR = 0.18, 95% CI: 0.09–0.39) and RAD (HR = 0.31, 95% CI: 0.18–0.54) groups compared to OBS, though neither adjuvant therapy was superior to the other. However, in grade 3 tumors, the CHEMO+/−RAD group had superior PFS compared to both RAD (HR 0.25; 95% CI: 0.12–0.52) and OBS cohorts (HR = 0.10, 95% CI: 0.03–0.32). Overall survival did not differ by treatment. Conclusions: In early-stage EEC with LVSI, adjuvant therapy improved PFS compared to observation alone. In those with grade 3 EEC, adjuvant chemotherapy with or without radiation improved PFS compared to observation or radiation alone.
AB - Objectives: Lymphovascular space invasion (LVSI) is an independent risk factor for recurrence and poor survival in early-stage endometrioid endometrial cancer (EEC), but optimal adjuvant treatment is unknown. We aimed to compare the survival of women with early-stage EEC with LVSI treated postoperatively with observation (OBS), radiation (RAD, external beam and/or vaginal brachytherapy), or chemotherapy (CHEMO)+/−RAD. Methods: This was a multi-institutional, retrospective cohort study of women with stage I or II EEC with LVSI who underwent hysterectomy+/−lymphadenectomy from 2005 to 2015 and received OBS, RAD, or CHEMO+/−RAD postoperatively. Progression-free survival and overall survival were evaluated using Kaplan-Meier estimates and Cox proportional hazards models. Results: In total, 478 women were included; median age was 64 years, median follow-up was 50.3 months. After surgery, 143 (30%) underwent OBS, 232 (48.5%) received RAD, and 103(21.5%) received CHEMO+/−RAD (95% of whom received RAD). Demographics were similar among groups, but those undergoing OBS had lower stage and grade. A total of 101 (21%) women recurred. Progression-free survival (PFS) was improved in both CHEMO+/−RAD (HR = 0.18, 95% CI: 0.09–0.39) and RAD (HR = 0.31, 95% CI: 0.18–0.54) groups compared to OBS, though neither adjuvant therapy was superior to the other. However, in grade 3 tumors, the CHEMO+/−RAD group had superior PFS compared to both RAD (HR 0.25; 95% CI: 0.12–0.52) and OBS cohorts (HR = 0.10, 95% CI: 0.03–0.32). Overall survival did not differ by treatment. Conclusions: In early-stage EEC with LVSI, adjuvant therapy improved PFS compared to observation alone. In those with grade 3 EEC, adjuvant chemotherapy with or without radiation improved PFS compared to observation or radiation alone.
KW - Adjuvant treatment
KW - Chemotherapy
KW - Endometrial cancer
KW - Lymphovascular space invasion
KW - Radiation
KW - Uterine cancer
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UR - http://www.scopus.com/inward/citedby.url?scp=85077931918&partnerID=8YFLogxK
U2 - 10.1016/j.ygyno.2019.12.028
DO - 10.1016/j.ygyno.2019.12.028
M3 - Article
C2 - 31948730
AN - SCOPUS:85077931918
SN - 0090-8258
VL - 156
SP - 568
EP - 574
JO - Gynecologic oncology
JF - Gynecologic oncology
IS - 3
ER -