Cancer Res Treat.  2015 Apr;47(2):298-305. 10.4143/crt.2014.038.

Postoperative Radiotherapy Alone Versus Chemoradiotherapy in Stage I-II Endometrial Carcinoma: An Investigational and Propensity Score Matching Analysis

• Lee JH
• Lee HC
• Kim SH
• Chung MJ
• Jeong SM
• Lee SJ
• Yoon JH
• Park DC

• KMID: 2132809
• DOI: http://doi.org/10.4143/crt.2014.038

Abstract

PURPOSE
The purpose of this study was to compare the results of postoperative adjuvant radiotherapy (RT) and concurrent chemoradiotherapy (CRT) in stage I-II endometrial carcinoma.
MATERIALS AND METHODS
We analyzed a total of 64 patients with surgically staged I-II endometrial carcinoma who were treated with postoperative adjuvant RT or concurrent CRT between March 1999 and July 2013. Thirty-two patients who received postoperative RT alone were matched with those who received postoperative CRT (n=32) in accordance to age, stage, and tumor histology. Overall survival and relapse-free survival, as well as toxicity of the RT and CRT arms were evaluated and compared.
RESULTS
The 5-year overall survival rate was 90.0% for the RT arm and 91.6% for the CRT arm. There was no significant difference in overall survival between the two treatment arms (p=0.798). The 5-year relapse-free survival rate was 87.2% in the RT arm and 88.0% in the CRT arm. Again, no significant difference in relapse-free survival was seen between the two arms (p=0.913). In a multivariate analysis, tumor histology was an independent prognostic factor for relapse-free survival (hazard ratio, 3.67; 95% of CI, 2.34 to 7.65; p=0.045). Acute grade 3 or 4 hematologic toxicities in the CRT arm were significantly higher than in the RT alone arm (6.2% vs. 31.2%, p=0.010).
CONCLUSION
Adjuvant pelvic concurrent chemoradioherapy did not show superior results in overall survival and relapse-free survival compared to RT alone in stage I-II endometrial carcinoma.

Keyword

Chemotherapy; Endometrial neoplasms; Radiotherapy

MeSH Terms

Arm
Chemoradiotherapy*
Drug Therapy
Endometrial Neoplasms*
Female
Humans
Multivariate Analysis
Propensity Score*
Radiotherapy*
Radiotherapy, Adjuvant
Survival Rate

Figure

• 

  Fig. 1. A) 5-Year overall survival of the postoperative chemoradiotherapy (CRT) arm is not significantly higher than the postoperative radiotherapy (RT) alone arm (91.6% vs. 90%, p=0.798). (B) 5-Year relapse-free survival of the postoperative chemoradiotherapy arm is not significantly higher than the postoperative radiotherapy alone arm (88.0% vs. 87.2%, p=0.913).

• 

  Fig. 2. Relapse-free survival according to the tumor histology is shown. Endometrial cancer patients with high-grade histology has significantly lower 5-year relapse-free survival than patients with low-grade histology (66.6% vs. 91.5%, p=0.034).

Reference

References

1. Jung KW, Won YJ, Kong HJ, Oh CM, Seo HG, Lee JS. Cancer statistics in Korea: incidence, mortality, survival and prevalence in 2010. Cancer Res Treat. 2013; 45:1–14.

2. Malzoni M, Tinelli R, Cosentino F, Perone C, Rasile M, Iuzzolino D, et al. Total laparoscopic hysterectomy versus abdominal hysterectomy with lymphadenectomy for earlystage endometrial cancer: a prospective randomized study. Gynecol Oncol. 2009; 112:126–33.

3. Elshaikh MA, Vance S, Suri JS, Mahan M, Munkarah A. Improved survival endpoints with adjuvant radiation treatment in patients with high-risk early-stage endometrial carcinoma. Int J Radiat Oncol Biol Phys. 2014; 88:351–6.

4. ASTEC/EN.5 Study Group, Blake P, Swart AM, Orton J, Kitchener H, Whelan T, et al. Adjuvant external beam radiotherapy in the treatment of endometrial cancer (MRC ASTEC and NCIC CTG EN.5 randomised trials): pooled trial results, systematic review, and meta-analysis. Lancet. 2009; 373:137–46.

5. Creutzberg CL, van Putten WL, Koper PC, Lybeert ML, Jobsen JJ, Warlam-Rodenhuis CC, et al. Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC Study Group. Post Operative Radiation Therapy in Endometrial Carcinoma. Lancet. 2000; 355:1404–11.

6. Scholten AN, van Putten WL, Beerman H, Smit VT, Koper PC, Lybeert ML, et al. Postoperative radiotherapy for Stage 1 endometrial carcinoma: long-term outcome of the randomized PORTEC trial with central pathology review. Int J Radiat Oncol Biol Phys. 2005; 63:834–8.

7. Keys HM, Roberts JA, Brunetto VL, Zaino RJ, Spirtos NM, Bloss JD, et al. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2004; 92:744–51.

8. Aalders J, Abeler V, Kolstad P, Onsrud M. Postoperative external irradiation and prognostic parameters in stage I endometrial carcinoma: clinical and histopathologic study of 540 patients. Obstet Gynecol. 1980; 56:419–27.

9. Susumu N, Sagae S, Udagawa Y, Niwa K, Kuramoto H, Satoh S, et al. Randomized phase III trial of pelvic radiotherapy versus cisplatin-based combined chemotherapy in patients with intermediate- and high-risk endometrial cancer: a Japanese Gynecologic Oncology Group study. Gynecol Oncol. 2008; 108:226–33.

10. Maggi R, Lissoni A, Spina F, Melpignano M, Zola P, Favalli G, et al. Adjuvant chemotherapy vs radiotherapy in high-risk endometrial carcinoma: results of a randomised trial. Br J Cancer. 2006; 95:266–71.

11. Randall ME, Filiaci VL, Muss H, Spirtos NM, Mannel RS, Fowler J, et al. Randomized phase III trial of whole-abdominal irradiation versus doxorubicin and cisplatin chemotherapy in advanced endometrial carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol. 2006; 24:36–44.

12. Mundt AJ, McBride R, Rotmensch J, Waggoner SE, Yamada SD, Connell PP. Significant pelvic recurrence in high-risk pathologic stage I--IV endometrial carcinoma patients after adjuvant chemotherapy alone: implications for adjuvant radiation therapy. Int J Radiat Oncol Biol Phys. 2001; 50:1145–53.

13. Creutzberg CL, Nout RA. The role of radiotherapy in endometrial cancer: current evidence and trends. Curr Oncol Rep. 2011; 13:472–8.

14. Anderson JM, Stea B, Hallum AV, Rogoff E, Childers J. High-dose-rate postoperative vaginal cuff irradiation alone for stage IB and IC endometrial cancer. Int J Radiat Oncol Biol Phys. 2000; 46:417–25.

15. Kuoppala T, Maenpaa J, Tomas E, Puistola U, Salmi T, Grenman S, et al. Surgically staged high-risk endometrial cancer: randomized study of adjuvant radiotherapy alone vs. sequential chemo-radiotherapy. Gynecol Oncol. 2008; 110:190–5.

16. Klopp AH, Jhingran A, Ramondetta L, Lu K, Gershenson DM, Eifel PJ. Node-positive adenocarcinoma of the endometrium: outcome and patterns of recurrence with and without external beam irradiation. Gynecol Oncol. 2009; 115:6–11.

17. Hogberg T, Signorelli M, de Oliveira CF, Fossati R, Lissoni AA, Sorbe B, et al. Sequential adjuvant chemotherapy and radiotherapy in endometrial cancer: results from two randomised studies. Eur J Cancer. 2010; 46:2422–31.

18. ClinicalTrials.gov. Randomized trial of radiation therapy with or without chemotherapy for endometrial cancer (PORTEC-3) [Internet]. Bethesda: US National Institute of Health;2006. [cited 2014 Sep 10]. Available from: http://clinicaltrials.gov/show/NCT00411138.

19. Morrow CP, Bundy BN, Kurman RJ, Creasman WT, Heller P, Homesley HD, et al. Relationship between surgicalpathological risk factors and outcome in clinical stage I and II carcinoma of the endometrium: a Gynecologic Oncology Group study. Gynecol Oncol. 1991; 40:55–65.

20. Zaino RJ, Kurman RJ, Diana KL, Morrow CP. Pathologic models to predict outcome for women with endometrial adenocarcinoma: the importance of the distinction between surgical stage and clinical stage: a Gynecologic Oncology Group study. Cancer. 1996; 77:1115–21.

21. Greven KM, Corn BW, Case D, Purser P, Lanciano RM. Which prognostic factors influence the outcome of patients with surgically staged endometrial cancer treated with adjuvant radiation? Int J Radiat Oncol Biol Phys. 1997; 39:413–8.

22. Irwin C, Levin W, Fyles A, Pintilie M, Manchul L, Kirkbride P. The role of adjuvant radiotherapy in carcinoma of the endometrium-results in 550 patients with pathologic stage I disease. Gynecol Oncol. 1998; 70:247–54.

23. Yalman D, Ozsaran Z, Anacak Y, Celik OK, Ozkok S, Ozsaran A, et al. Postoperative radiotherapy in endometrial carcinoma: analysis of prognostic factors in 440 cases. Eur J Gynaecol Oncol. 2000; 21:311–5.

24. Yu M, Lee JH, Jang HS, Jeon DM, Cheon JS, Lee HC, et al. A comparison of dosimetric parameters between tomotherapy and three-dimensional conformal radiotherapy in rectal cancer. Radiat Oncol. 2013; 8:181.

25. Yu M, Jang HS, Jeon DM, Cheon GS, Lee HC, Chung MJ, et al. Dosimetric evaluation of Tomotherapy and four-box field conformal radiotherapy in locally advanced rectal cancer. Radiat Oncol J. 2013; 31:252–9.