Cancer Res Treat.  2016 Jul;48(3):1074-1083. 10.4143/crt.2015.356.

Adjuvant Treatment after Surgery in Stage IIIA Endometrial Adenocarcinoma

Affiliations
  • 1Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea.
  • 2Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. wonro.park@samsung.com
  • 3Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea.
  • 4Department of Radiation Oncology, Asan Medical Center, Seoul, Korea.
  • 5Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea.
  • 6Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
  • 7Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
  • 8Department of Radiation Oncology, Inha University School of Medicine, Incheon, Korea.
  • 9Department of Radiation Oncology, Yonsei University Wonju College of Medicine, Wonju, Korea.
  • 10Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
  • 11Department of Radiation Oncology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea.
  • 12Department of Radiation Oncology Korea University College of Medicine, Seoul, Korea.
  • 13Department of Radiation Oncology, Chung-Ang University Hospital, Seoul, Korea.
  • 14Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea.
  • 15Department of Radiation Oncology, Dong-A University School of Medicine, Busan, Korea.
  • 16Department of Radiation Oncology, University of Wonkwang School of Medicine, Iksan, Korea.
  • 17Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.
  • 18Department of Radiation Oncology, CHA Bundang Medical Center, CHA University, Seongnam, Korea. skc6603@chamc.co.kr

Abstract

PURPOSE
We evaluated the role of adjuvant therapy in stage IIIA endometrioid adenocarcinoma patients who underwent surgery followed by radiotherapy (RT) alone or chemoradiotherapy (CTRT) according to risk group.
MATERIALS AND METHODS
A multicenter retrospective study was conducted including patients with surgical stage IIIA endometrial cancertreated by radical surgery and adjuvant RT or CTRT. Disease-free survival (DFS) and overall survival (OS) were analyzed.
RESULTS
Ninety-three patients with stage IIIA disease were identified. Nineteen patients (20.4%) experienced recurrence, mostly distant metastasis (17.2%). Combined CTRT did not affect DFS (74.1% vs. 82.4%, p=0.130) or OS (96.3% vs. 91.9%, p=0.262) in stage IIIA disease compared with RT alone. Patients with age ≥ 60 years, grade G2/3, and lymphovascular space involvement had a significantly worse DFS and those variables were defined as risk factors. The high-risk group showed a significant reduction in 5-year DFS (≥ 2 risk factors) (49.0% vs. 88.0%, p < 0.001) compared with the low-risk group (< 2). Multivariate analysis confirmed that more than one risk factor was the only predictor of worse DFS (hazard ratio, 5.45; 95% confidence interval, 2.12 to 13.98; p < 0.001). Of patients with no risk factors, a subset treated with RT alone showed an excellent 5-year DFS and OS (93.8% and 100%, respectively).
CONCLUSION
We identified a low-risk subset of stage IIIA endometrioid adenocarcinoma patients who might be reasonable candidates for adjuvant RT alone. Further randomized studies are needed to determine which subset might benefit from combined CTRT.

Keyword

Endometrial neoplasms; Adjuvant radiotherapy; Adjuvant chemoradiotherapy
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