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Adjuvant Chemotherapy With External BeamRadiation Therapy for High-Grade, Node-Positive Endometrial Cancer
  1. Larissa J. Lee, MD*,,
  2. Paula Bu, AB*,
  3. Colleen Feltmate, MD, and
  4. Akila N. Viswanathan, MD, MPH*,
  1. *Department of Radiation Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute;
  2. Harvard Medical School; and
  3. Department of Gynecologic Oncology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Boston, MA.
  1. Address correspondence and reprint requests to Larissa J. Lee, MD, Brigham Women’s Hospital, Department of Radiation Oncology,75 Francis St, ASB1-L2, Boston, MA.E-mail: llee{at}lroc.harvard.edu.

Abstract

Objective The objective of this study was to evaluate clinical outcomes including disease-free survival (DFS) and overall survival (OS) for women with node-positive, high-grade adenocarcinoma of the uterus.

Methods Database review identified 73 patients with International Federation of Gynecology and Obstetrics stage IIIC 1/2 grade 3 endometrial cancer diagnosed from 1995 to 2009. Study inclusion required total abdominal hysterectomy/bilateral salpingo-oophorectomy and negative chest imaging. Histologic subtypes were endometrioid (22, 30%), papillary serous (20, 27%), clear cell (9, 12%), mixed (21, 29%), and undifferentiated (1, 1%). Adjuvant treatment was chemotherapy with external beam radiation therapy (EBRT) in 55 patients (75%), EBRT alone in 14 (19%), chemotherapy in 2 (3%), and no adjuvant therapy in 2 (3%).

Results With a median follow-up of 50 months, DFS/OS rates at 5 years were 44%/53%, respectively. Intraperitoneal relapse was more common in patients with positive cytology (30% vs 6%, P = 0.02) and nonendometrioid histology (16% vs 4%, P = 0.3). By histologic subtype, 5-year DFS/OS rates were 59%/82% for grade 3 endometrioid, 25%/30% for serous, 22%/17% for clear cell, and 50%/51% for mixed histology (P = 0.1/P < 0.001). The 5-year DFS/OS rates were 56%/68% for those who received both chemotherapy and EBRT. Among patients treated with adjuvant EBRT, pelvic control was 93%.

Conclusions For node-positive, high-grade endometrial cancer, patients with endometrioid and mixed histologic subtypes had better clinical outcomes than did those with serous and clear cell cancers. Distinct patterns of relapse were observed with a greater risk of intraperitoneal failure for nonendometrioid histologic subtypes. Future studies are needed to define the optimal chemotherapy regimen and radiation fields.

  • Stage IIIC endometrial cancer
  • Node-positive endometrial cancer
  • High-grade endometrial cancer
  • Radiation therapy
  • Chemotherapy

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Footnotes

  • The authors declare no conflicts of interest.

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