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Adjuvant Carboplatin, Paclitaxel, and Vaginal Cuff Brachytherapy for Stage III Endometrial Cancer: Analysis of Outcomes and Patterns of Recurrence Based on Pathologic Characteristics
  1. Melissa Rasar Young, MD, PhD*,
  2. Susan A. Higgins, MD*,
  3. Elena Ratner, MD,
  4. James B. Yu, MD*,
  5. Sheida Mani, MD*,
  6. Dan-Arin Silasi, MD,
  7. Masoud Azodi, MD,
  8. Thomas Rutherford, MD, PhD,
  9. Peter E. Schwartz, MD and
  10. Shari Damast, MD*
  1. *Department of Therapeutic Radiology, and
  2. Department of Gynecologic Oncology, Yale University School of Medicine, New Haven, CT.
  1. Address correspondence reprint requests to Melissa Rasar Young, MD, PhD, Department of Therapeutic Radiology, Yale University School of Medicine, 35 Park St LL509, New Haven, CT 06510. E-mail:


Objective The aim of this study was to evaluate outcomes of patients with stage III endometrial adenocarcinoma treated with surgery followed by adjuvant chemotherapy and vaginal cuff brachytherapy.

Methods We retrospectively identified 83 patients treated for 1988 International Federation of Gynecology and Obstetrics (FIGO) stage III endometrial adenocarcinoma at our institution between 2003 and 2010. All patients underwent comprehensive surgical staging. Adjuvant therapy was carboplatin and paclitaxel for 6 cycles and vaginal cuff brachytherapy. For analysis, patients were grouped into type I (FIGO grade 1–2 endometrioid histology, n = 41) or type II (FIGO grade 3, clear cell or papillary serous histology, n = 42) disease. Forty-three patients (52%) had node-positive disease, with similar node-positive rates for type I (n = 21, 51.2%) and type II (n = 22, 52.4%).

Results The median follow-up was 38.6 months. There were no isolated vaginal failures. The estimated 3-year disease-free survival (DFS) and overall survival (OS) for type I versus type II were 92.4% versus 58.0% (P = 0.001) and 97.2% versus 65.8% (P = 0.002), respectively. The 3-year DFS and OS for node negative versus node positive were 85.0% versus 63.6% (P = 0.02) and 84.2% versus 78.0% (P = 0.02), respectively. Associations between type I histology and node-negative disease with improved DFS and OS persisted on multivariate analysis.

Conclusions Our institutional approach of adjuvant chemotherapy and vaginal cuff brachytherapy for stage III endometrial cancer seemed acceptable for patients with low-risk histology or node-negative disease. In contrast, higher rates of failure among those with high-risk histology and/or node-positive disease support intensification of therapy in these subsets.

  • Endometrial cancer
  • Adenocarcinoma
  • Vaginal cuff brachytherapy
  • Carboplatin
  • Paclitaxel

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  • The authors declare no conflicts of interest.