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Treatment outcomes of endometrial cancer patients with paraaortic lymph node metastasis: a multi-institutional analysis
  1. Cem Onal1,
  2. Berna Akkus Yildirim1,
  3. Sezin Yuce Sari2,
  4. Guler Yavas3,
  5. Melis Gultekin2,
  6. Ozan Cem Guler1,
  7. Ferah Yildiz2 and
  8. Serap Akyurek4
  1. 1 Department of Radiation Oncology, Başkent University Faculty of Medicine, Adana Dr Turgut Noyan Research and Treatment Center, Adana, Turkey
  2. 2 Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
  3. 3 Department of Radiation Oncology, Selcuk University Faculty of Medicine, Konya, Turkey
  4. 4 Department of Radiation Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
  1. Correspondence to Cem Onal, Department of Radiation Oncology, Baskent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Treatment Center, Adana 01120, Turkey; hcemonal{at}hotmail.com

Abstract

Objective To analyze the prognostic factors and treatment outcomes in endometrial cancer patients with paraaortic lymph node metastasis.

Methods Data from four centers were collected retrospectively for 92 patients with endometrial cancer treated with combined radiotherapy and chemotherapy or adjuvant radiotherapy alone postoperatively, delivered by either the sandwich or sequential method. Prognostic factors affecting overall survival and progression-free survival were analyzed.

Results The 5-year overall survival and progression-free survival rates were 35 % and 33 %, respectively, after a median follow-up time of 33 months. The 5-year overall survival and progression-free survival rates were significantly higher in patients receiving radiotherapy and chemotherapy postoperatively compared with patients treated with adjuvant radiotherapy alone (P < 0.001 and P < 0.001, respectively). In a subgroup analysis of patients treated with adjuvant combined chemotherapy and radiotherapy, the 5-year overall survival and progression-free survival rates were significantly higher in patients receiving chemotherapy and radiotherapy via the sandwich method compared with patients treated with sequential chemotherapy and radiotherapy (P = 0.02 and P = 0.03, respectively). In the univariate analysis, in addition to treatment strategy, pathology, depth of myometrial invasion, and tumor grade were significant prognostic factors for both overall survival and progression-free survival. In the multivariate analysis, grade III disease, myometrial invasion greater than or equal to 50%, and adjuvant radiotherapy alone were negative predictors for both overall survival and progression-free survival.

Conclusion We demonstrated that adjuvant combined treatment including radiotherapyand chemotherapy significantly increases overall survival and progression-free survival rates compared with postoperative pelvic and paraaortic radiotherapy.

  • endometrial cancer
  • radiotherapy
  • chemotherapy
  • lymph node metastasis
  • paraaortic lymph node
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Footnotes

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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