Introduction/Background Endometrial cancer is largely a disease of older women. The incidence is increasing and age is a prognostic factor, with subsequent resource implications. Poorer outcomes may be due to biological factors and/or suboptimal treatment. Interestingly, PORTEC-3 indicates that high-risk women >70 years benefit from adjuvant chemoradiotherapy (5-year OS 67%). We investigated real-world outcomes of elderly women in West of Scotland Cancer Network (WoSCAN) who received pelvic external beam radiotherapy (PRT) for endometrial cancer.
Methodology Data were collected retrospectively from WoSCAN electronic clinical records in women 70 years who commenced PRT for endometrial cancer between January 2011 and December 2015. Statistical analysis was performed using R®. Overall survival (OS) was estimated using Kaplan-Meier method.
Results 93 patients were identified. The median age was 75 years (range 70–90); 28% >80years. Median number of co-morbidities was 2 (range 0–7). Treatment intent was as follows: adjuvant (60%), primary (inoperable) (21%), salvage (vault/pelvic recurrence) (19%). Only 30% had Stage 1 disease, over 25% had aggressive pathology. 90% completed all radiotherapy as planned (4500cGy/25# ± brachytherapy), 5% discontinued PRT and 5% completed PRT but defaulted from brachytherapy. 30-day mortality was 5%. Over 50% received chemotherapy. 5-year OS was 50%. Enhanced OS was associated with low-grade pathology, early stage and adjuvant/salvage intent; 5-year OS 55% (adjuvant/salvage) versus 20% (primary). OS was significantly worse in >80 cohort (25%) compared with 70–79 cohort (55%).
Conclusion Compliance with PRT for endometrial cancer in women >70 years is >90%. OS in adjuvant setting is slightly less favourable than PORTEC-3 but we included very elderly women, often with multiple medical co-morbidities. PRT is justified in patients aged 70–79 years. However, it may be appropriate to consider a more pragmatic approach in women >80 years, especially in the context of inoperable disease, as survival may not be sufficiently long to benefit from aggressive therapy.
Disclosure Nothing to disclose.
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