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Adjuvant therapy for grade 3, deeply invasive endometrioid adenocarcinoma of the uterus
  1. Michaela Onstad1,
  2. Jennifer Ducie2,
  3. Bryan M Fellman3,
  4. Nadeem R Abu-Rustum2,
  5. Mario Leitao2,
  6. Andrea Mariani4,
  7. Francesco Multinu5,
  8. Karen H Lu1 and
  9. Pamela Soliman1
  1. 1 Gynecologic Oncology & Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  2. 2 Memorial Sloan Kettering Cancer Center, New York City, New York, USA
  3. 3 Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  4. 4 Gynecologic Surgery, Mayo Clinic, Rochester, New York, USA
  5. 5 Istituto Europeo di Oncologia, Milan, Italy
  1. Correspondence to Dr Michaela Onstad, Gynecologic Oncology & Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; maonstad{at}


Background Patients with grade 3, deeply invasive endometrioid adenocarcinoma are typically managed with primary surgery. The role and type of adjuvant therapy used is controversial. We sought to evaluate the role of adjuvant radiation and/or chemotherapy in women with deeply invasive grade 3 endometrioid tumors.

Methods A multi-center retrospective chart review was performed at three large medical institutions in the United States. Patients with grade 3 endometrioid adenocarcinoma invading >50% of the myometrium were included. Medical records were queried to evaluate whether lymph node assessment was performed, the status of the lymph nodes, adjuvant treatment strategy used, and dates of death or recurrence.

Results Between 1984 and 2013, 257 patients were identified with a median follow-up of 3.08 years. Most patients (84.7%) had evaluation of pelvic and/or para-aortic lymph nodes and 43% had positive lymph nodes. For node negative patients, there was no difference in overall survival (OS) between those who received adjuvant pelvic radiation +/- vaginal brachytherapy (n=52) vs brachytherapy alone (n=46) (5-year probabilities were 0.73 vs 0.70, P=0.729). Among patients with positive lymph nodes (n=92), the adjuvant treatment strategy utilized impacted OS, with women undergoing a combination of chemotherapy and external beam radiation having the best outcomes (P=0.003).

Conclusions Among women with grade 3, deeply invasive endometrioid adenocarcinoma, vaginal cuff brachytherapy alone resulted in similar survival when compared with pelvic radiation in node negative patients. The combination of chemotherapy with external beam radiation was associated with improved OS for women with positive nodes.

  • endometrial neoplasms
  • radiotherapy
  • lymph nodes
  • pathology

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  • Twitter @maonstad, @leitaomd, @Fmultinu, @PamSolimanMD

  • Presented at This work was presented as a poster at the Society of Gynecologic Oncology Annual Meeting in 2015 in San Diego, California and as an oral presentation at the Western Association of Gynecologic Oncologists Annual Meeting in 2017 in Rancho Mirage, California.

  • Contributors Study conception and design: PS, AM, KHL, ML, MO. Acquisition of data: MO, JD, FM. Analysis and interpretation of data: BMF, MO, PS, AM, ML, NRA-R. Drafting of manuscript: MO. Critical revision: PS, AM, KHL, Leitao, NRA-R.

  • Funding This work was supported in part by Cancer Center Support Grant (NCI Grant P30 CA016672), the NCI SPORE in Uterine Cancer (2P50 CA098258-06), and a T32 training grant for gynecologic oncology (CA101642). ML and NRA-R are supported in part by the NIH/NCI MSK Cancer Center Support Grant P30CA008748.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement Data are available upon reasonable request.