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Adjuvant chemotherapy for stage I high-intermediate risk endometrial carcinoma with lymph-vascular invasion
  1. Dimitrios Nasioudis1,
  2. Jinhee Oh2,
  3. Emily M Ko1,
  4. Ashley F Haggerty1,
  5. Lori Cory1,
  6. Robert L Giuntoli II1,
  7. Sarah H Kim1,
  8. Mark A Morgan1 and
  9. Nawar A Latif1
  1. 1Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  2. 2Pennsylvania Hospital, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Dimitrios Nasioudis, Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; dimitrios.nasioudis{at}


Objective The goal of this study was to evaluate if addition of adjuvant chemotherapy to radiation therapy improves overall survival in patients with high-intermediate risk stage I endometrial carcinoma with lymphovascular invasion.

Methods Patients diagnosed between January 2010 and December 2015 with FIGO (International Federation of Gynecology and Obstetrics) stage I endometrioid endometrial carcinoma with lymphovascular invasion who underwent hysterectomy with lymphadenectomy and met the GOG-99 criteria for high-intermediate risk were identified in the National Cancer Database. Patients who received adjuvant radiotherapy with or without adjuvant chemotherapy (administered within 6 months of surgery) and had at least 1 month of follow-up were selected for further analysis. Overall survival was compared with the log-rank test following stratification by type of radiation treatment. A Cox model was constructed to control for a priori selected confounders.

Results A total of 2881 patients who met the inclusion criteria were identified; 2417 (83.9%) patients received radiation therapy alone while 464 (16.1%) received chemoradiation. Rate of adjuvant chemotherapy administration was comparable between patients who received vaginal brachytherapy alone (16.2%), and external beam radiation therapy (with or without vaginal brachytherapy) (15.8%), p=0.78. Rate of chemoradiation was higher for patients with grade 3 (28.8%) tumors compared with those with grade 2 (9.9%) and grade 1 (8.3%) tumors, p<0.001. After controlling for confounders for patients receiving external beam radiation, addition of chemotherapy was not associated with improved overall survival (HR 0.90, 95% CI 0.56 to 1.46). For patients receiving vaginal brachytherapy addition of chemotherapy was associated with better overall survival (HR 0.644, 95% CI 0.45 to 0.92). Benefit was limited to patients with grade 3 tumors, p=0.026; 4-year overall survival rate was 81.1% versus 74.9%.

Conclusions In patients with high-intermediate risk FIGO stage I endometrioid endometrial carcinoma and lymphovascular invasion, addition of chemotherapy to radiation therapy was associated with a survival benefit for patients with grade 3 tumors receiving vaginal brachytherapy.

  • Uterine Cancer
  • Radiotherapy

Data availability statement

Data may be obtained from a third party and are not publicly available. Data obtained from American College of Surgeons.

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Data availability statement

Data may be obtained from a third party and are not publicly available. Data obtained from American College of Surgeons.

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  • Contributors DN: conception, data acquisition, data management, statistical analysis, critical analysis, drafting/final editing, guarantor. JO, EMK, AFH, LC, SK, RLG, MM: critical analysis, drafting/final editing. NL: supervision, critical analysis, drafting/final editing. All authors contributed significantly.

  • 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 related to this study. RLG: medical monitor for CAPRI trial by Astra Zeneca. AFH: GSK research fund, GSK advisory board, Honoraria: Axess ovarian cancer lecture.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.