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A population-based study of outcomes in adjuvant radiotherapy for stage II endometrial carcinoma
  1. Nataliya Moldovan1,
  2. Pascal Lambert2,
  3. Aldrich Ong1 and
  4. Alon D Altman3,4
  1. 1Radiation Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
  2. 2Department of Epidemiology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
  3. 3CancerCare Manitoba, Winnipeg, Manitoba, Canada
  4. 4Gynecologic Oncology, University of Manitoba, Winnipeg, Manitoba, Canada
  1. Correspondence to Dr Nataliya Moldovan, Radiation Oncology, CancerCare Manitoba, Winnipeg, Canada; nmoldovan{at}cancercare.mb.ca

Abstract

Objective Our study aimed to analyze recurrence and survival outcomes in stage II endometrial cancer patients treated with adjuvant radiotherapy at CancerCare Manitoba, a Canadian provincial cancer program.

Methods This retrospective population-based cohort study identified all International Federation of Gynecology and Obstetrics (FIGO) 2009 stage II endometrioid type endometrial carcinoma diagnosed between January 1995 and December 2019. All patients underwent surgery followed by vaginal vault brachytherapy alone or external beam pelvic radiotherapy plus vaginal vault brachytherapy. We used Kaplan-Meier curves to describe overall survival and recurrence-free survival, and cumulative incidence to describe recurrence. Cox regression was used to predict overall survival and recurrence-free survival competing risk regression to predict recurrence.

Results A total of 121 patients were included (78 vaginal brachytherapy alone and 43 external beam pelvic radiotherapy plus vaginal brachytherapy) with a median age of 62 (range 24–85). The median follow-up was 55.2 months (range 7.1–147.9) in the vaginal brachytherapy group and 41.9 months (range 7.4–127.0) in the pelvic radiotherapy group. Lymph node dissection was performed in 79 (65.3%) patients. There were 14 (17.9%) recurrences (8 vaginal vault, 3 pelvic, 3 distant) with vaginal brachytherapy and 7 (16.3%) recurrences (3 vaginal vault, 2 pelvic, 2 distant) with external beam pelvic radiotherapy. The 5 year overall survival was 73.1% with vaginal vault brachytherapy vs 73.7% with external beam pelvic radiotherapy plus vaginal brachytherapy (p=0.31), the 5 year recurrence-free survival was 65.0% vs 68.2% (p=0.61), and the 5 year recurrence risk was 20.3% vs 19.4% (p=0.94). On univariable and multivariable analysis, only age was a statistically significant predictor for overall survival and recurrence-free survival (p<0.05), but not lymphovascular space invasion (HR, 2.97; 95% CI, 0.99 to 8.93 for overall survival, p=0.15). The type of adjuvant radiotherapy did not predict for recurrence (p=0.94).

Conclusions There was no significant difference in overall survival, recurrence-free survival, and recurrence risk between vaginal vault brachytherapy vs external beam pelvic radiotherapy plus vaginal vault brachytherapy in patients with stage II endometrial cancer.

  • Radiotherapy
  • Endometrial Neoplasms

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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Footnotes

  • Twitter @DrAlonAltman

  • Contributors NM, AD, AA devised the project. NM collected the data, drafted the manuscript, designed the tables and figures, and is the guarantor. PL performed the statistical analysis. AD, AA supervised the work and aided in interpreting the results. All authors discussed the results and commented on the manuscript before submission.

  • 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.

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