TY - JOUR T1 - Adjuvant treatment improves overall survival in women with high-intermediate risk early-stage endometrial cancer with lymphovascular space invasion JF - International Journal of Gynecologic Cancer JO - Int J Gynecol Cancer DO - 10.1136/ijgc-2020-001454 SP - ijgc-2020-001454 AU - Ji Son AU - Laura M Chambers AU - Caitlin Carr AU - Chad M Michener AU - Meng Yao AU - Anna Beavis AU - Ting-Tai Yen AU - Rebecca L Stone AU - Stephanie L Wethington AU - Amanda N Fader AU - Wesley C Burkett AU - Debra L Richardson AU - Allison S Staley AU - Susie Ahn AU - Paola A Gehrig AU - Diogo Torres AU - Sean C Dowdy AU - Mackenzie W Sullivan AU - Susan C Modesitt AU - Catherine Watson AU - Ashley Veade AU - Jessie Ehrisman AU - Laura Havrilesky AU - Angeles Alvarez Secord AU - Amy Loreen AU - Kaitlyn Griffin AU - Amanda Jackson AU - Akila Viswanathan AU - Stephanie Ricci Y1 - 2020/08/07 UR - http://ijgc.bmj.com/content/early/2020/08/07/ijgc-2020-001454.abstract N2 - Background Adjuvant therapy in early-stage endometrial cancer has not shown a clear overall survival benefit, and hence, patient selection remains crucial.Objective To determine whether women with high-intermediate risk, early-stage endometrial cancer with lymphovascular space invasion particularly benefit from adjuvant treatment in improving oncologic outcomes.Methods A multi-center retrospective study was conducted in women with stage IA, IB, and II endometrial cancer with lymphovascular space invasion who met criteria for high-intermediate risk by Gynecologic Oncology Group (GOG) 99. Patients were stratified by the type of adjuvant treatment received. Clinical and pathologic features were abstracted. Progression-free and overall survival were evaluated using multivariable analysis.Results 405 patients were included with the median age of 67 years (range 27–92, IQR 59–73). 75.0% of the patients had full staging with lymphadenectomy, and 8.6% had sentinel lymph node biopsy (total 83.6%). After surgery, 24.9% of the patients underwent observation and 75.1% received adjuvant therapy, which included external beam radiation therapy (15.1%), vaginal brachytherapy (45.4%), and combined brachytherapy + chemotherapy (19.1%). Overall, adjuvant treatment resulted in improved oncologic outcomes for both 5-year progression-free survival (77.2% vs 69.6%, HR 0.55, p=0.01) and overall survival (81.5% vs 60.2%, HR 0.42, p<0.001). After adjusting for stage, grade 2/3, and age, improved progression-free survival and overall survival were observed for the following adjuvant subgroups compared with observation: external beam radiation (overall survival HR 0.47, p=0.047, progression-free survival not significant), vaginal brachytherapy (overall survival HR 0.35, p<0.001; progression-free survival HR 0.42, p=0.003), and brachytherapy + chemotherapy (overall survival HR 0.30 p=0.002; progression-free survival HR 0.35, p=0.006). Compared with vaginal brachytherapy alone, external beam radiation or the addition of chemotherapy did not further improve progression-free survival (p=0.80, p=0.65, respectively) or overall survival (p=0.47, p=0.74, respectively).Conclusion Adjuvant therapy improves both progression-free survival and overall survival in women with early-stage endometrial cancer meeting high-intermediate risk criteria with lymphovascular space invasion. External beam radiation or adding chemotherapy did not confer additional survival advantage compared with vaginal brachytherapy alone. ER -