Louis J M van der Putten1, Yvette P Geels, Nicole P M Ezendam, Hans W H M van der Putten, Marc P M L Snijders, Lonneke V van de Poll-Franse, Johanna M A Pijnenborg. 1. *Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands; †Comprehensive Cancer Center South, Eindhoven, The Netherlands; ‡Center of Research on Psychology in Somatic Diseases, Tilburg University, The Netherlands; §Department of Obstetrics and Gynaecology, Catharina Hospital, Eindhoven, The Netherlands; ∥Department of Obstetrics and Gynaecology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands; and ¶Department of Obstetrics and Gynaecology, TweeSteden Hospital, Tilburg, The Netherlands.
Abstract
OBJECTIVES: Treatment of clinical early-stage endometrioid endometrial cancer (EEC) in The Netherlands consists of primary hysterectomy and bilateral salpingo-oophorectomy. Adjuvant radiotherapy is given when 2 or more the following risk factors are present: 60 years or older, grade 3 histology, and 50% or more myometrial invasion. Lymphovascular space invasion (LVSI) is a predictor of poor prognosis and early distant spread. It is unclear whether adjuvant radiotherapy is sufficient in patients with LVSI-positive EEC. METHODS/MATERIALS: Eighty-one patients treated from 1999 until 2011 for stage I LVSI-positive EEC in 11 Dutch hospitals were included. The outcomes of patients with 0 to 1 risk factors were compared with those with 2 to 3 risk factors, and both were compared with the known literature. RESULTS: Eighteen patients presented with recurrent disease, and 12 of those recurrences had a distant component. Overall and distant recurrence rates were 19.2% and 11.5% in patients with 0 to 1 risk factors followed by observation and 25.5% and 17% in patients with 2 to 3 risk factors who received adjuvant radiotherapy. Only 1 patient with grade 1 disease had a recurrence. CONCLUSIONS: In stage I LVSI-positive EEC with 0 to 1 risk factors, observation might not be adequate. Moreover, despite adjuvant radiotherapy, a high overall and distant recurrence rate was observed in patients with 2 to 3 risk factors. The use of systemic treatment in these patients, with the exception of patients with grade 1 disease, should be investigated.
OBJECTIVES: Treatment of clinical early-stage endometrioid endometrial cancer (EEC) in The Netherlands consists of primary hysterectomy and bilateral salpingo-oophorectomy. Adjuvant radiotherapy is given when 2 or more the following risk factors are present: 60 years or older, grade 3 histology, and 50% or more myometrial invasion. Lymphovascular space invasion (LVSI) is a predictor of poor prognosis and early distant spread. It is unclear whether adjuvant radiotherapy is sufficient in patients with LVSI-positive EEC. METHODS/MATERIALS: Eighty-one patients treated from 1999 until 2011 for stage I LVSI-positive EEC in 11 Dutch hospitals were included. The outcomes of patients with 0 to 1 risk factors were compared with those with 2 to 3 risk factors, and both were compared with the known literature. RESULTS: Eighteen patients presented with recurrent disease, and 12 of those recurrences had a distant component. Overall and distant recurrence rates were 19.2% and 11.5% in patients with 0 to 1 risk factors followed by observation and 25.5% and 17% in patients with 2 to 3 risk factors who received adjuvant radiotherapy. Only 1 patient with grade 1 disease had a recurrence. CONCLUSIONS: In stage I LVSI-positive EEC with 0 to 1 risk factors, observation might not be adequate. Moreover, despite adjuvant radiotherapy, a high overall and distant recurrence rate was observed in patients with 2 to 3 risk factors. The use of systemic treatment in these patients, with the exception of patients with grade 1 disease, should be investigated.
Authors: Noemie Body; Vincent Lavoué; Olivier De Kerdaniel; Fabrice Foucher; Sébastien Henno; Aurélie Cauchois; Bruno Laviolle; Marc Leblanc; Jean Levêque Journal: BMC Cancer Date: 2016-07-19 Impact factor: 4.430
Authors: Anna L Beavis; Ting-Tai Yen; Rebecca L Stone; Stephanie L Wethington; Caitlin Carr; Ji Son; Laura Chambers; Chad M Michener; Stephanie Ricci; Wesley C Burkett; Debra L Richardson; Allison-Stuart Staley; Susie Ahn; Paola A Gehrig; Diogo Torres; Sean C Dowdy; Mackenzie W Sullivan; Susan C Modesitt; Catherine Watson; Ashely Veade; Jessie Ehrisman; Laura Havrilesky; Angeles Alvarez Secord; Amy Loreen; Kaitlyn Griffin; Amanda Jackson; Akila N Viswanathan; Leah R Jager; Amanda N Fader Journal: Gynecol Oncol Date: 2020-01-14 Impact factor: 5.482