X Melody Qu1, Vikram M Velker2, Eric Leung3, Janice S Kwon4, Mohamed A Elshaikh5, Iwa Kong6, Natalie A Logie7, Lucas C Mendez3, Louis J van der Putten4, Elysia K Donovan6, Adnan R Munkarah8, Ericka M Wiebe7, Carlos Parra-Herran9, Andrew Warner2, Alexander V Louie2, David P D'Souza10. 1. Department of Oncology, Queen's University, Kingston K7L 5P9, Canada. 2. Department of Radiation Oncology, London Regional Cancer Program, Western University, London N6A 5W9, Canada. 3. Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto M4N 3M5, Canada. 4. Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver V6Z 2K8, Canada. 5. Department of Radiation Oncology, Henry Ford Hospital, Detroit 48202, USA. 6. Department of Oncology, McMaster University, Hamilton L8S 4L8, Canada. 7. Department of Oncology, University of Alberta, Edmonton T6G 2R7, Canada. 8. Department of Gynecologic Oncology, Henry Ford Hospital, Detroit 48202, USA. 9. Department of Pathology, Sunnybrook Health Sciences Centre and Odette Cancer Centre, University of Toronto, Toronto M4N 3M5, Canada. 10. Department of Radiation Oncology, London Regional Cancer Program, Western University, London N6A 5W9, Canada. Electronic address: david.dsouza@lhsc.on.ca.
Abstract
OBJECTIVE: As the optimal adjuvant management of stage IA serous or clear cell endometrial cancer is controversial, a multi-institutional review was conducted with the objective of evaluating the appropriateness of various strategies including observation. METHODS: Retrospective chart reviews for 414 consecutive patients who underwent hysterectomy for FIGO stage IA endometrial cancer with serous, clear cell or mixed histology between 2004 and 2015 were conducted in 6 North American centers. Time-to-event outcomes were analyzed by Kaplan-Meier estimates, log-rank test, univariable and multivariable cox proportional hazard regression models. RESULTS: Post-operative management included observation (50%), chemotherapy and radiotherapy (RT) (27%), RT only (16%) and chemotherapy only (7%). The 178 RT patients received external beam (EBRT, 16%), vaginal vault brachytherapy (VVB, 56%) or both (28%). Among patients without any adjuvant treatment, 5-year local control (LC), disease free survival (DFS) and cancer-specific survival (CSS) were 82% (95% confidence interval: 74-88), 70% (62-78) and 90% (82-94), respectively. CSS in patients without adjuvant treatment was improved with adequate surgical staging (100% vs. 87% (77-92), log-rank p=0.022). Adjuvant VVB was associated with improved LC (5-year 96% (91-99) vs. 84% (76-89), log-rank p=0.007) and DFS (5-year 79% (66-88) vs. 71% (63-77), log-rank p=0.033). Adjuvant chemotherapy was associated with better LC (5-year 96% (90-98) vs. 84% (77-89), log-rank p=0.014) and DFS (5-year 84% (74-91) vs. 69% (61-76), log-rank p=0.009). On multivariable analysis, adjuvant chemotherapy and VVB were associated with improved LC while adjuvant chemotherapy and age were significant for DFS. CONCLUSIONS: In stage IA serous or clear cell uterine cancer, adjuvant RT and chemotherapy were associated with better LC and DFS. Observation may be appropriate in patients who have had adequate surgical staging.
OBJECTIVE: As the optimal adjuvant management of stage IA serous or clear cell endometrial cancer is controversial, a multi-institutional review was conducted with the objective of evaluating the appropriateness of various strategies including observation. METHODS: Retrospective chart reviews for 414 consecutive patients who underwent hysterectomy for FIGO stage IA endometrial cancer with serous, clear cell or mixed histology between 2004 and 2015 were conducted in 6 North American centers. Time-to-event outcomes were analyzed by Kaplan-Meier estimates, log-rank test, univariable and multivariable cox proportional hazard regression models. RESULTS: Post-operative management included observation (50%), chemotherapy and radiotherapy (RT) (27%), RT only (16%) and chemotherapy only (7%). The 178 RT patients received external beam (EBRT, 16%), vaginal vault brachytherapy (VVB, 56%) or both (28%). Among patients without any adjuvant treatment, 5-year local control (LC), disease free survival (DFS) and cancer-specific survival (CSS) were 82% (95% confidence interval: 74-88), 70% (62-78) and 90% (82-94), respectively. CSS in patients without adjuvant treatment was improved with adequate surgical staging (100% vs. 87% (77-92), log-rank p=0.022). Adjuvant VVB was associated with improved LC (5-year 96% (91-99) vs. 84% (76-89), log-rank p=0.007) and DFS (5-year 79% (66-88) vs. 71% (63-77), log-rank p=0.033). Adjuvant chemotherapy was associated with better LC (5-year 96% (90-98) vs. 84% (77-89), log-rank p=0.014) and DFS (5-year 84% (74-91) vs. 69% (61-76), log-rank p=0.009). On multivariable analysis, adjuvant chemotherapy and VVB were associated with improved LC while adjuvant chemotherapy and age were significant for DFS. CONCLUSIONS: In stage IA serous or clear cell uterine cancer, adjuvant RT and chemotherapy were associated with better LC and DFS. Observation may be appropriate in patients who have had adequate surgical staging.
Authors: Nicole Concin; Carien L Creutzberg; Ignace Vergote; David Cibula; Mansoor Raza Mirza; Simone Marnitz; Jonathan A Ledermann; Tjalling Bosse; Cyrus Chargari; Anna Fagotti; Christina Fotopoulou; Antonio González-Martín; Sigurd F Lax; Domenica Lorusso; Christian Marth; Philippe Morice; Remi A Nout; Dearbhaile E O'Donnell; Denis Querleu; Maria Rosaria Raspollini; Jalid Sehouli; Alina E Sturdza; Alexandra Taylor; Anneke M Westermann; Pauline Wimberger; Nicoletta Colombo; François Planchamp; Xavier Matias-Guiu Journal: Virchows Arch Date: 2021-02 Impact factor: 4.064
Authors: Giorgio Bogani; Isabelle Ray-Coquard; Nicole Concin; Natalie Y L Ngoi; Philippe Morice; Takayuki Enomoto; Kazuhiro Takehara; Hannelore Denys; Remi A Nout; Domenica Lorusso; Michelle M Vaughan; Marta Bini; Masashi Takano; Diane Provencher; Alice Indini; Satoru Sagae; Pauline Wimberger; Robert Póka; Yakir Segev; Se Ik Kim; Francisco J Candido Dos Reis; Salvatore Lopez; Andrea Mariani; Mario M Leitao; Francesco Raspagliesi; Pieluigi Benedetti Panici; Violante Di Donato; Ludovico Muzii; Nicoletta Colombo; Giovanni Scambia; Sandro Pignata; Bradley J Monk Journal: Gynecol Oncol Date: 2021-04-30 Impact factor: 5.304