Samual R Francis1, Bryan J Ager1, Olivia A Do2, Yu-Huei Jessica Huang1, Andrew P Soisson3, Mark K Dodson3, Theresa L Werner4, William T Sause5, Jonathan D Grant5, David K Gaffney6. 1. Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA. 2. Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA. 3. Department of Obstetrics and Gynecology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA. 4. Department of Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA. 5. Department of Radiation Oncology, Intermountain Medical Group, Intermountain Healthcare, Salt Lake City, UT, USA. 6. Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA. Electronic address: david.gaffney@hci.utah.edu.
Abstract
OBJECTIVE: To analyze our institutional experience and oncologic outcomes for salvage treatment for the recurrence of early-stage endometrial cancer patients. METHODS: We included women of all ages diagnosed with FIGO stage I-II, any grade endometrial cancer from 2000 to 2016 at our institutions who were treated with at least a hysterectomy. Recurrences in the pelvis and/or vagina were considered locoregional recurrences (LRR). Overall survival (OS) was assessed using Kaplan-Meier survival analysis. Univariate (UV) and multivariate (MV) Cox proportional hazards modeling was also used. RESULTS: A total of 2691 women were analyzed. The majority had endometrioid histology (91%), stage IA disease (61%), and were grade 1 (57%). With a median follow-up of 6.1 years, the overall rate of recurrence was 7.2%, and the rate of LRR was 3.7%. Women with vaginal-only recurrences had a longer median OS after recurrence (14.0 years) compared to both pelvic (1.2 years) and distant (1.0 year) failures. For women with vaginal-only recurrences, salvage radiotherapy (RT) was the only factor associated with improved OS on MVA (HR 0.1, p = .04). For women with pelvic recurrences, salvage surgery (HR 0.3, p = .01), salvage RT (HR 0.3, p < .01), and salvage chemotherapy (HR 0.4, p = .03) were associated with improved OS. CONCLUSIONS: Failure rates for women with early-stage endometrial cancer are low. Women with vaginal-only recurrences have improved OS compared to pelvic or distant recurrences. Salvage RT appears to be an important factor for treatment of women with vaginal-only recurrences. Aggressive multimodality treatment may be beneficial for women with pelvic recurrences.
OBJECTIVE: To analyze our institutional experience and oncologic outcomes for salvage treatment for the recurrence of early-stage endometrial cancerpatients. METHODS: We included women of all ages diagnosed with FIGO stage I-II, any grade endometrial cancer from 2000 to 2016 at our institutions who were treated with at least a hysterectomy. Recurrences in the pelvis and/or vagina were considered locoregional recurrences (LRR). Overall survival (OS) was assessed using Kaplan-Meier survival analysis. Univariate (UV) and multivariate (MV) Cox proportional hazards modeling was also used. RESULTS: A total of 2691 women were analyzed. The majority had endometrioid histology (91%), stage IA disease (61%), and were grade 1 (57%). With a median follow-up of 6.1 years, the overall rate of recurrence was 7.2%, and the rate of LRR was 3.7%. Women with vaginal-only recurrences had a longer median OS after recurrence (14.0 years) compared to both pelvic (1.2 years) and distant (1.0 year) failures. For women with vaginal-only recurrences, salvage radiotherapy (RT) was the only factor associated with improved OS on MVA (HR 0.1, p = .04). For women with pelvic recurrences, salvage surgery (HR 0.3, p = .01), salvage RT (HR 0.3, p < .01), and salvage chemotherapy (HR 0.4, p = .03) were associated with improved OS. CONCLUSIONS: Failure rates for women with early-stage endometrial cancer are low. Women with vaginal-only recurrences have improved OS compared to pelvic or distant recurrences. Salvage RT appears to be an important factor for treatment of women with vaginal-only recurrences. Aggressive multimodality treatment may be beneficial for women with pelvic recurrences.
Authors: Cristina Anton; Rodolpho Truffa Kleine; Eric Mayerhoff; Maria Del Pilar Esteves Diz; Daniela de Freitas; Heloisa de Andrade Carvalho; João Paulo Mancusi de Carvalho; Alexandre Silva E Silva; Maria Luiza Nogueira Dias Genta; André Lopes de Faria E Silva; Rafael Calil Salim; Andrea Aranha; Rossana Veronica Mendoza Lopez; Filomena Marino Carvalho; Edmund Chada Baracat; Jesus Paula Carvalho Journal: PLoS One Date: 2020-03-05 Impact factor: 3.240
Authors: Rebecca C Arend; Carly B Scalise; Jhalak Dholakia; Maahum Z Kamal; Haley B Thigpen; David Crossman; Warner K Huh; Charles A Leath Journal: Cancer Med Date: 2021-11-02 Impact factor: 4.452