Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
권호 표지
DOI QR코드

DOI QR Code

Evaluation of Treatment Outcomes of Early-Stage Endometrial Cancer Radiotherapy: A Single Center Experience

  • Demiral, S. (Department of Radiation Oncology, Division of Epidemiology, Gulhane Military Medical Academy) ;
  • Beyzadeoglu, M. (Department of Radiation Oncology, Division of Epidemiology, Gulhane Military Medical Academy) ;
  • Sager, O. (Department of Radiation Oncology, Division of Epidemiology, Gulhane Military Medical Academy) ;
  • Dincoglan, F. (Department of Radiation Oncology, Division of Epidemiology, Gulhane Military Medical Academy) ;
  • Uysal, B. (Department of Radiation Oncology, Division of Epidemiology, Gulhane Military Medical Academy) ;
  • Gamsiz, H. (Department of Radiation Oncology, Division of Epidemiology, Gulhane Military Medical Academy) ;
  • Akin, M. (Department of Radiation Oncology, Division of Epidemiology, Gulhane Military Medical Academy) ;
  • Turker, T. (Department of Public Health, Division of Epidemiology, Gulhane Military Medical Academy) ;
  • Dirican, B. (Department of Radiation Oncology, Division of Epidemiology, Gulhane Military Medical Academy)
  • Published : 2014.12.18
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Postoperative adjuvant radiotherapy (RT) in the management of early stage endometrial cancer (EC) is still controversial. Here we report our institutional experience with patients who received postoperative RT for stage I-II EC over a period of 35 years and assess potential predictors of local recurrence (LR), distant metastasis (DM), and overall survival (OS). Materials and Methods: A total of 188 patients undergoing postoperative RT for stage IA-II EC between 1977 and 2012 were evaluated. Some 96 received median 46 Gy whole pelvic radiotherapy (WPRT) (range: 40-60 Gy), 37 were given WPRT with vaginal cuff therapy (VCT), and 55 received only VCT either with brachytherapy (BT) or stereotactic body radiotherapy (SBRT). Chemotherapy was given to 5 patients with uterine papillary serous carcinoma (UPSC). Logistic regression analysis was used to assess the effect of clinicopathological factors on LR, DM, and OS. Results: Median follow-up time was 11 years (range: 1-35 years). At the time of analysis, 34 patients were not alive. Of the 15 patients with LR, 7 (46.7%) recurred in the vaginal stump, 5 (33.3%) in the pelvic region, and 3 (20%) in the paraaortic nodal region, while 12 had distant metastasis. UPSC histology (p=0.027), sole VCT (p=0.041), high histologic grade (p=0.034), and age ${\geq}71$ (p=0.04) were poor prognostic factors on univariate analysis. Conclusions: In our patients receiving radiotherapy for early-stage EC, grade III disease and age ${\geq}71$ were associated with shorter OS whereas UPSC histology was an independent predictor for both LR and DM.

Keywords

References

  1. Aalders J, Abeler V, Kolstad P, Onsrud M (1980). Postoperative external irradiation and prognostic parameters in stage I endometrial carcinoma: Clinical and histopathologic study of 540 patients. Obstet Gynecol, 56, 419-27.
  2. Al Husaini H, Soudy H, Darwish A, et al (2012). Evaluation of adjuvant therapy in women with uterine papillary serous cancer. Ann Saudi Med, 32, 27-31.
  3. Balasubramaniam G, Sushama S, Rasika B, et al (2013). Hospital-based study of endometrial cancer survival in Mumbai, India. Asian Pac J Cancer Prev, 14, 977-80. https://doi.org/10.7314/APJCP.2013.14.2.977
  4. Beyzadeoglu M, Ozyigit G, Ebruli C (2010). Basic Radiation Oncology. Springer-Verlag, Berlin Heidelberg, 432.
  5. Cecere SC, Pisano C, Bamias A, et al (2013). Multidisciplinary treatment of early stage endometrial cancer. Anticancer Agents Med Chem, 13, 861-71. https://doi.org/10.2174/18715206113139990111
  6. Creutzberg CL, van Putten WL, Koper PC, et al (2000). Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: Multicentre randomised trial. PORTEC Study Group. Post Operative Radiation Therapy in Endometrial Carcinoma. Lancet, 355, 1404-11. https://doi.org/10.1016/S0140-6736(00)02139-5
  7. Creutzberg CL, van Putten WL, Warlam-Rodenhuis CC, et al (2004). Postoperative Radiation Therapy in Endometrial Carcinoma Trial. Outcome of high-risk stage IC, grade 3, compared with stage I endometrial carcinoma patients: the Postoperative Radiation Therapy in Endometrial Carcinoma Trial. J Clin Oncol, 22, 1234-41. https://doi.org/10.1200/JCO.2004.08.159
  8. Demiral S, Beyzadeoglu M, Uysal B, et al (2013). Evaluation of stereotactic body radiotherapy (SBRT) boost in the management of endometrial cancer. Neoplasma, 60, 322-27. https://doi.org/10.4149/neo_2013_043
  9. Fader AN, Santin AD, Gehrig PA (2013). Early stage uterine serous carcinoma: management updates and genomic advances. Gynecol Oncol, 129, 244-50. https://doi.org/10.1016/j.ygyno.2013.01.004
  10. Jaishuen A, Kunakornporamat K, Viriyapak B, et al (2014). Incidence and clinical outcomes of non-endometrioid carcinoma of endometrium: Siriraj Hospital experience. Asian Pac J Cancer Prev, 15, 2905-9. https://doi.org/10.7314/APJCP.2014.15.6.2905
  11. Krusun S, Pesee M, Rasio W, et al (2014). Survival rate of early stage endometrioid adenocarcinoma of endometrium treated at Srinagarind Hospital. Asian Pac J Cancer Prev, 15, 2217-20. https://doi.org/10.7314/APJCP.2014.15.5.2217
  12. Polyzos NP, Pavlidis N, Paraskevaidis E, Ioannidis JP (2006). Randomized evidence on chemotherapy and hormonal therapy regimens for advanced endometrial cancer: an overview of survival data. Eur J Cancer, 42, 319-26. https://doi.org/10.1016/j.ejca.2005.09.026
  13. Scotti V, Borghesi S, Meattini I, et al (2010). Postoperative radiotherapy in stage I/II endometrial cancer: retrospective analysis of 883 patients treated at the University of Florence. Int J Gynecol Cancer, 20, 1540-48.
  14. Setakornnukul J, Petsuksiri J, Wanglikitkoon S et al (2014). Long term outcomes of patients with endometrial carcinoma treated with radiation - Siriraj Hospital experience. Asian Pac J Cancer Prev, 15, 2279-85. https://doi.org/10.7314/APJCP.2014.15.5.2279
  15. Tangjitgamol S, Manusirivithaya S, Srijaipracharoen S, et al (2010). Endometrial cancer in Thai women: clinicopathological presentation and survival. Asian Pac J Cancer Prev, 11, 1267-72.
  16. Townamchai K, Berkowitz R, Bhagwat M, et al (2013). Vaginal brachytherapy for early stage uterine papillary serous and clear cell endometrial cancer. Gynecol Oncol, 129, 18-21. https://doi.org/10.1016/j.ygyno.2012.12.026
  17. Vavra N, Kucera H, Weghaupt K (1991). Recurrence of stage I endometrial cancer: effect of prognostic factors on therapeutic results. Geburtshilfe Frauenheilkd, 51, 267-71. https://doi.org/10.1055/s-2007-1023717
  18. Zighelboim I, Powell MA (2011). Adjuvant treatment for earlystage endometrial cancer. Clin Obstet Gynecol, 54, 245-55. https://doi.org/10.1097/GRF.0b013e318218c5b8
  19. Zusterzeel PL, Bekkers RL, Hendriks JC, et al (2008). Prognostic factors for recurrence in patients with FIGO stage I and II, intermediate or high risk endometrial cancer. Acta Obstet Gynecol Scand, 87, 240-46. https://doi.org/10.1080/00016340701876163

Cited by

  1. Lympho-Vascular Space Invasion Indicates Advanced Disease for Uterine Papillary Serous Tumors Arising from Polyps vol.16, pp.10, 2015, https://doi.org/10.7314/APJCP.2015.16.10.4257
  2. Relapse Patterns and Outcomes Following Recurrence of Endometrial Cancer in Northern Thai Women vol.16, pp.9, 2015, https://doi.org/10.7314/APJCP.2015.16.9.3861
  3. A Retrospective Study of the Treatment Results & Patterns of Failure of Type II Endometrial Cancer Patients Treated at Radiotherapy Department, NCI, Cairo University during the Period from January 2000 till December 2012 vol.07, pp.08, 2016, https://doi.org/10.4236/jct.2016.78063