Adjuvant Treatment after Surgery in Stage IIIA Endometrial Adenocarcinoma.

Mee Sun Yoon; Seung Jae Huh; Hak Jae Kim; Young Seok Kim; Yong Bae Kim; Joo-Young Kim; Jong-Hoon Lee; Hun Jung Kim; Jihye Cha; Jin Hee Kim; Juree Kim; Won Sup Yoon; Jin Hwa Choi; Mison Chun; Youngmin Choi; Kang Kyoo Lee; Myungsoo Kim; Jae-Uk Jeong; Sei Kyung Chang; Won Park

Purpose: We evaluated the role of adjuvant therapy in stage IIIA endometrioid adenocarcinoma patients who underwent surgery followed by radiotherapy (RT) alone or chemoradiotherapy (CTRT) according to risk group. Materials and Methods: A multicenter retrospective study was conducted including patients with surgical stage IIIA endometrial cancer treated by radical surgery and adjuvant RT or CTRT. Disease-free survival (DFS) and overall survival (OS) were analyzed. Results: Ninety-three patients with stage IIIA disease were identified. Nineteen patients (20.4%) experienced recurrence, mostly distant metastasis (17.2%). Combined CTRT did not affect DFS (74.1% vs. 82.4%, p=0.130) or OS (96.3% vs. 91.9%, p=0.262) in stage IIIA disease compared with RT alone. Patients with age ≥ 60 years, grade G2/3, and lymphovascular space involvement had a significantly worse DFS and those variables were defined as risk factors. The high-risk group showed a significant reduction in 5-year DFS (≥ 2 risk factors) (49.0% vs. 88.0%, p < 0.001) compared with the low-risk group (< 2). Multivariate analysis confirmed that more than one risk factor was the only predictor of worse DFS (hazard ratio, 5.45; 95% confidence interval, 2.12 to 13.98; p < 0.001). Of patients with no risk factors, a subset treated with RT alone showed an excellent 5-year DFS and OS (93.8% and 100%, respectively). Conclusion: We identified a low-risk subset of stage IIIA endometrioid adenocarcinoma patients who might be reasonable candidates for adjuvant RT alone. Further randomized studies are needed to determine which subset might benefit from combined CTRT.

ADJUVANT treatment of cancer; ADENOCARCINOMA; ENDOMETRIOSIS; RADIOTHERAPY; METASTASIS; CANCER treatment; PATIENTS

Cancer Research & Treatment, 2016, Vol 48, Issue 3, p1074

1598-2998

Academic Journal

10.4143/crt.2015.356