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Multicenter Study
. 2020 Apr;30(4):485-490.
doi: 10.1136/ijgc-2019-000807. Epub 2020 Jan 23.

Adjuvant therapy for grade 3, deeply invasive endometrioid adenocarcinoma of the uterus

Michaela Onstad  1 , Jennifer Ducie  2 , Bryan M Fellman  3 , Nadeem R Abu-Rustum  2 , Mario Leitao  2 , Andrea Mariani  4 , Francesco Multinu  5 , Karen H Lu  6 , Pamela Soliman  6
Affiliations
Multicenter Study

Adjuvant therapy for grade 3, deeply invasive endometrioid adenocarcinoma of the uterus

Michaela Onstad et al. Int J Gynecol Cancer. 2020 Apr.

Abstract

Background: Patients with grade 3, deeply invasive endometrioid adenocarcinoma are typically managed with primary surgery. The role and type of adjuvant therapy used is controversial. We sought to evaluate the role of adjuvant radiation and/or chemotherapy in women with deeply invasive grade 3 endometrioid tumors.

Methods: A multi-center retrospective chart review was performed at three large medical institutions in the United States. Patients with grade 3 endometrioid adenocarcinoma invading >50% of the myometrium were included. Medical records were queried to evaluate whether lymph node assessment was performed, the status of the lymph nodes, adjuvant treatment strategy used, and dates of death or recurrence.

Results: Between 1984 and 2013, 257 patients were identified with a median follow-up of 3.08 years. Most patients (84.7%) had evaluation of pelvic and/or para-aortic lymph nodes and 43% had positive lymph nodes. For node negative patients, there was no difference in overall survival (OS) between those who received adjuvant pelvic radiation +/- vaginal brachytherapy (n=52) vs brachytherapy alone (n=46) (5-year probabilities were 0.73 vs 0.70, P=0.729). Among patients with positive lymph nodes (n=92), the adjuvant treatment strategy utilized impacted OS, with women undergoing a combination of chemotherapy and external beam radiation having the best outcomes (P=0.003).

Conclusions: Among women with grade 3, deeply invasive endometrioid adenocarcinoma, vaginal cuff brachytherapy alone resulted in similar survival when compared with pelvic radiation in node negative patients. The combination of chemotherapy with external beam radiation was associated with improved OS for women with positive nodes.

Keywords: endometrial neoplasms; lymph nodes; pathology; radiotherapy.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1:
Figure 1:
Progression free survival (1a) and overall survival (1b) based on lymph node assessment
Figure 2:
Figure 2:
Progression free survival (2a) and overall survival (2b) in pelvic radiation versus brachytherapy alone among staged women with node negative disease
Figure 3:
Figure 3:
Adjuvant treatment strategies employed in staged, node positive patients with hazard ratios (HR) for overall survival (3a) and Kaplan Meier curve for overall survival based on treatment (3b). Comparison of overall survival based on adjuvant treatment regimen used (3c) and location of first recurrence based on adjuvant treatment regimen used (3d).
Figure 3:
Figure 3:
Adjuvant treatment strategies employed in staged, node positive patients with hazard ratios (HR) for overall survival (3a) and Kaplan Meier curve for overall survival based on treatment (3b). Comparison of overall survival based on adjuvant treatment regimen used (3c) and location of first recurrence based on adjuvant treatment regimen used (3d).
Figure 3:
Figure 3:
Adjuvant treatment strategies employed in staged, node positive patients with hazard ratios (HR) for overall survival (3a) and Kaplan Meier curve for overall survival based on treatment (3b). Comparison of overall survival based on adjuvant treatment regimen used (3c) and location of first recurrence based on adjuvant treatment regimen used (3d).
See this image and copyright information in PMC

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