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. 2022 Oct 25;8(1):101003.
doi: 10.1016/j.adro.2022.101003. eCollection 2023 Jan-Feb.

Definitive Radiation Therapy for Medically Inoperable Endometrial Carcinoma

James L Shen  1 , Kevin W O'Connor  1 , Janaki Moni  2 , Susan Zweizig  3 , Thomas J Fitzgerald  2 , Eric C Ko  2
Affiliations

Definitive Radiation Therapy for Medically Inoperable Endometrial Carcinoma

James L Shen et al. Adv Radiat Oncol. .

Abstract

Purpose: Upfront radiation therapy consisting of brachytherapy with or without external beam radiation therapy is considered standard of care for patients with endometrial carcinoma who are unable to undergo surgical intervention. This study evaluated the cancer-free survival (CFS), cancer-specific survival (CSS), and overall survival (OS) of patients with endometrial carcinoma managed with definitive-intent radiation therapy.

Methods and materials: This was a single-institution retrospective analysis of medically inoperable patients with biopsy-proven endometrial carcinoma managed with up-front, definitive radiation therapy at UMass Memorial Medical Center between May 2010 and October 2021. A total of 55 cases were included for analysis. Patients were stratified as having low-risk endometrial carcinoma (LREC; uterine-confined grade 1-2 endometrioid adenocarcinoma) or high-risk endometrial carcinoma (HREC; stage III/IV and/or grade 3 endometrioid carcinoma, or any stage serous or clear cell carcinoma or carcinosarcoma). The CFS, CSS, OS, and grade ≥3 toxic effects were reported for patients with LREC and HREC.

Results: The median age was 66 years (range, 42-86 years), and the median follow-up was 44 months (range, 4-135 months). Twelve patients (22%) were diagnosed with HREC. Six patients (11%) were treated with high-dose-rate brachytherapy alone and 49 patients (89%) were treated with high-dose-rate brachytherapy and external beam radiation therapy. Twelve patients (22%) were treated with radiation and chemotherapy. The 2-year CFS was 82% for patients with LREC and 80% for patients with HREC (log rank P = .0654). The 2-year CSS was 100% for both LREC and HREC patients. The 2-year OS was 92% for LREC and 80% for HREC (log P = .0064). There were no acute grade ≥3 toxic effects. There were 3 late grade ≥3 toxic effects owing to endometrial bleeding and gastrointestinal adverse effects.

Conclusions: For medically inoperable patients with endometrial carcinoma, up-front radiation therapy provided excellent CFS, CSS, and OS. The CSS and OS were higher in patients with LREC than in those with HREC. Toxic effects were limited in both cohorts.

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Figures

Fig 1
Figure 1
A, Cancer-free survival stratified by routine follow-up and screening in patients with low-risk endometrial carcinoma (LREC) (n = 43) and high-risk endometrial carcinoma (HREC) (n = 12). There was no significant difference in cancer-free survival (log rank P = .0654). B, Cancer-specific survival stratified by routine follow-up and screening. The cancer-specific survival of patients with LREC was significantly higher compared to those treated for HREC (log rank P = .0009). C, Overall survival stratified by routine follow-up and screening. Patients treated for LREC had a significantly increased overall survival time compared with those with HREC (log rank P = .0064). D, Percentage of patients with grade 3 toxic effects following radiation therapy as defined by the Common Terminology Criteria for Adverse Events, version 5, stratified by routine follow-up and screening. There was no significant difference between patients with LREC compared with patients with HREC (log rank P = .5196). Survival in A-C is reported as a percentage. Abbreviations: HREC = high-risk endometrial carcinoma; LREC = low-risk endometrial carcinoma.
Fig 2
Figure 2
Box and whisker plots of body mass index (BMI) versus A, cancer-free survival; B, overall survival; C, development of grade 3 toxic effects; D, cancer-specific survival; E, grade; and F, stage (n = 53). Low-grade was defined as grades 1 or 2, and high-grade was defined as grade 3. Low stage was defined as stage I or II, and high stage was defined as stage III or IV. Two-tailed t-test P values are as follows: BMI versus cancer-free survival, P = .7598; BMI versus overall survival, P = .7598; BMI versus grade 3 toxic effects, P = .9114; BMI versus cancer-specific survival, P = 0.0470; BMI versus grade, P = .6368; and BMI versus stage, P = .9917. At the time of treatment, BMI was not obtainable for 2 patients. Abbreviations: BMI = body mass index.
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