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Survival, Failure Patterns, and Toxicity Outcomes in Endometrial Cancer Patients Receiving Adjuvant Radiotherapy

Year 2023, , 465 - 471, 30.09.2023
https://doi.org/10.31832/smj.1309164

Abstract

Objective: This study aimed to investigate the survival outcomes, recurrence patterns, and treatment-related toxicities of endometrial cancer (EC) patients who underwent adjuvant radiotherapy.
Materials and Methods: Between January 2012 and December 2021, one hundred fourteen patients who underwent adjuvant radiotherapy with the diagnosis of endometrial cancer were retrospectively analyzed. Cases were evaluated for overall survival (OS), disease-free survival (DFS), local recurrence-free survival (LRFS), cancer-specific survival (CSS), and distant metastasis-free survival (DMFS).
Results: Median follow-up was 63 months (8 -135). At 5 years OS, DFS, LRFS, CSS, and DMFS were 85.5%, 90.5%, 98.9%, 94.1%, and 90.5%, respectively. Univariate analysis of lymphovascular space invasion (LVSI) is statistically significant for DFS, DMFS, and CSS, respectively (p=0.019, p=0.019, p=0.021) and histology, tumor grade, stage were statistically significant for LRFS, respectively (p=0.031, p=0.010, p=0.049). Grade 1 and 2 acute gastrointestinal toxicity were observed in 40 patients (35.1%). Grade 1 acute genitourinary toxicity was observed in 35 patients (30.7%). Grade 3 late genitourinary and gastrointestinal toxicity was observed in 0.9% and 1.8%, respectively.
Conclusion: Histology, grade, LVSI, and stage didn’t significantly affect overall survival, but LVSI and stage were the most influential prognostic factors on relapse patterns. Adjuvant radiotherapy is safe and well tolerated by patients with endometrial cancer with acceptable toxicity.

Project Number

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References

  • 1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [published correction appears in CA Cancer J Clin. 2020 Jul;70(4):313]. CA Cancer J Clin. 2018;68(6):394-424.
  • 2. Sherman ME, Sturgeon S, Brinton LA, Potischman N, Kurman RJ, Berman ML, et al. Risk factors and hormone levels in patients with serous and endometrioid uterine carcinomas. Mod Pathol. 1997;10(10):963-968.
  • 3. Cree IA, White VA, Indave BI, Lokuhetty D. Revising the WHO classification: female genital tract tumours. Histopathology. 2020;76(1):151-156.
  • 4. Colombo N, Creutzberg C, Amant F, Bosse T, González-Martín A, Ledermann J, et al. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: Diagnosis, Treatment and Follow-up. Int J Gynecol Cancer. 2016;26(1):2-30.
  • 5. Concin N, Matias-Guiu X, Vergote I, Cibula D, Mirza MR, Marnitz S, et al. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Radiother Oncol. 2021;154:327-353.
  • 6. Bosse T, Peters EE, Creutzberg CL, Jürgenliemk-Schulz IM, Jobsen JJ, Mens JW, et al. Substantial lymph-vascular space invasion (LVSI) is a significant risk factor for recurrence in endometrial cancer--A pooled analysis of PORTEC 1 and 2 trials. Eur J Cancer. 2015;51(13):1742-1750.
  • 7. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65(1):5-29.
  • 8. Creasman WT, Odicino F, Maisonneuve P, Quinn MA, Beller U, Benedet JL, et al. Carcinoma of the corpus uteri. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer. Int J Gynaecol Obstet. 2006;95 Suppl 1:S105-S143.
  • 9. Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB. Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer. 1987;60(8 Suppl):2035-2041.
  • 10. Pellerin GP, Finan MA. Endometrial cancer in women 45 years of age or younger: a clinicopathological analysis. Am J Obstet Gynecol. 2005;193(5):1640-1644.
  • 11. Boronow RC, Morrow CP, Creasman WT, Disaia PJ, Silverberg SG, Miller A, et al. Surgical staging in endometrial cancer: clinical-pathologic findings of a prospective study. Obstet Gynecol. 1984;63(6):825-832.
  • 12. Abu-Rustum NR, Zhou Q, Gomez JD, Alektiar KM, Hensley ML, Soslow RA, et al. A nomogram for predicting overall survival of women with endometrial cancer following primary therapy: toward improving individualized cancer care. Gynecol Oncol. 2010;116(3):399-403.
  • 13. Creutzberg CL, van Stiphout RG, Nout RA, Lutgens LC, Jürgenliemk-Schulz IM, Jobsen JJ, et al. Nomograms for prediction of outcome with or without adjuvant radiation therapy for patients with endometrial cancer: a pooled analysis of PORTEC-1 and PORTEC-2 trials. Int J Radiat Oncol Biol Phys. 2015;91(3):530-539.
  • 14. Bansal N, Yendluri V, Wenham RM. The molecular biology of endometrial cancers and the implications for pathogenesis, classification, and targeted therapies. Cancer Control. 2009;16(1):8-13.
  • 15. Bokhman JV. Two pathogenetic types of endometrial carcinoma. Gynecol Oncol. 1983;15(1):10-17.
  • 16. Keys HM, Roberts JA, Brunetto VL, Zaino RJ, Spirtos NM, Bloss JD, et al. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study [published correction appears in Gynecol Oncol. 2004 Jul;94(1):241-2]. Gynecol Oncol. 2004;92(3):744-751.
  • 17. Inoue Y, Obata K, Abe K, Ohmura G, Doh K, Yoshioka T, et al. The prognostic significance of vascular invasion by endometrial carcinoma. Cancer. 1996;78(7):1447-1451.
  • 18. Alektiar KM, McKee A, Lin O, Venkatraman E, Zelefsky MJ, Mychalczak BR, et al. The significance of the amount of myometrial invasion in patients with Stage IB endometrial carcinoma. Cancer. 2002;95(2):316-321.
  • 19. Woodhouse EC, Chuaqui RF, Liotta LA. General mechanisms of metastasis. Cancer. 1997;80(8 Suppl):1529-1537.
  • 20. Rasool N, Fader AN, Seamon L, Neubauer NL, Shahin FA, Alexander HA, et al. Stage I, grade 3 endometrioid adenocarcinoma of the endometrium: an analysis of clinical outcomes and patterns of recurrence. Gynecol Oncol. 2010;116(1):10-14.
  • 21. Gadducci A, Cavazzana A, Cosio S, C DIC, Tana R, Fanucchi A, et al. Lymph-vascular space involvement and outer one-third myometrial invasion are strong predictors of distant haematogeneous failures in patients with stage I-II endometrioid-type endometrial cancer. Anticancer Res. 2009;29(5):1715-1720.
  • 22. Kurman RJ, Carcangiu ML, Herrington CS. World Health Organisation classification of tumours of the female reproductive organs: International agency for research on cancer; 2014.
  • 23. Ries, Lynn A. Gloeckler. Cancer survival among adults: US SEER program, 1988-2001, patient and tumor characteristics. No. 7. US Department of Health and Human Services, National Institutes of Health, National Cancer Institute, 2007.
  • 24. Ferriss JS, Brix W, Tambouret R, DeSimone CP, Stoler M, Modesitt SC. Cervical stromal invasion predicting survival in endometrial cancer. Obstet Gynecol. 2010;116(5):1035-1041.
  • 25. Barakat RR, Markman M, Randall M. Principles and practice of gynecologic oncology: Lippincott Williams & Wilkins; 2009.
  • 26. Nout RA, van de Poll-Franse LV, Lybeert ML, Wárlám-Rodenhuis CC, Jobsen JJ, Mens JW, et al. Long-term outcome and quality of life of patients with endometrial carcinoma treated with or without pelvic radiotherapy in the post operative radiation therapy in endometrial carcinoma 1 (PORTEC-1) trial. J Clin Oncol. 2011;29(13):1692-1700.

Adjuvan radyoterapi uygulanan endometriyal kanser hastalarında sağkalım, nüks paternleri ve toksisite sonuçları

Year 2023, , 465 - 471, 30.09.2023
https://doi.org/10.31832/smj.1309164

Abstract

Amaç: Bu çalışma, adjuvan radyoterapi uygulanan endometrium kanser (EK) hastalarının sağkalım sonuçlarını, nüks paternlerini ve tedaviye bağlı toksisiteleri araştırmayı amaçladı.
Gereç ve Yöntemler: Ocak 2012-Aralık 2021 tarihleri arasında endometrium kanser tanısı ile adjuvan radyoterapi uygulanan 114 hasta retrospektif olarak incelendi. Vakalar, genel sağkalım (OS), hastalıksız sağkalım (DFS), lokal nükssüz sağkalım (LRFS), kansere özgü sağkalım (CSS) ve uzak metastazsız sağkalım (DMFS) açısından değerlendirildi.
Bulgular: Medyan takip süresi 63 aydı (8 -135). 5 yıllık OS, DFS, LRFS, CSS ve DMFS, sırasıyla, %85.5, %90.5, %98.9, %94.1 ve %90.5 idi. Tek değişkenli analizde, lenfovasküler alan invazyonu (LVSI) ile DFS, DMFS ve CSS arasında istatistiksel olarak anlamlı bir ilişki vardı (sırasıyla, p=0,019, p=0,019, p=0,021). LRFS ile histoloji, tümör derecesi, evre ve brakiterapi uygulaması arasında anlamlı ilşki vardı. (sırasıyla, p=0,031, p=0,010, p=0,049, p=0,001). 40 hastada (%35.1), grade 1 ve 2 akut gastrointestinal toksisite gözlendi. 35 hastada (%30.7), grade 1 akut genitoüriner toksisite gözlendi. Grade 3 geç genitoüriner ve gastrointestinal toksisite sırasıyla %0.9 ve %1.8 oranında gözlendi.
Sonuç: Histoloji, grade, LVSI, evre ve brakiterapi genel sağkalımı üzerinde anlamlı etkisi olmamasına karşın, LVSI ve evre nüks açısından en etkili prognostik faktörlerdi. Adjuvan radyoterapi güvenli ve kabul edilebilir toksisite ile endometriyum kanserli hastalar tarafından iyi tolere edilmektedir.

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References

  • 1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [published correction appears in CA Cancer J Clin. 2020 Jul;70(4):313]. CA Cancer J Clin. 2018;68(6):394-424.
  • 2. Sherman ME, Sturgeon S, Brinton LA, Potischman N, Kurman RJ, Berman ML, et al. Risk factors and hormone levels in patients with serous and endometrioid uterine carcinomas. Mod Pathol. 1997;10(10):963-968.
  • 3. Cree IA, White VA, Indave BI, Lokuhetty D. Revising the WHO classification: female genital tract tumours. Histopathology. 2020;76(1):151-156.
  • 4. Colombo N, Creutzberg C, Amant F, Bosse T, González-Martín A, Ledermann J, et al. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: Diagnosis, Treatment and Follow-up. Int J Gynecol Cancer. 2016;26(1):2-30.
  • 5. Concin N, Matias-Guiu X, Vergote I, Cibula D, Mirza MR, Marnitz S, et al. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Radiother Oncol. 2021;154:327-353.
  • 6. Bosse T, Peters EE, Creutzberg CL, Jürgenliemk-Schulz IM, Jobsen JJ, Mens JW, et al. Substantial lymph-vascular space invasion (LVSI) is a significant risk factor for recurrence in endometrial cancer--A pooled analysis of PORTEC 1 and 2 trials. Eur J Cancer. 2015;51(13):1742-1750.
  • 7. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65(1):5-29.
  • 8. Creasman WT, Odicino F, Maisonneuve P, Quinn MA, Beller U, Benedet JL, et al. Carcinoma of the corpus uteri. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer. Int J Gynaecol Obstet. 2006;95 Suppl 1:S105-S143.
  • 9. Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB. Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer. 1987;60(8 Suppl):2035-2041.
  • 10. Pellerin GP, Finan MA. Endometrial cancer in women 45 years of age or younger: a clinicopathological analysis. Am J Obstet Gynecol. 2005;193(5):1640-1644.
  • 11. Boronow RC, Morrow CP, Creasman WT, Disaia PJ, Silverberg SG, Miller A, et al. Surgical staging in endometrial cancer: clinical-pathologic findings of a prospective study. Obstet Gynecol. 1984;63(6):825-832.
  • 12. Abu-Rustum NR, Zhou Q, Gomez JD, Alektiar KM, Hensley ML, Soslow RA, et al. A nomogram for predicting overall survival of women with endometrial cancer following primary therapy: toward improving individualized cancer care. Gynecol Oncol. 2010;116(3):399-403.
  • 13. Creutzberg CL, van Stiphout RG, Nout RA, Lutgens LC, Jürgenliemk-Schulz IM, Jobsen JJ, et al. Nomograms for prediction of outcome with or without adjuvant radiation therapy for patients with endometrial cancer: a pooled analysis of PORTEC-1 and PORTEC-2 trials. Int J Radiat Oncol Biol Phys. 2015;91(3):530-539.
  • 14. Bansal N, Yendluri V, Wenham RM. The molecular biology of endometrial cancers and the implications for pathogenesis, classification, and targeted therapies. Cancer Control. 2009;16(1):8-13.
  • 15. Bokhman JV. Two pathogenetic types of endometrial carcinoma. Gynecol Oncol. 1983;15(1):10-17.
  • 16. Keys HM, Roberts JA, Brunetto VL, Zaino RJ, Spirtos NM, Bloss JD, et al. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study [published correction appears in Gynecol Oncol. 2004 Jul;94(1):241-2]. Gynecol Oncol. 2004;92(3):744-751.
  • 17. Inoue Y, Obata K, Abe K, Ohmura G, Doh K, Yoshioka T, et al. The prognostic significance of vascular invasion by endometrial carcinoma. Cancer. 1996;78(7):1447-1451.
  • 18. Alektiar KM, McKee A, Lin O, Venkatraman E, Zelefsky MJ, Mychalczak BR, et al. The significance of the amount of myometrial invasion in patients with Stage IB endometrial carcinoma. Cancer. 2002;95(2):316-321.
  • 19. Woodhouse EC, Chuaqui RF, Liotta LA. General mechanisms of metastasis. Cancer. 1997;80(8 Suppl):1529-1537.
  • 20. Rasool N, Fader AN, Seamon L, Neubauer NL, Shahin FA, Alexander HA, et al. Stage I, grade 3 endometrioid adenocarcinoma of the endometrium: an analysis of clinical outcomes and patterns of recurrence. Gynecol Oncol. 2010;116(1):10-14.
  • 21. Gadducci A, Cavazzana A, Cosio S, C DIC, Tana R, Fanucchi A, et al. Lymph-vascular space involvement and outer one-third myometrial invasion are strong predictors of distant haematogeneous failures in patients with stage I-II endometrioid-type endometrial cancer. Anticancer Res. 2009;29(5):1715-1720.
  • 22. Kurman RJ, Carcangiu ML, Herrington CS. World Health Organisation classification of tumours of the female reproductive organs: International agency for research on cancer; 2014.
  • 23. Ries, Lynn A. Gloeckler. Cancer survival among adults: US SEER program, 1988-2001, patient and tumor characteristics. No. 7. US Department of Health and Human Services, National Institutes of Health, National Cancer Institute, 2007.
  • 24. Ferriss JS, Brix W, Tambouret R, DeSimone CP, Stoler M, Modesitt SC. Cervical stromal invasion predicting survival in endometrial cancer. Obstet Gynecol. 2010;116(5):1035-1041.
  • 25. Barakat RR, Markman M, Randall M. Principles and practice of gynecologic oncology: Lippincott Williams & Wilkins; 2009.
  • 26. Nout RA, van de Poll-Franse LV, Lybeert ML, Wárlám-Rodenhuis CC, Jobsen JJ, Mens JW, et al. Long-term outcome and quality of life of patients with endometrial carcinoma treated with or without pelvic radiotherapy in the post operative radiation therapy in endometrial carcinoma 1 (PORTEC-1) trial. J Clin Oncol. 2011;29(13):1692-1700.
There are 26 citations in total.

Details

Primary Language English
Subjects Health Services and Systems (Other)
Journal Section Articles
Authors

Hatice Halis 0000-0002-9938-1856

Sedef Gökhan Açıkgöz 0000-0002-6615-9714

Project Number yok
Publication Date September 30, 2023
Submission Date June 2, 2023
Published in Issue Year 2023

Cite

AMA Halis H, Gökhan Açıkgöz S. Survival, Failure Patterns, and Toxicity Outcomes in Endometrial Cancer Patients Receiving Adjuvant Radiotherapy. Sakarya Tıp Dergisi. September 2023;13(3):465-471. doi:10.31832/smj.1309164

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