TY - JOUR
T1 - Adjuvant therapy for early stage, endometrial cancer with lymphovascular space invasion
T2 - Is there a role for chemotherapy?
AU - Beavis, Anna L.
AU - Yen, Ting Tai
AU - Stone, Rebecca L.
AU - Wethington, Stephanie L.
AU - Carr, Caitlin
AU - Son, Ji
AU - Chambers, Laura
AU - Michener, Chad M.
AU - Ricci, Stephanie
AU - Burkett, Wesley C.
AU - Richardson, Debra L.
AU - Staley, Allison Stuart
AU - Ahn, Susie
AU - Gehrig, Paola A.
AU - Torres, Diogo
AU - Dowdy, Sean C.
AU - Sullivan, Mackenzie W.
AU - Modesitt, Susan C.
AU - Watson, Catherine
AU - Veade, Ashely
AU - Ehrisman, Jessie
AU - Havrilesky, Laura
AU - Secord, Angeles Alvarez
AU - Loreen, Amy
AU - Griffin, Kaitlyn
AU - Jackson, Amanda
AU - Viswanathan, Akila N.
AU - Jager, Leah R.
AU - Fader, Amanda N.
N1 - Funding Information:
We would like to acknowledge support for the statistical analysis from Dhananjay Viadya and the National Center for Research Resources and the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health through Grant Number 1UL1TR001079 .
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/3
Y1 - 2020/3
N2 - Objectives: Lymphovascular space invasion (LVSI) is an independent risk factor for recurrence and poor survival in early-stage endometrioid endometrial cancer (EEC), but optimal adjuvant treatment is unknown. We aimed to compare the survival of women with early-stage EEC with LVSI treated postoperatively with observation (OBS), radiation (RAD, external beam and/or vaginal brachytherapy), or chemotherapy (CHEMO)+/−RAD. Methods: This was a multi-institutional, retrospective cohort study of women with stage I or II EEC with LVSI who underwent hysterectomy+/−lymphadenectomy from 2005 to 2015 and received OBS, RAD, or CHEMO+/−RAD postoperatively. Progression-free survival and overall survival were evaluated using Kaplan-Meier estimates and Cox proportional hazards models. Results: In total, 478 women were included; median age was 64 years, median follow-up was 50.3 months. After surgery, 143 (30%) underwent OBS, 232 (48.5%) received RAD, and 103(21.5%) received CHEMO+/−RAD (95% of whom received RAD). Demographics were similar among groups, but those undergoing OBS had lower stage and grade. A total of 101 (21%) women recurred. Progression-free survival (PFS) was improved in both CHEMO+/−RAD (HR = 0.18, 95% CI: 0.09–0.39) and RAD (HR = 0.31, 95% CI: 0.18–0.54) groups compared to OBS, though neither adjuvant therapy was superior to the other. However, in grade 3 tumors, the CHEMO+/−RAD group had superior PFS compared to both RAD (HR 0.25; 95% CI: 0.12–0.52) and OBS cohorts (HR = 0.10, 95% CI: 0.03–0.32). Overall survival did not differ by treatment. Conclusions: In early-stage EEC with LVSI, adjuvant therapy improved PFS compared to observation alone. In those with grade 3 EEC, adjuvant chemotherapy with or without radiation improved PFS compared to observation or radiation alone.
AB - Objectives: Lymphovascular space invasion (LVSI) is an independent risk factor for recurrence and poor survival in early-stage endometrioid endometrial cancer (EEC), but optimal adjuvant treatment is unknown. We aimed to compare the survival of women with early-stage EEC with LVSI treated postoperatively with observation (OBS), radiation (RAD, external beam and/or vaginal brachytherapy), or chemotherapy (CHEMO)+/−RAD. Methods: This was a multi-institutional, retrospective cohort study of women with stage I or II EEC with LVSI who underwent hysterectomy+/−lymphadenectomy from 2005 to 2015 and received OBS, RAD, or CHEMO+/−RAD postoperatively. Progression-free survival and overall survival were evaluated using Kaplan-Meier estimates and Cox proportional hazards models. Results: In total, 478 women were included; median age was 64 years, median follow-up was 50.3 months. After surgery, 143 (30%) underwent OBS, 232 (48.5%) received RAD, and 103(21.5%) received CHEMO+/−RAD (95% of whom received RAD). Demographics were similar among groups, but those undergoing OBS had lower stage and grade. A total of 101 (21%) women recurred. Progression-free survival (PFS) was improved in both CHEMO+/−RAD (HR = 0.18, 95% CI: 0.09–0.39) and RAD (HR = 0.31, 95% CI: 0.18–0.54) groups compared to OBS, though neither adjuvant therapy was superior to the other. However, in grade 3 tumors, the CHEMO+/−RAD group had superior PFS compared to both RAD (HR 0.25; 95% CI: 0.12–0.52) and OBS cohorts (HR = 0.10, 95% CI: 0.03–0.32). Overall survival did not differ by treatment. Conclusions: In early-stage EEC with LVSI, adjuvant therapy improved PFS compared to observation alone. In those with grade 3 EEC, adjuvant chemotherapy with or without radiation improved PFS compared to observation or radiation alone.
KW - Adjuvant treatment
KW - Chemotherapy
KW - Endometrial cancer
KW - Lymphovascular space invasion
KW - Radiation
KW - Uterine cancer
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U2 - 10.1016/j.ygyno.2019.12.028
DO - 10.1016/j.ygyno.2019.12.028
M3 - Article
C2 - 31948730
AN - SCOPUS:85077931918
SN - 0090-8258
VL - 156
SP - 568
EP - 574
JO - Gynecologic oncology
JF - Gynecologic oncology
IS - 3
ER -