Primary radiation therapy for medically inoperable patients with clinical stage I and II endometrial carcinoma

doi:10.1016/j.ygyno.2011.09.022

Gynecologic Oncology

Volume 124, Issue 1, January 2012, Pages 36-41

https://doi.org/10.1016/j.ygyno.2011.09.022 Get rights and content

Abstract

Objective

To determine the outcomes associated with primary radiation therapy for medically inoperable, clinical stage I and II, endometrial adenocarcinoma (EAC).

Methods

A multi-institution, retrospective chart review from January 1997 to January 2009 was performed. Overall survival (OS), disease-specific survival (DSS), progression-free survival (PFS) and time to progression (TTP) were assessed using the Kaplan–Meier method. Disease-specific survival was analyzed using a competing risks approach.

Results

Seventy-four patients were evaluable. The median age and BMI were 65 years (range 36–92 years) and 46 kg/m² (range 23–111 kg/m²), respectively. 85.1% had severe systemic disease, most frequently cardiopulmonary risk and morbid obesity. With a mean follow-up of 31 months, 13 patients (17.6%) experienced a recurrence. The median PFS and OS were 43.5 months and 47.2 months, respectively. Overall, 35 women died, including 4 women who died of unknown cause. Of the remaining 31 women, 7 patients (9.5%) died of disease, while 24 died of other causes (32.4%). The hazard ratio comparing the risk of death due to other causes to the risk of death due to disease was 3.4 (95% CI 1.4–9.4, p = 0.003). Among patients who are alive three years after diagnosis, 14% recurred and the conditional recurrence estimate did not exceed 16%.

Conclusions

Primary radiation therapy for clinical stage I and II EAC is a feasible option for medically inoperable patients and provides disease control, with fewer than 16% of surviving patients experiencing recurrence.

Highlights

► Primary radiation therapy for stage I and II endometrial cancer is a feasible option. ► The probability of cancer recurrence in patients receiving such treatment is 15%. ► These patients are 3.4 times likely to die from causes other than endometrial cancer.

Introduction

Endometrial adenocarcinoma is the most common gynecologic cancer in the United States. It is the 4th most common malignancy among American women, with 43,470 new cases and 7950 deaths from disease reported in 2010 [1]. The majority of patients present with an abnormal uterine bleeding which leads to an early diagnosis with favorable disease distribution and an excellent prognosis [2]. Although the cornerstone of therapy is surgery, including hysterectomy, bilateral salpingo-oophorectomy, and staging, 3.5–9% of patients will not undergo a surgical procedure due to medical co-morbidities [3], [4], [5], [6]. For these patients, primary radiation is an option for curative therapy.

There is limited data describing clinical outcomes in women with early stage endometrial cancer who are treated primarily with modern radiation therapy. Documented 5-year survival rates range from 24 to 88%. However, the majority of these studies were published prior to 1998, involve a limited number of patients, and describe heterogeneous treatments [3], [4], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21]. Counseling these women regarding endometrial cancer prognosis presents a challenge to the gynecologic and radiation oncologists. Thus, we aim to define survival expectations for this high risk group of patients, undergoing modern primary radiation therapy for clinical stage I and II endometrial adenocarcinoma.

Section snippets

Materials and methods

An Institutional Review Board approval was obtained from the University of Kentucky, Cleveland Clinic, The Ohio State University, Duke University, and Indiana University. A chart review of eligible patients from January 1997 to January 2009 was performed and included the electronic medical records, cancer registries, radiation oncology records, gynecologic oncology charts and their databases. Eligibility criteria included medically inoperable patients with clinical stage I or II endometrial

Results

From January 1997 to January 2009, 119 medically inoperable patients in five collaborating institutions treated with primary radiation therapy for histologically confirmed epithelial adenocarcinoma of the endometrium were initially identified. A median of 15 patients was reported per institution (range: 6–65 patients). Forty five patients were excluded from the study for the following reasons: hormonal therapy alone or in sequence with radiation therapy (18), previous or subsequent diagnosis of

Discussion

This study demonstrates that primary radiation therapy is a feasible treatment option for medically inoperable patients with clinical stage I and II endometrial adenocarcinoma. The overall median survival of 47.2 months is consistent with the literature prior to 1998 that reported median overall survival spans from 37 to 50 months [3], [7], [8], [9], [10], [11], [13], [14], [15], [16], [17], [18], [19], [20], [27], [28]. We found that patients treated with primary radiation therapy were 3.4 times

Conflicts of interest statement

We have no conflicts of interest to declare.

Acknowledgments

We wanted to recognize John R. van Nagell, M.D. (University of Kentucky), Christopher P. DeSimone, M.D. (University of Kentucky), Frederick B. Stehman, M.D. (Indiana University School of Medicine), Angeles Alvarez Secord, M.D. (Duke University Medical Center), and Laura J. Havrilesky, M.D., M.H. Sc. (Duke University Medical Center), for their important contributions to the development of this manuscript.

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Primary radiation therapy for medically inoperable patients with clinical stage I and II endometrial carcinoma☆

Abstract

Objective

Methods

Results

Conclusions

Highlights

Introduction

Section snippets

Materials and methods

Results

Discussion

Conflicts of interest statement

Acknowledgments

Int J Gynaecol Obstet

Int J Radiat Oncol Biol Phys

Gynecol Oncol

Int J Radiat Oncol Biol Phys

Gynecol Oncol

Gynecol Oncol

Int J Radiat Oncol Biol Phys

Am J Obstet Gynecol

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

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Int J Radiat Oncol Biol Phys

Int J Radiat Oncol Biol Phys

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