Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
권호 표지
DOI QR코드

DOI QR Code

Long Term Outcomes of Patients with Endometrial Carcinoma Treated with Radiation - Siriraj Hospital Experience

  • Setakornnukul, Jiraporn (Division of Radiation Oncology, Siriraj Hospital, Faculty of Medicine, Mahidol University) ;
  • Petsuksiri, Janjira (Division of Radiation Oncology, Siriraj Hospital, Faculty of Medicine, Mahidol University) ;
  • Wanglikitkoon, Sirentra (Udon Thani Cancer Hospital) ;
  • Warnnissorn, Malee (Department of Pathology, Siriraj Hospital, Faculty of Medicine, Mahidol University) ;
  • Thephamongkhol, Kullathorn (Division of Radiation Oncology, Siriraj Hospital, Faculty of Medicine, Mahidol University) ;
  • Chansilp, Yaowalak (Division of Radiation Oncology, Siriraj Hospital, Faculty of Medicine, Mahidol University) ;
  • Veerasarn, Vutisiri (Division of Radiation Oncology, Siriraj Hospital, Faculty of Medicine, Mahidol University)
  • Published : 2014.03.01
Download PDF
⟨ Previous Next ⟩

Abstract

Background: To evaluate treatment outcomes of patients with stage I-III endometrial cancer treated with postoperative radiation. Materials and Methods: A retrospective review of 166 endometrial cancer patients, undergoing surgery and postoperative radiotherapy at Siriraj Hospital from 2005-2008 was performed. Pathology was reviewed. Results of treatment were reported with 5-year loco-regional recurrence free survival (LRRFS), 5-year overall survival (OS), patterns of failure and toxicity, and according to stage and risk groups. Results: Median follow up time was 62.8 months. Pathological changes were found in 36.3% of the patients after central reviews, leading to 19% changes in risk groups. Most of the patients (83.7%) received pelvic radiation (PRT) and vaginal brachytherapy (VBT). Five-year LRRFS and OS of all patients were 94.9% and 85.5%, respectively. There was no recurrence or death in low and low-intermediate risk groups. For the high-intermediate risk group, 5-year LRRFS and OS were 96.2% and 90.8%, respectively, and for the high risk group 90.5% and 71%. Late grade 3 and 5 gastrointestinal toxicity was found in 3% and 1.2% of patients, respectively. All of them received PRT 5,000 cGy in 25 fractions. Conclusions: Low and intermediate risk patients had good results with surgery and adjuvant radiation therapy. For high risk patients, postoperative radiation therapy alone appeared to be inadequate as the most common pattern of failure was distant metastasis.

Keywords

References

  1. Aalders J, Abeler V, Kolstad P, et al (1980). Postoperative external irradiation and prognostic parameters in stage I endometrial carcinoma: clinical and histopathologic study of 540 patients. Obstet Gynecol, 56, 419-27.
  2. AJCC. AJCC Cancer Staging Manual. Seventh, editor (2010). New York: Springer Verlag.
  3. Altman (1991). Practical statistics for medical research. London: Chapman and Hall.
  4. Benedetti Panici P, Basile S, Maneschi F, et al (2008). Systematic pelvic lymphadenectomy vs. no lymphadenectomy in earlystage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst, 100, 1707-16. https://doi.org/10.1093/jnci/djn397
  5. Blake P, Swart AM, Orton J, et al (2009). Adjuvant external beam radiotherapy in the treatment of endometrial cancer (MRC ASTEC and NCIC CTG EN.5 randomised trials): pooled trial results, systematic review, and meta-analysis. Lancet, 373, 137-46. https://doi.org/10.1016/S0140-6736(08)61767-5
  6. Chan JK, Wu H, Cheung MK, et al (2007). The outcomes of 27,063 women with unstaged endometrioid uterine cancer. Gynecol Oncol, 106, 282-8. https://doi.org/10.1016/j.ygyno.2007.05.033
  7. Cox JD, Stetz J, Pajak TF (1995). Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys, 31, 1341-6. https://doi.org/10.1016/0360-3016(95)00060-C
  8. Creasman W (2009). Revised FIGO staging for carcinoma of the endometrium. Int J Gynaecol Obstet, 105, 109. https://doi.org/10.1016/j.ijgo.2009.02.010
  9. Creutzberg CL, van Putten WL, Koper PC, et al (2000). Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC Study Group. Post Operative Radiation Therapy in Endometrial Carcinoma. Lancet, 355, 1404-11. https://doi.org/10.1016/S0140-6736(00)02139-5
  10. Dowdy SC, Borah BJ, Bakkum-Gamez JN, et al (2012). Prospective assessment of survival, morbidity, and cost associated with lymphadenectomy in low-risk endometrial cancer. Gynecol Oncol, 127, 5-10. https://doi.org/10.1016/j.ygyno.2012.06.035
  11. Georgopoulou E, Mirasgedis S, Sarafidis Y, et al (2007). A decision-aid framework to provide guidance for the enhanced use of best available techniques in industry. Environ Manage, 40, 413-29. https://doi.org/10.1007/s00267-006-0131-z
  12. Greven K, Winter K, Underhill K, et al (2006). Final analysis of RTOG 9708: adjuvant postoperative irradiation combined with cisplatin/paclitaxel chemotherapy following surgery for patients with high-risk endometrial cancer. Gynecol Oncol, 103, 155-9. https://doi.org/10.1016/j.ygyno.2006.02.007
  13. Hogberg T, Signorelli M, de Oliveira CF, et al (2010). Sequential adjuvant chemotherapy and radiotherapy in endometrial cancer--results from two randomised studies. Eur J Cancer, 46, 2422-31. https://doi.org/10.1016/j.ejca.2010.06.002
  14. Huscher A, Biqnardi M, Maqri E, et al (2009). Determinants of small bowel toxicity in postoperative pelvic irradiation for gynaecological malignancies. Anticancer Res, 29, 4821-6.
  15. Iraha S, Oqawa K, Moromizato H, et al (2007). Radiation enterocolitis requiring surgery in patients with gynecological malignancies. Int J Radiat Oncol Biol Phys, 68, 1088-93. https://doi.org/10.1016/j.ijrobp.2007.01.040
  16. Keys HM, Roberts JA, Brunetto VL, et al (2004). A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study. Gynecol Oncol, 92, 744-51. https://doi.org/10.1016/j.ygyno.2003.11.048
  17. Kitchener H, Swart AM, Qian Q, et al (2009). Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet, 373, 125-36. https://doi.org/10.1016/S0140-6736(08)61766-3
  18. Kuoppala T, Maenpaa J, Tomas E, et al (2008). Surgically staged high-risk endometrial cancer: randomized study of adjuvant radiotherapy alone vs. sequential chemo-radiotherapy. Gynecol Oncol, 110, 190-5. https://doi.org/10.1016/j.ygyno.2008.03.020
  19. Lutman CV, Havrilesky LJ, Cragun JM, et al (2006). Pelvic lymph node count is an important prognostic variable for FIGO stage I and II endometrial carcinoma with high-risk histology. Gynecol Oncol, 102, 92-7. https://doi.org/10.1016/j.ygyno.2005.11.032
  20. Maggi R, Lissoni A, Spina F, et al (2006). Adjuvant chemotherapy vs radiotherapy in high-risk endometrial carcinoma: results of a randomised trial. Br J Cancer, 95, 266-71. https://doi.org/10.1038/sj.bjc.6603279
  21. Morrow CP, Bundy BN, Homesley HD, et al (1990). Doxorubicin as an adjuvant following surgery and radiation therapy in patients with high-risk endometrial carcinoma, stage I and occult stage II: a Gynecologic Oncology Group Study. Gynecol Oncol, 36, 166-71. https://doi.org/10.1016/0090-8258(90)90166-I
  22. Nout RA, Smit VT, Putter H, et al (2010). Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): an open-label, non-inferiority, randomised trial. Lancet, 375, 816-23. https://doi.org/10.1016/S0140-6736(09)62163-2
  23. Perez CA KB (2004). Principles and practice of radiation oncology. Perez CA., Halperin EC ed. Perez CA. HE.
  24. Randall ME, Filiaci VL, Muss H, et al (2006). Randomized phase III trial of whole-abdominal irradiation versus doxorubicin and cisplatin chemotherapy in advanced endometrial carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol, 24, 36-44. https://doi.org/10.1200/JCO.2004.00.7617
  25. Ratanawichitrasin A (2008). Siriraj Cancer Registry. Bangkok.
  26. Scholten AN, van Putten WL, Beerman H, et al (2005). Postoperative radiotherapy for Stage 1 endometrial carcinoma: long-term outcome of the randomized PORTEC trial with central pathology review. Int J Radiat Oncol Biol Phys, 63, 834-8. https://doi.org/10.1016/j.ijrobp.2005.03.007
  27. Sorbe BG, Horvath G, Andersson H, et al (2012). External pelvic and vaginal irradiation versus vaginal irradiation alone as postoperative therapy in medium-risk endometrial carcinoma: a prospective, randomized study-quality-of-life analysis. Int J Gynecol Cancer, 22, 1281-8. https://doi.org/10.1097/IGC.0b013e3182643ba0
  28. Susumu N, Sagae S, Udagawa Y, et al (2008). Randomized phase III trial of pelvic radiotherapy versus cisplatin-based combined chemotherapy in patients with intermediate- and high-risk endometrial cancer: a Japanese Gynecologic Oncology Group study. Gynecol Oncol, 108, 226-33. https://doi.org/10.1016/j.ygyno.2007.09.029
  29. Tangjitgamol S, Srijaipracharoen S, Manusirivithaya S, et al (2013). Endometrial carcinoma: clinical characteristic and survival rates by the new compared to the prior FIGO staging system. J Med Assoc Thai, 96, 505-12.
  30. Werner HM, Trovik J, Marcickiewicz J, et al (2012). Revision of FIGO surgical staging in 2009 for endometrial cancer validates to improve risk stratification. Gynecol Oncol, 125, 103-8. https://doi.org/10.1016/j.ygyno.2011.11.008

Cited by

  1. Good Outcomes of Patients with Stage IB Endometrial Cancer with Surgery Alone vol.15, pp.9, 2014, https://doi.org/10.7314/APJCP.2014.15.9.3891
  2. Relapse Patterns and Outcomes Following Recurrence of Endometrial Cancer in Northern Thai Women vol.16, pp.9, 2015, https://doi.org/10.7314/APJCP.2015.16.9.3861
  3. Clinical outcomes of stage I endometrial carcinoma patients treated with surgery alone: Siriraj Hospital experiences vol.27, pp.5, 2016, https://doi.org/10.3802/jgo.2016.27.e48