Journal article
A Multi-Institutional Analysis of Adjuvant Chemotherapy and Radiation Sequence in Women With Stage IIIC Endometrial Cancer
International journal of radiation oncology, biology, physics, v 110(5), pp 1423-1431
01 Aug 2021
PMID: 33677053
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Purpose: Our purpose was to evaluate the effect of sequence and type of adjuvant therapy for patients with stage IIIC endometrial carcinoma (EC) on outcomes.
Methods and Materials: In a multi-institutional retrospective cohort study, patients with stage IIIC EC who had surgical staging and received both adjuvant chemotherapy and radiation therapy (RT) were included. Adjuvant treatment regimens were classified as adjuvant chemotherapy followed by sequential RT (upfront chemo), which was predominant sequence; RT with concurrent chemotherapy followed by chemotherapy (concurrent); systemic chemotherapy before and after RT (sandwich); adjuvant RT followed by chemotherapy (upfront RT); or chemotherapy concurrent with vaginal cuff brachytherapy alone (chemo-brachy). Overall survival (OS) and recurrence-free survival (RFS) rates were estimated by the Kaplan-Meier method.
Results: A total of 686 eligible patients were included with a median follow-up of 45.3 months. The estimated 5-year OS and RFS rates were 74% and 66%, respectively. The sequence and type of adjuvant therapy were not correlated with OS or RFS (adjusted P = .68 and.84, respectively). On multivariate analysis, black race, nonendometrioid histology, grade 3 tumor, stage IIIC2, and presence of adnexal and cervical involvement were associated with worse OS and RFS (all P <.05). Regardless of the sequence of treatment, the most common site of first recurrence was distant metastasis (20.1%). Vaginal only, pelvic only, and paraortic lymph node (PALN) recurrences occurred in 11 (1.6%),15 (2.2 %), and 43 (6.3 %) patients, respectively. Brachytherapy alone was associated with a higher rate of PALN recurrence (15%) compared with external beam radiation therapy (5%) P <.0001.
Conclusions: The sequence and type of combined adjuvant therapy did not affect OS or RFS rates. Brachytherapy alone was associated with a higher rate of PALN recurrence, emphasizing the role of nodal radiation for stage IIIC EC. The vast proportion of recurrences were distant despite systemic chemotherapy, highlighting the need for novel regimens. (C) 2021 Elsevier Inc. All rights reserved.
Metrics
Details
- Title
- A Multi-Institutional Analysis of Adjuvant Chemotherapy and Radiation Sequence in Women With Stage IIIC Endometrial Cancer
- Creators
- Lara Hathout - Rutgers, The State University of New JerseyYaqun Wang - Rutgers, The State University of New JerseyQingyang Wang - Rutgers, The State University of New JerseyIrina Vergalasova - Rutgers, The State University of New JerseyMohamed A. Elshaikh - The Barbara Ann Karmanos Cancer InstituteIrina Dimitrova - Henry Ford Canc Inst, Dept Gynecol Oncol, Detroit, MI USAShari Damast - Yale UniversityJessie Y. Li - Yale UniversityEmma C. Fields - Virginia Commonwealth UniversitySushil Beriwal - UPMC Hillman Cancer CenterAndrew Keller - UPMC Hillman Cancer CenterElizabeth A. Kidd - Stanford UniversityMelissa Usoz - Stanford UniversityShruti Jolly - University of Michigan–Ann ArborElizabeth Jaworski - University of Michigan–Ann ArborEric W. Leung - Sunnybrook Health Science CentreElysia Donovan - Sunnybrook Health Science CentreNeil K. Taunk - University of PennsylvaniaJunzo Chino - Duke Medical CenterDivya Natesan - Duke Medical CenterAndrea L. Russo - Massachusetts General HospitalJayanthi S. Lea - The University of Texas Southwestern Medical CenterKevin Albuquerque - The University of Texas Southwestern Medical CenterLarissa J. Lee - Dana-Farber Brigham Cancer Center
- Publication Details
- International journal of radiation oncology, biology, physics, v 110(5), pp 1423-1431
- Publisher
- Elsevier
- Number of pages
- 9
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Radiation Oncology (and Nuclear Medicine)
- Web of Science ID
- WOS:000680259900023
- Scopus ID
- 2-s2.0-85103990928
- Other Identifier
- 991021897288704721
UN Sustainable Development Goals (SDGs)
This publication has contributed to the advancement of the following goals:
InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Oncology
- Radiology, Nuclear Medicine & Medical Imaging