Journal article
Improved survival with adjuvant brachytherapy in stage IA endometrial cancer of unfavorable histology
Gynecologic oncology, v 151(1), pp 82-90
01 Oct 2018
PMID: 30170976
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
We evaluated the utilization of vaginal brachytherapy (BT) and the resulting impact on survival in stage IA endometrial cancer of clear cell (CC), papillary serous (PS), and carcinosarcoma (CS) histology.
Patients with uterine cancer diagnosed from 2004 to 2015 were identified from the National Cancer Database. Patients underwent hysterectomy, showing FIGO stage IA disease with CC, PS, or CS histology. Logistic regression was used to evaluate predictors of BT utilization and to generate propensity scores. Survival was compared using log-rank test and Cox proportional hazards modeling, with propensity score adjustment.
We identified 5711 patients who underwent hysterectomy showing FIGO pT1a, N0 or NX endometrial cancer with CC, PS, or CS histology, of which 29.5% received BT. Multivariate predictors of increased receipt of BT were identified. With a median follow-up of 3.3 years, 3-year overall survival (OS) was 87% for those receiving BT versus 78% for those without (p < 0.001). A survival benefit to BT was maintained across histologies. Similar results were seen whether tumor was confined to endometrium or had <50% myometrial invasion. On multivariate analysis, receipt of BT was associated with increased survival (hazard ratio [HR] 0.75, 95% confidence interval 0.65–0.87, p < 0.001). The benefit of BT persisted after propensity score adjustment (HR 0.76, p < 0.001).
In this cohort of women with stage IA endometrial cancer of unfavorable histology, the use of BT was associated with improved survival. In this study, 29.5% of patients in our cohort received BT.
•Adjuvant brachytherapy is associated with improved survival in stage IA endometrial cancer of unfavorable histology.•Utilization of brachytherapy in this clinical scenario is rare currently, at 29.5% of patients from a national cohort.•Adjuvant chemotherapy improves survival in most situations, but may not be beneficial in clear cell patients.•Adjuvant external beam radiation is not routinely beneficial. It may help in those with additional risk factors.
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Details
- Title
- Improved survival with adjuvant brachytherapy in stage IA endometrial cancer of unfavorable histology
- Creators
- Ashwin Shinde - City Of Hope National Medical CenterRichard Li - City Of Hope National Medical CenterArya Amini - City Of Hope National Medical CenterYi-Jen Chen - City Of Hope National Medical CenterMihaela Cristea - City Of Hope National Medical CenterThanh Dellinger - City Of Hope National Medical CenterWenge Wang - City Of Hope National Medical CenterMark Wakabayashi - City Of Hope National Medical CenterSushil Beriwal - University of Pittsburgh Medical CenterScott Glaser - City Of Hope National Medical Center
- Publication Details
- Gynecologic oncology, v 151(1), pp 82-90
- Publisher
- Elsevier
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Radiation Oncology (and Nuclear Medicine)
- Web of Science ID
- WOS:000447815600014
- Scopus ID
- 2-s2.0-85053521394
- Other Identifier
- 991021897270004721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Obstetrics & Gynecology
- Oncology