Journal article
Neoadjuvant radiotherapy with or without chemotherapy followed by extrafascial hysterectomy for locally advanced endometrial cancer clinically extending to the cervix or parametria
Gynecologic oncology, v 135(2), pp 190-195
01 Nov 2014
PMID: 25218303
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
For locally-advanced uterine cancer clinically extending to the cervix, two treatment paradigms exist: surgical staging radical hysterectomy with tailored adjuvant therapy or neoadjuvant therapy followed by a less extensive simple hysterectomy. Currently, insufficient data exists to guide consensus guidelines and practical application of preoperative radiotherapy.
Retrospective IRB approved cohort study from 1999 to 2014 of 36 endometrial cancer patients with clinical involvement of cervix±parametria treated with neoadjuvant external beam radiotherapy (45–50.4Gy in 25–28 fractions) and image-based HDR brachytherapy (5–5.5Gy times 3–4 fractions)±chemotherapy followed by extrafascial hysterectomy performed at a median of 6weeks after radiotherapy.
All patients had clinical cervical extension, 50% also had parametria extension, and 31% had nodal involvement. At the time of surgery 91% had no clinical cervical involvement, 58% had no pathologic cervical involvement, and all had margin negative resection. The pathologic complete response rate was 24%. Median follow-up from the time of surgery was 20months (range: 0–153). The 3-year local control, regional control, distant control, disease free survival and overall survival rates were 96%, 89%, 84%, 73%, and 100%. The 3-year rate of grade 3 complications was 11%, with no grade 4+ toxicity.
Neoadjuvant radiation therapy±chemotherapy followed by extrafascial hysterectomy appears to be a viable option for patients with endometrial cancer clinically extending to the cervix and parametria. The HDR brachytherapy schema of 5–5.5Gy times 3–4 fractions, for a cumulative EQD2 of 60–70Gy, is well tolerated with high rates of clinical and pathological response.
•Clinical stage II or IIIB endometrial cancer, pre-operative chemoradiotherapy followed by extrafascial hysterectomy.•High rates of clinical and pathologic response, low rates of toxicity.•Impact of image-based HDR brachytherapy, chemotherapy, and PET/CT staging.
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Details
- Title
- Neoadjuvant radiotherapy with or without chemotherapy followed by extrafascial hysterectomy for locally advanced endometrial cancer clinically extending to the cervix or parametria
- Creators
- John A. Vargo - UPMC Hillman Cancer CenterMichelle M. Boisen - UPMC Hillman Cancer CenterJohn T. Comerci - UPMC Hillman Cancer CenterHayeon Kim - UPMC Hillman Cancer CenterChristopher J. Houser - UPMC Hillman Cancer CenterPaniti Sukumvanich - UPMC Hillman Cancer CenterAlexander B. Olawaiye - UPMC Hillman Cancer CenterJoseph L. Kelley - UPMC Hillman Cancer CenterRobert P. Edwards - UPMC Hillman Cancer CenterMarilyn Huang - UPMC Hillman Cancer CenterMadeleine Courtney-Brooks - UPMC Hillman Cancer CenterSushil Beriwal - UPMC Hillman Cancer Center
- Publication Details
- Gynecologic oncology, v 135(2), pp 190-195
- Publisher
- Elsevier
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Radiation Oncology (and Nuclear Medicine)
- Web of Science ID
- WOS:000345605200004
- Scopus ID
- 2-s2.0-84913607541
- Other Identifier
- 991021897272104721
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InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Web of Science research areas
- Obstetrics & Gynecology
- Oncology