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Abstract
Objective
Locally advanced endometrioid adenocarcinoma (LA-EAC) accounts for the majority of deaths for this cancer, yet there is no consensus on adjuvant treatment after surgery. Past studies suggest that combined modality treatment (CMT) may improve outcomes over treatment with chemotherapy (CT) or radiation therapy (RT, either external beam radiotherapy [EBRT] or vaginal brachytherapy [VBT]) alone. Using a large US-based population-based registry, we evaluated adjuvant CMT in LA-EAC and the relative benefit of regional EBRT compared to focused VBT.
Methods
We studied patients diagnosed with Stage III LA-EAC between 2004 and 2013 from the National Cancer Data Base (NCDB). We used Cox regression and a log-rank test to assess survival based on treatment with CT alone, EBRT alone, VBT alone, or CMT with EBRT and/or VBT. We used a χ2 test to compare covariates between patients receiving CMT with EBRT or VBT.
Results
Patients who received CMT had better survival than those who received CT or EBRT/VBT alone. Compared to CMT with VBT, patients who received CMT with EBRT were slightly older and had more advanced-stage or positive nodes, and fewer had lymph node surgery. We found no survival difference between CMT with EBRT and CMT with VBT even when categorizing patients as high or low risk according to age, grade, and stage (low-risk p=0.3460; high-risk p=0.2158).
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Fig. 1.
CONSORT diagram of patients with stage III endometrioid adenocarcinoma from NCDB receiving adjuvant therapy. CT, chemotherapy; EBRT, external beam radiotherapy; EC, endometrial cancer; NCDB, National Cancer Data Base; RT, radiation therapy; VBT, vaginal brachytherapy.
Fig. 2.
Survival of patients with LA-EAC according to adjuvant treatment modality. CMT with either EBRT or VBT had better survival compared to monotherapy. CI, confidence interval; CMT, combined modality treatment; CT, chemotherapy; EBRT, external beam radiotherapy; HR, hazard ratio; LA-EAC, locally advanced endometrioid adenocarcinoma; OS, overall survival; VBT, vaginal brachytherapy.
Fig. 3.
Survival of patients receiving adjuvant hemoradiation. (A) Low-risk (age <60, grade 1–2, stage IIIA) patients according to type of adjuvant radiation modality. (B) High-risk (age >60, grade 3–4, stage IIIC) patients according to type of adjuvant radiation modality. CT, chemotherapy; EBRT, external beam radiotherapy; OS, overall survival; VBT, vaginal brachytherapy.
Table 1.
Demographics and clinical characteristics according to adjuvant CMT
Table 2.
Multivariate analysis of survival by CMT
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