A multicenter analysis of adjuvant therapy after surgery for stage IIIC endometrial adenocarcinoma: A Korean Radiation Oncology Group study (KROG 13-17)

Mee Sun Yoon, Won Park, Seung Jae Huh, Hak Jae Kim, Young Seok Kim, Yong Bae Kim, Joo Young Kim, Jong Hoon Lee, Hun Jung Kim, Jihye Cha, Jin Hee Kim, Juree Kim, Won Sup Yoon, Jin Hwa Choi, Mison Chun, Youngmin Choi, Sei Kyung Chang, Kang Kyoo Lee, Myungsoo Kim

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Abstract

Objective To investigate whether combined chemoradiotherapy (CTRT) confers a benefit for survival outcome over radiotherapy (RT) alone after primary surgery in patients with FIGO stage IIIC endometrial adenocarcinoma. Methods We conducted a multicenter retrospective study of patients with surgical stage IIIC endometrial cancer from 1990 to 2011. Adjuvant RT alone was performed in 85 patients (40.3%) and adjuvant CTRT in 126 patients (59.7%). Disease-free survival (DFS) and overall survival (OS) were analyzed using Kaplan-Meier method and Cox proportional hazards model. Results Stage IIIC1 and stage IIIC2 accounted for 63% and 37%, respectively. FIGO IIIC2 had a higher recurrence rate than FIGO IIIC1 (38.5% vs. 29.3%, p = 0.172). Five-year OS and DFS were lower in FIGO IIIC2 than FIGO IIIC1 (85.1% vs. 76.9%, p = 0.417; 71.0% vs. 59.2%, p = 0.108, respectively). Eighteen patients (13.5%) in stage IIIC1 developed PALN recurrence, whereas only one (3.3%) in stage IIIC2 had PALN recurrence (p = 0.001). In multivariate analysis, predictors of DFS were parametrial invasion (HR, 3.49; 95% CI, 1.83-6.64; p < 0.001), higher grade (HR, 2.78; 95% CI, 1.31-5.89; p = 0.008), and > 3 positive pelvic nodes (HR, 1.84; 95% CI, 1.11-3.05; p = 0.019). Combined CTRT did not affect DFS or OS in IIIC1 and IIIC2 compared with RT alone. Conclusion CTRT showed comparable survival outcome to RT alone. Half of relapses (46%) in stage IIIC1 occurred in PALN region, whereas relapse in stage IIIC2 primarily occurred in distant metastasis (90%). Future randomized studies are needed to determine which subgroup may be most likely to benefit from CCRT.

Original languageEnglish
Pages (from-to)519-525
Number of pages7
JournalGynecologic Oncology
Volume138
Issue number3
DOIs
Publication statusPublished - 2015 Sep 1

Keywords

  • Adjuvant chemoradiotherapy
  • Adjuvant radiotherapy
  • Endometrial cancer

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynaecology

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    Yoon, M. S., Park, W., Huh, S. J., Kim, H. J., Kim, Y. S., Kim, Y. B., Kim, J. Y., Lee, J. H., Kim, H. J., Cha, J., Kim, J. H., Kim, J., Yoon, W. S., Choi, J. H., Chun, M., Choi, Y., Chang, S. K., Lee, K. K., & Kim, M. (2015). A multicenter analysis of adjuvant therapy after surgery for stage IIIC endometrial adenocarcinoma: A Korean Radiation Oncology Group study (KROG 13-17). Gynecologic Oncology, 138(3), 519-525. https://doi.org/10.1016/j.ygyno.2015.06.030