Adjuvant treatment after surgery in stage IIIA endometrial adenocarcinoma

Mee Sun Yoon, 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, Kang Kyoo Lee, Myungsoo Kim, Jae Uk Jeong, Sei Kyung Chang, Won Park

Research output: Contribution to journalArticle

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Abstract

Purpose We evaluated the role of adjuvant therapy in stage IIIA endometrioid adenocarcinoma patients who underwent surgery followed by radiotherapy (RT) alone or chemoradiotherapy (CTRT) according to risk group. Materials and Methods A multicenter retrospective study was conducted including patients with surgical stage IIIA endometrial cancer treated by radical surgery and adjuvant RT or CTRT. Disease-free survival (DFS) and overall survival (OS) were analyzed. Results Ninety-three patients with stage IIIA disease were identified. Nineteen patients (20.4%) experienced recurrence, mostly distant metastasis (17.2%). Combined CTRT did not affect DFS (74.1% vs. 82.4%, p=0.130) or OS (96.3% vs. 91.9%, p=0.262) in stage IIIA disease compared with RT alone. Patients with age ≥ 60 years, grade G2/3, and lymphovascular space involvement had a significantly worse DFS and those variables were defined as risk factors. The high-risk group showed a significant reduction in 5-year DFS (≥ 2 risk factors) (49.0% vs. 88.0%, p < 0.001) compared with the low-risk group (< 2). Multivariate analysis confirmed that more than one risk factor was the only predictor of worse DFS (hazard ratio, 5.45; 95% confidence interval, 2.12 to 13.98; p < 0.001). Of patients with no risk factors, a subset treated with RT alone showed an excellent 5-year DFS and OS (93.8% and 100%, respectively). Conclusion We identified a low-risk subset of stage IIIA endometrioid adenocarcinoma patients who might be reasonable candidates for adjuvant RT alone. Further randomized studies are needed to determine which subset might benefit from combined CTRT.

Original languageEnglish
Pages (from-to)1074-1083
Number of pages10
JournalCancer Research and Treatment
Volume48
Issue number3
DOIs
Publication statusPublished - 2016 Jan 1

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Adenocarcinoma
Disease-Free Survival
Endometrioid Carcinoma
Adjuvant Radiotherapy
Radiotherapy
Therapeutics
Survival
Chemoradiotherapy
Endometrial Neoplasms
Multicenter Studies
Multivariate Analysis
Retrospective Studies
Confidence Intervals
Neoplasm Metastasis
Recurrence

Keywords

  • Adjuvant chemoradiotherapy
  • Adjuvant radiotherapy
  • Endometrial neoplasms

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Yoon, M. S., Huh, S. J., Kim, H. J., Kim, Y. S., Kim, Y. B., Kim, J. Y., ... Park, W. (2016). Adjuvant treatment after surgery in stage IIIA endometrial adenocarcinoma. Cancer Research and Treatment, 48(3), 1074-1083. https://doi.org/10.4143/crt.2015.356

Adjuvant treatment after surgery in stage IIIA endometrial adenocarcinoma. / Yoon, Mee Sun; Huh, Seung Jae; Kim, Hak Jae; Kim, Young Seok; Kim, Yong Bae; Kim, Joo Young; Lee, Jong Hoon; Kim, Hun Jung; Cha, Jihye; Kim, Jin Hee; Kim, Juree; Yoon, Won Sup; Choi, Jin Hwa; Chun, Mison; Choi, Youngmin; Lee, Kang Kyoo; Kim, Myungsoo; Jeong, Jae Uk; Chang, Sei Kyung; Park, Won.

In: Cancer Research and Treatment, Vol. 48, No. 3, 01.01.2016, p. 1074-1083.

Research output: Contribution to journalArticle

Yoon, MS, Huh, SJ, Kim, HJ, Kim, YS, Kim, YB, Kim, JY, Lee, JH, Kim, HJ, Cha, J, Kim, JH, Kim, J, Yoon, WS, Choi, JH, Chun, M, Choi, Y, Lee, KK, Kim, M, Jeong, JU, Chang, SK & Park, W 2016, 'Adjuvant treatment after surgery in stage IIIA endometrial adenocarcinoma', Cancer Research and Treatment, vol. 48, no. 3, pp. 1074-1083. https://doi.org/10.4143/crt.2015.356
Yoon, Mee Sun ; Huh, Seung Jae ; Kim, Hak Jae ; Kim, Young Seok ; Kim, Yong Bae ; Kim, Joo Young ; Lee, Jong Hoon ; Kim, Hun Jung ; Cha, Jihye ; Kim, Jin Hee ; Kim, Juree ; Yoon, Won Sup ; Choi, Jin Hwa ; Chun, Mison ; Choi, Youngmin ; Lee, Kang Kyoo ; Kim, Myungsoo ; Jeong, Jae Uk ; Chang, Sei Kyung ; Park, Won. / Adjuvant treatment after surgery in stage IIIA endometrial adenocarcinoma. In: Cancer Research and Treatment. 2016 ; Vol. 48, No. 3. pp. 1074-1083.
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abstract = "Purpose We evaluated the role of adjuvant therapy in stage IIIA endometrioid adenocarcinoma patients who underwent surgery followed by radiotherapy (RT) alone or chemoradiotherapy (CTRT) according to risk group. Materials and Methods A multicenter retrospective study was conducted including patients with surgical stage IIIA endometrial cancer treated by radical surgery and adjuvant RT or CTRT. Disease-free survival (DFS) and overall survival (OS) were analyzed. Results Ninety-three patients with stage IIIA disease were identified. Nineteen patients (20.4{\%}) experienced recurrence, mostly distant metastasis (17.2{\%}). Combined CTRT did not affect DFS (74.1{\%} vs. 82.4{\%}, p=0.130) or OS (96.3{\%} vs. 91.9{\%}, p=0.262) in stage IIIA disease compared with RT alone. Patients with age ≥ 60 years, grade G2/3, and lymphovascular space involvement had a significantly worse DFS and those variables were defined as risk factors. The high-risk group showed a significant reduction in 5-year DFS (≥ 2 risk factors) (49.0{\%} vs. 88.0{\%}, p < 0.001) compared with the low-risk group (< 2). Multivariate analysis confirmed that more than one risk factor was the only predictor of worse DFS (hazard ratio, 5.45; 95{\%} confidence interval, 2.12 to 13.98; p < 0.001). Of patients with no risk factors, a subset treated with RT alone showed an excellent 5-year DFS and OS (93.8{\%} and 100{\%}, respectively). Conclusion We identified a low-risk subset of stage IIIA endometrioid adenocarcinoma patients who might be reasonable candidates for adjuvant RT alone. Further randomized studies are needed to determine which subset might benefit from combined CTRT.",
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T1 - Adjuvant treatment after surgery in stage IIIA endometrial adenocarcinoma

AU - Yoon, Mee Sun

AU - Huh, Seung Jae

AU - Kim, Hak Jae

AU - Kim, Young Seok

AU - Kim, Yong Bae

AU - Kim, Joo Young

AU - Lee, Jong Hoon

AU - Kim, Hun Jung

AU - Cha, Jihye

AU - Kim, Jin Hee

AU - Kim, Juree

AU - Yoon, Won Sup

AU - Choi, Jin Hwa

AU - Chun, Mison

AU - Choi, Youngmin

AU - Lee, Kang Kyoo

AU - Kim, Myungsoo

AU - Jeong, Jae Uk

AU - Chang, Sei Kyung

AU - Park, Won

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Purpose We evaluated the role of adjuvant therapy in stage IIIA endometrioid adenocarcinoma patients who underwent surgery followed by radiotherapy (RT) alone or chemoradiotherapy (CTRT) according to risk group. Materials and Methods A multicenter retrospective study was conducted including patients with surgical stage IIIA endometrial cancer treated by radical surgery and adjuvant RT or CTRT. Disease-free survival (DFS) and overall survival (OS) were analyzed. Results Ninety-three patients with stage IIIA disease were identified. Nineteen patients (20.4%) experienced recurrence, mostly distant metastasis (17.2%). Combined CTRT did not affect DFS (74.1% vs. 82.4%, p=0.130) or OS (96.3% vs. 91.9%, p=0.262) in stage IIIA disease compared with RT alone. Patients with age ≥ 60 years, grade G2/3, and lymphovascular space involvement had a significantly worse DFS and those variables were defined as risk factors. The high-risk group showed a significant reduction in 5-year DFS (≥ 2 risk factors) (49.0% vs. 88.0%, p < 0.001) compared with the low-risk group (< 2). Multivariate analysis confirmed that more than one risk factor was the only predictor of worse DFS (hazard ratio, 5.45; 95% confidence interval, 2.12 to 13.98; p < 0.001). Of patients with no risk factors, a subset treated with RT alone showed an excellent 5-year DFS and OS (93.8% and 100%, respectively). Conclusion We identified a low-risk subset of stage IIIA endometrioid adenocarcinoma patients who might be reasonable candidates for adjuvant RT alone. Further randomized studies are needed to determine which subset might benefit from combined CTRT.

AB - Purpose We evaluated the role of adjuvant therapy in stage IIIA endometrioid adenocarcinoma patients who underwent surgery followed by radiotherapy (RT) alone or chemoradiotherapy (CTRT) according to risk group. Materials and Methods A multicenter retrospective study was conducted including patients with surgical stage IIIA endometrial cancer treated by radical surgery and adjuvant RT or CTRT. Disease-free survival (DFS) and overall survival (OS) were analyzed. Results Ninety-three patients with stage IIIA disease were identified. Nineteen patients (20.4%) experienced recurrence, mostly distant metastasis (17.2%). Combined CTRT did not affect DFS (74.1% vs. 82.4%, p=0.130) or OS (96.3% vs. 91.9%, p=0.262) in stage IIIA disease compared with RT alone. Patients with age ≥ 60 years, grade G2/3, and lymphovascular space involvement had a significantly worse DFS and those variables were defined as risk factors. The high-risk group showed a significant reduction in 5-year DFS (≥ 2 risk factors) (49.0% vs. 88.0%, p < 0.001) compared with the low-risk group (< 2). Multivariate analysis confirmed that more than one risk factor was the only predictor of worse DFS (hazard ratio, 5.45; 95% confidence interval, 2.12 to 13.98; p < 0.001). Of patients with no risk factors, a subset treated with RT alone showed an excellent 5-year DFS and OS (93.8% and 100%, respectively). Conclusion We identified a low-risk subset of stage IIIA endometrioid adenocarcinoma patients who might be reasonable candidates for adjuvant RT alone. Further randomized studies are needed to determine which subset might benefit from combined CTRT.

KW - Adjuvant chemoradiotherapy

KW - Adjuvant radiotherapy

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