Adjuvant therapy for early stage, endometrial cancer with lymphovascular space invasion: Is there a role for chemotherapy?
Lymphovascular space invasion (LVSI) is an independent risk factor for recurrence and poor survival in early-stage endometrioid endometrial cancer (EEC), but optimal adjuvant treatment is unknown. We aimed to compare the survival of women with early-stage EEC with LVSI treated postoperatively with o...
Gespeichert in:
| Veröffentlicht in: | Gynecologic oncology 2020-03, Vol.156 (3), p.568-574 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 574 |
|---|---|
| container_issue | 3 |
| container_start_page | 568 |
| container_title | Gynecologic oncology |
| container_volume | 156 |
| creator | Beavis, Anna L. Yen, Ting-Tai Stone, Rebecca L. Wethington, Stephanie L. Carr, Caitlin Son, Ji Chambers, Laura Michener, Chad M. Ricci, Stephanie Burkett, Wesley C. Richardson, Debra L. Staley, Allison-Stuart Ahn, Susie Gehrig, Paola A. Torres, Diogo Dowdy, Sean C. Sullivan, Mackenzie W. Modesitt, Susan C. Watson, Catherine Veade, Ashely Ehrisman, Jessie Havrilesky, Laura Secord, Angeles Alvarez Loreen, Amy Griffin, Kaitlyn Jackson, Amanda Viswanathan, Akila N. Jager, Leah R. Fader, Amanda N. |
| description | Lymphovascular space invasion (LVSI) is an independent risk factor for recurrence and poor survival in early-stage endometrioid endometrial cancer (EEC), but optimal adjuvant treatment is unknown. We aimed to compare the survival of women with early-stage EEC with LVSI treated postoperatively with observation (OBS), radiation (RAD, external beam and/or vaginal brachytherapy), or chemotherapy (CHEMO)+/−RAD.
This was a multi-institutional, retrospective cohort study of women with stage I or II EEC with LVSI who underwent hysterectomy+/−lymphadenectomy from 2005 to 2015 and received OBS, RAD, or CHEMO+/−RAD postoperatively. Progression-free survival and overall survival were evaluated using Kaplan-Meier estimates and Cox proportional hazards models.
In total, 478 women were included; median age was 64 years, median follow-up was 50.3 months. After surgery, 143 (30%) underwent OBS, 232 (48.5%) received RAD, and 103(21.5%) received CHEMO+/−RAD (95% of whom received RAD). Demographics were similar among groups, but those undergoing OBS had lower stage and grade. A total of 101 (21%) women recurred. Progression-free survival (PFS) was improved in both CHEMO+/−RAD (HR = 0.18, 95% CI: 0.09–0.39) and RAD (HR = 0.31, 95% CI: 0.18–0.54) groups compared to OBS, though neither adjuvant therapy was superior to the other. However, in grade 3 tumors, the CHEMO+/−RAD group had superior PFS compared to both RAD (HR 0.25; 95% CI: 0.12–0.52) and OBS cohorts (HR = 0.10, 95% CI: 0.03–0.32). Overall survival did not differ by treatment.
In early-stage EEC with LVSI, adjuvant therapy improved PFS compared to observation alone. In those with grade 3 EEC, adjuvant chemotherapy with or without radiation improved PFS compared to observation or radiation alone.
•In this cohort of early-stage endometrioid endometrial cancer cases with LVSI, 28% who underwent observation alone recurred.•Adjuvant therapy (radiation or chemotherapy) improved progression-free survival in early-stage endometrial cancer with LVSI•In high-grade tumors with LVSI, chemotherapy +/- radiation improved PFS compared to radiation or observation |
| doi_str_mv | 10.1016/j.ygyno.2019.12.028 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7388269</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0090825819318499</els_id><sourcerecordid>2341631498</sourcerecordid><originalsourceid>FETCH-LOGICAL-c459t-93ce139ac3846aa43672043d4b963a77104c43e7b8414b3f4cad5351835d85cd3</originalsourceid><addsrcrecordid>eNp9kc1u1DAURi1ERYfCEyAhL1mQ1H9JbCSKqgpopUpsYG3dce5MPEriYCeDwtOTzgwVbLqyZH_3fFc-hLzhLOeMl5e7fN7OfcgF4ybnImdCPyMrzkyRlbowz8mKMcMyLQp9Tl6mtGOMScbFC3IuuVG6kmxFfl_Xu2kP_UjHBiMMM92ESBFiO9M0whbfU-zr0OEYPbTUQe8w0l9-bGg7d0MT9pDc1EKkaQCH1PfLhQ_9B3qXDkikQGNo8cB1DXbhVPTpFTnbQJvw9em8ID--fP5-c5vdf_t6d3N9nzlVmDEz0iGXBpzUqgRQsqwEU7JWa1NKqCrOlFMSq7VWXK3lRjmoC1lwLYtaF66WF-TqyB2mdYe1w36M0Noh-g7ibAN4-_9L7xu7DXtbSa1FaRbAuxMghp8TptF2PjlsW-gxTMkKqXgpuTJ6icpj1MWQUsTNYw1n9sGa3dmDNftgzXJhF2vL1Nt_N3yc-atpCXw8BnD5p73HaJPzuKiofUQ32jr4Jwv-AHvJrOg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2341631498</pqid></control><display><type>article</type><title>Adjuvant therapy for early stage, endometrial cancer with lymphovascular space invasion: Is there a role for chemotherapy?</title><source>MEDLINE</source><source>Access via ScienceDirect (Elsevier)</source><creator>Beavis, Anna L. ; Yen, Ting-Tai ; Stone, Rebecca L. ; Wethington, Stephanie L. ; Carr, Caitlin ; Son, Ji ; Chambers, Laura ; Michener, Chad M. ; Ricci, Stephanie ; Burkett, Wesley C. ; Richardson, Debra L. ; Staley, Allison-Stuart ; Ahn, Susie ; Gehrig, Paola A. ; Torres, Diogo ; Dowdy, Sean C. ; Sullivan, Mackenzie W. ; Modesitt, Susan C. ; Watson, Catherine ; Veade, Ashely ; Ehrisman, Jessie ; Havrilesky, Laura ; Secord, Angeles Alvarez ; Loreen, Amy ; Griffin, Kaitlyn ; Jackson, Amanda ; Viswanathan, Akila N. ; Jager, Leah R. ; Fader, Amanda N.</creator><creatorcontrib>Beavis, Anna L. ; Yen, Ting-Tai ; Stone, Rebecca L. ; Wethington, Stephanie L. ; Carr, Caitlin ; Son, Ji ; Chambers, Laura ; Michener, Chad M. ; Ricci, Stephanie ; Burkett, Wesley C. ; Richardson, Debra L. ; Staley, Allison-Stuart ; Ahn, Susie ; Gehrig, Paola A. ; Torres, Diogo ; Dowdy, Sean C. ; Sullivan, Mackenzie W. ; Modesitt, Susan C. ; Watson, Catherine ; Veade, Ashely ; Ehrisman, Jessie ; Havrilesky, Laura ; Secord, Angeles Alvarez ; Loreen, Amy ; Griffin, Kaitlyn ; Jackson, Amanda ; Viswanathan, Akila N. ; Jager, Leah R. ; Fader, Amanda N.</creatorcontrib><description>Lymphovascular space invasion (LVSI) is an independent risk factor for recurrence and poor survival in early-stage endometrioid endometrial cancer (EEC), but optimal adjuvant treatment is unknown. We aimed to compare the survival of women with early-stage EEC with LVSI treated postoperatively with observation (OBS), radiation (RAD, external beam and/or vaginal brachytherapy), or chemotherapy (CHEMO)+/−RAD.
This was a multi-institutional, retrospective cohort study of women with stage I or II EEC with LVSI who underwent hysterectomy+/−lymphadenectomy from 2005 to 2015 and received OBS, RAD, or CHEMO+/−RAD postoperatively. Progression-free survival and overall survival were evaluated using Kaplan-Meier estimates and Cox proportional hazards models.
In total, 478 women were included; median age was 64 years, median follow-up was 50.3 months. After surgery, 143 (30%) underwent OBS, 232 (48.5%) received RAD, and 103(21.5%) received CHEMO+/−RAD (95% of whom received RAD). Demographics were similar among groups, but those undergoing OBS had lower stage and grade. A total of 101 (21%) women recurred. Progression-free survival (PFS) was improved in both CHEMO+/−RAD (HR = 0.18, 95% CI: 0.09–0.39) and RAD (HR = 0.31, 95% CI: 0.18–0.54) groups compared to OBS, though neither adjuvant therapy was superior to the other. However, in grade 3 tumors, the CHEMO+/−RAD group had superior PFS compared to both RAD (HR 0.25; 95% CI: 0.12–0.52) and OBS cohorts (HR = 0.10, 95% CI: 0.03–0.32). Overall survival did not differ by treatment.
In early-stage EEC with LVSI, adjuvant therapy improved PFS compared to observation alone. In those with grade 3 EEC, adjuvant chemotherapy with or without radiation improved PFS compared to observation or radiation alone.
•In this cohort of early-stage endometrioid endometrial cancer cases with LVSI, 28% who underwent observation alone recurred.•Adjuvant therapy (radiation or chemotherapy) improved progression-free survival in early-stage endometrial cancer with LVSI•In high-grade tumors with LVSI, chemotherapy +/- radiation improved PFS compared to radiation or observation</description><identifier>ISSN: 0090-8258</identifier><identifier>EISSN: 1095-6859</identifier><identifier>DOI: 10.1016/j.ygyno.2019.12.028</identifier><identifier>PMID: 31948730</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adjuvant treatment ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Endometrioid - drug therapy ; Carcinoma, Endometrioid - pathology ; Carcinoma, Endometrioid - radiotherapy ; Carcinoma, Endometrioid - surgery ; Chemoradiotherapy, Adjuvant ; Chemotherapy ; Chemotherapy, Adjuvant ; Cohort Studies ; Disease-Free Survival ; Endometrial cancer ; Endometrial Neoplasms - drug therapy ; Endometrial Neoplasms - pathology ; Endometrial Neoplasms - radiotherapy ; Endometrial Neoplasms - surgery ; Female ; Humans ; Hysterectomy ; Lymph Node Excision ; Lymphatic Metastasis ; Lymphovascular space invasion ; Middle Aged ; Neoplasm Grading ; Neoplasm Metastasis ; Neoplasm Staging ; Radiation ; Retrospective Studies ; Survival Rate ; Uterine cancer</subject><ispartof>Gynecologic oncology, 2020-03, Vol.156 (3), p.568-574</ispartof><rights>2020 Elsevier Inc.</rights><rights>Copyright © 2020 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c459t-93ce139ac3846aa43672043d4b963a77104c43e7b8414b3f4cad5351835d85cd3</citedby><cites>FETCH-LOGICAL-c459t-93ce139ac3846aa43672043d4b963a77104c43e7b8414b3f4cad5351835d85cd3</cites><orcidid>0000-0002-5130-4763</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ygyno.2019.12.028$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,780,784,885,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31948730$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Beavis, Anna L.</creatorcontrib><creatorcontrib>Yen, Ting-Tai</creatorcontrib><creatorcontrib>Stone, Rebecca L.</creatorcontrib><creatorcontrib>Wethington, Stephanie L.</creatorcontrib><creatorcontrib>Carr, Caitlin</creatorcontrib><creatorcontrib>Son, Ji</creatorcontrib><creatorcontrib>Chambers, Laura</creatorcontrib><creatorcontrib>Michener, Chad M.</creatorcontrib><creatorcontrib>Ricci, Stephanie</creatorcontrib><creatorcontrib>Burkett, Wesley C.</creatorcontrib><creatorcontrib>Richardson, Debra L.</creatorcontrib><creatorcontrib>Staley, Allison-Stuart</creatorcontrib><creatorcontrib>Ahn, Susie</creatorcontrib><creatorcontrib>Gehrig, Paola A.</creatorcontrib><creatorcontrib>Torres, Diogo</creatorcontrib><creatorcontrib>Dowdy, Sean C.</creatorcontrib><creatorcontrib>Sullivan, Mackenzie W.</creatorcontrib><creatorcontrib>Modesitt, Susan C.</creatorcontrib><creatorcontrib>Watson, Catherine</creatorcontrib><creatorcontrib>Veade, Ashely</creatorcontrib><creatorcontrib>Ehrisman, Jessie</creatorcontrib><creatorcontrib>Havrilesky, Laura</creatorcontrib><creatorcontrib>Secord, Angeles Alvarez</creatorcontrib><creatorcontrib>Loreen, Amy</creatorcontrib><creatorcontrib>Griffin, Kaitlyn</creatorcontrib><creatorcontrib>Jackson, Amanda</creatorcontrib><creatorcontrib>Viswanathan, Akila N.</creatorcontrib><creatorcontrib>Jager, Leah R.</creatorcontrib><creatorcontrib>Fader, Amanda N.</creatorcontrib><title>Adjuvant therapy for early stage, endometrial cancer with lymphovascular space invasion: Is there a role for chemotherapy?</title><title>Gynecologic oncology</title><addtitle>Gynecol Oncol</addtitle><description>Lymphovascular space invasion (LVSI) is an independent risk factor for recurrence and poor survival in early-stage endometrioid endometrial cancer (EEC), but optimal adjuvant treatment is unknown. We aimed to compare the survival of women with early-stage EEC with LVSI treated postoperatively with observation (OBS), radiation (RAD, external beam and/or vaginal brachytherapy), or chemotherapy (CHEMO)+/−RAD.
This was a multi-institutional, retrospective cohort study of women with stage I or II EEC with LVSI who underwent hysterectomy+/−lymphadenectomy from 2005 to 2015 and received OBS, RAD, or CHEMO+/−RAD postoperatively. Progression-free survival and overall survival were evaluated using Kaplan-Meier estimates and Cox proportional hazards models.
In total, 478 women were included; median age was 64 years, median follow-up was 50.3 months. After surgery, 143 (30%) underwent OBS, 232 (48.5%) received RAD, and 103(21.5%) received CHEMO+/−RAD (95% of whom received RAD). Demographics were similar among groups, but those undergoing OBS had lower stage and grade. A total of 101 (21%) women recurred. Progression-free survival (PFS) was improved in both CHEMO+/−RAD (HR = 0.18, 95% CI: 0.09–0.39) and RAD (HR = 0.31, 95% CI: 0.18–0.54) groups compared to OBS, though neither adjuvant therapy was superior to the other. However, in grade 3 tumors, the CHEMO+/−RAD group had superior PFS compared to both RAD (HR 0.25; 95% CI: 0.12–0.52) and OBS cohorts (HR = 0.10, 95% CI: 0.03–0.32). Overall survival did not differ by treatment.
In early-stage EEC with LVSI, adjuvant therapy improved PFS compared to observation alone. In those with grade 3 EEC, adjuvant chemotherapy with or without radiation improved PFS compared to observation or radiation alone.
•In this cohort of early-stage endometrioid endometrial cancer cases with LVSI, 28% who underwent observation alone recurred.•Adjuvant therapy (radiation or chemotherapy) improved progression-free survival in early-stage endometrial cancer with LVSI•In high-grade tumors with LVSI, chemotherapy +/- radiation improved PFS compared to radiation or observation</description><subject>Adjuvant treatment</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Carcinoma, Endometrioid - drug therapy</subject><subject>Carcinoma, Endometrioid - pathology</subject><subject>Carcinoma, Endometrioid - radiotherapy</subject><subject>Carcinoma, Endometrioid - surgery</subject><subject>Chemoradiotherapy, Adjuvant</subject><subject>Chemotherapy</subject><subject>Chemotherapy, Adjuvant</subject><subject>Cohort Studies</subject><subject>Disease-Free Survival</subject><subject>Endometrial cancer</subject><subject>Endometrial Neoplasms - drug therapy</subject><subject>Endometrial Neoplasms - pathology</subject><subject>Endometrial Neoplasms - radiotherapy</subject><subject>Endometrial Neoplasms - surgery</subject><subject>Female</subject><subject>Humans</subject><subject>Hysterectomy</subject><subject>Lymph Node Excision</subject><subject>Lymphatic Metastasis</subject><subject>Lymphovascular space invasion</subject><subject>Middle Aged</subject><subject>Neoplasm Grading</subject><subject>Neoplasm Metastasis</subject><subject>Neoplasm Staging</subject><subject>Radiation</subject><subject>Retrospective Studies</subject><subject>Survival Rate</subject><subject>Uterine cancer</subject><issn>0090-8258</issn><issn>1095-6859</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc1u1DAURi1ERYfCEyAhL1mQ1H9JbCSKqgpopUpsYG3dce5MPEriYCeDwtOTzgwVbLqyZH_3fFc-hLzhLOeMl5e7fN7OfcgF4ybnImdCPyMrzkyRlbowz8mKMcMyLQp9Tl6mtGOMScbFC3IuuVG6kmxFfl_Xu2kP_UjHBiMMM92ESBFiO9M0whbfU-zr0OEYPbTUQe8w0l9-bGg7d0MT9pDc1EKkaQCH1PfLhQ_9B3qXDkikQGNo8cB1DXbhVPTpFTnbQJvw9em8ID--fP5-c5vdf_t6d3N9nzlVmDEz0iGXBpzUqgRQsqwEU7JWa1NKqCrOlFMSq7VWXK3lRjmoC1lwLYtaF66WF-TqyB2mdYe1w36M0Noh-g7ibAN4-_9L7xu7DXtbSa1FaRbAuxMghp8TptF2PjlsW-gxTMkKqXgpuTJ6icpj1MWQUsTNYw1n9sGa3dmDNftgzXJhF2vL1Nt_N3yc-atpCXw8BnD5p73HaJPzuKiofUQ32jr4Jwv-AHvJrOg</recordid><startdate>20200301</startdate><enddate>20200301</enddate><creator>Beavis, Anna L.</creator><creator>Yen, Ting-Tai</creator><creator>Stone, Rebecca L.</creator><creator>Wethington, Stephanie L.</creator><creator>Carr, Caitlin</creator><creator>Son, Ji</creator><creator>Chambers, Laura</creator><creator>Michener, Chad M.</creator><creator>Ricci, Stephanie</creator><creator>Burkett, Wesley C.</creator><creator>Richardson, Debra L.</creator><creator>Staley, Allison-Stuart</creator><creator>Ahn, Susie</creator><creator>Gehrig, Paola A.</creator><creator>Torres, Diogo</creator><creator>Dowdy, Sean C.</creator><creator>Sullivan, Mackenzie W.</creator><creator>Modesitt, Susan C.</creator><creator>Watson, Catherine</creator><creator>Veade, Ashely</creator><creator>Ehrisman, Jessie</creator><creator>Havrilesky, Laura</creator><creator>Secord, Angeles Alvarez</creator><creator>Loreen, Amy</creator><creator>Griffin, Kaitlyn</creator><creator>Jackson, Amanda</creator><creator>Viswanathan, Akila N.</creator><creator>Jager, Leah R.</creator><creator>Fader, Amanda N.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-5130-4763</orcidid></search><sort><creationdate>20200301</creationdate><title>Adjuvant therapy for early stage, endometrial cancer with lymphovascular space invasion: Is there a role for chemotherapy?</title><author>Beavis, Anna L. ; Yen, Ting-Tai ; Stone, Rebecca L. ; Wethington, Stephanie L. ; Carr, Caitlin ; Son, Ji ; Chambers, Laura ; Michener, Chad M. ; Ricci, Stephanie ; Burkett, Wesley C. ; Richardson, Debra L. ; Staley, Allison-Stuart ; Ahn, Susie ; Gehrig, Paola A. ; Torres, Diogo ; Dowdy, Sean C. ; Sullivan, Mackenzie W. ; Modesitt, Susan C. ; Watson, Catherine ; Veade, Ashely ; Ehrisman, Jessie ; Havrilesky, Laura ; Secord, Angeles Alvarez ; Loreen, Amy ; Griffin, Kaitlyn ; Jackson, Amanda ; Viswanathan, Akila N. ; Jager, Leah R. ; Fader, Amanda N.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c459t-93ce139ac3846aa43672043d4b963a77104c43e7b8414b3f4cad5351835d85cd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adjuvant treatment</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Carcinoma, Endometrioid - drug therapy</topic><topic>Carcinoma, Endometrioid - pathology</topic><topic>Carcinoma, Endometrioid - radiotherapy</topic><topic>Carcinoma, Endometrioid - surgery</topic><topic>Chemoradiotherapy, Adjuvant</topic><topic>Chemotherapy</topic><topic>Chemotherapy, Adjuvant</topic><topic>Cohort Studies</topic><topic>Disease-Free Survival</topic><topic>Endometrial cancer</topic><topic>Endometrial Neoplasms - drug therapy</topic><topic>Endometrial Neoplasms - pathology</topic><topic>Endometrial Neoplasms - radiotherapy</topic><topic>Endometrial Neoplasms - surgery</topic><topic>Female</topic><topic>Humans</topic><topic>Hysterectomy</topic><topic>Lymph Node Excision</topic><topic>Lymphatic Metastasis</topic><topic>Lymphovascular space invasion</topic><topic>Middle Aged</topic><topic>Neoplasm Grading</topic><topic>Neoplasm Metastasis</topic><topic>Neoplasm Staging</topic><topic>Radiation</topic><topic>Retrospective Studies</topic><topic>Survival Rate</topic><topic>Uterine cancer</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Beavis, Anna L.</creatorcontrib><creatorcontrib>Yen, Ting-Tai</creatorcontrib><creatorcontrib>Stone, Rebecca L.</creatorcontrib><creatorcontrib>Wethington, Stephanie L.</creatorcontrib><creatorcontrib>Carr, Caitlin</creatorcontrib><creatorcontrib>Son, Ji</creatorcontrib><creatorcontrib>Chambers, Laura</creatorcontrib><creatorcontrib>Michener, Chad M.</creatorcontrib><creatorcontrib>Ricci, Stephanie</creatorcontrib><creatorcontrib>Burkett, Wesley C.</creatorcontrib><creatorcontrib>Richardson, Debra L.</creatorcontrib><creatorcontrib>Staley, Allison-Stuart</creatorcontrib><creatorcontrib>Ahn, Susie</creatorcontrib><creatorcontrib>Gehrig, Paola A.</creatorcontrib><creatorcontrib>Torres, Diogo</creatorcontrib><creatorcontrib>Dowdy, Sean C.</creatorcontrib><creatorcontrib>Sullivan, Mackenzie W.</creatorcontrib><creatorcontrib>Modesitt, Susan C.</creatorcontrib><creatorcontrib>Watson, Catherine</creatorcontrib><creatorcontrib>Veade, Ashely</creatorcontrib><creatorcontrib>Ehrisman, Jessie</creatorcontrib><creatorcontrib>Havrilesky, Laura</creatorcontrib><creatorcontrib>Secord, Angeles Alvarez</creatorcontrib><creatorcontrib>Loreen, Amy</creatorcontrib><creatorcontrib>Griffin, Kaitlyn</creatorcontrib><creatorcontrib>Jackson, Amanda</creatorcontrib><creatorcontrib>Viswanathan, Akila N.</creatorcontrib><creatorcontrib>Jager, Leah R.</creatorcontrib><creatorcontrib>Fader, Amanda N.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Gynecologic oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Beavis, Anna L.</au><au>Yen, Ting-Tai</au><au>Stone, Rebecca L.</au><au>Wethington, Stephanie L.</au><au>Carr, Caitlin</au><au>Son, Ji</au><au>Chambers, Laura</au><au>Michener, Chad M.</au><au>Ricci, Stephanie</au><au>Burkett, Wesley C.</au><au>Richardson, Debra L.</au><au>Staley, Allison-Stuart</au><au>Ahn, Susie</au><au>Gehrig, Paola A.</au><au>Torres, Diogo</au><au>Dowdy, Sean C.</au><au>Sullivan, Mackenzie W.</au><au>Modesitt, Susan C.</au><au>Watson, Catherine</au><au>Veade, Ashely</au><au>Ehrisman, Jessie</au><au>Havrilesky, Laura</au><au>Secord, Angeles Alvarez</au><au>Loreen, Amy</au><au>Griffin, Kaitlyn</au><au>Jackson, Amanda</au><au>Viswanathan, Akila N.</au><au>Jager, Leah R.</au><au>Fader, Amanda N.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Adjuvant therapy for early stage, endometrial cancer with lymphovascular space invasion: Is there a role for chemotherapy?</atitle><jtitle>Gynecologic oncology</jtitle><addtitle>Gynecol Oncol</addtitle><date>2020-03-01</date><risdate>2020</risdate><volume>156</volume><issue>3</issue><spage>568</spage><epage>574</epage><pages>568-574</pages><issn>0090-8258</issn><eissn>1095-6859</eissn><abstract>Lymphovascular space invasion (LVSI) is an independent risk factor for recurrence and poor survival in early-stage endometrioid endometrial cancer (EEC), but optimal adjuvant treatment is unknown. We aimed to compare the survival of women with early-stage EEC with LVSI treated postoperatively with observation (OBS), radiation (RAD, external beam and/or vaginal brachytherapy), or chemotherapy (CHEMO)+/−RAD.
This was a multi-institutional, retrospective cohort study of women with stage I or II EEC with LVSI who underwent hysterectomy+/−lymphadenectomy from 2005 to 2015 and received OBS, RAD, or CHEMO+/−RAD postoperatively. Progression-free survival and overall survival were evaluated using Kaplan-Meier estimates and Cox proportional hazards models.
In total, 478 women were included; median age was 64 years, median follow-up was 50.3 months. After surgery, 143 (30%) underwent OBS, 232 (48.5%) received RAD, and 103(21.5%) received CHEMO+/−RAD (95% of whom received RAD). Demographics were similar among groups, but those undergoing OBS had lower stage and grade. A total of 101 (21%) women recurred. Progression-free survival (PFS) was improved in both CHEMO+/−RAD (HR = 0.18, 95% CI: 0.09–0.39) and RAD (HR = 0.31, 95% CI: 0.18–0.54) groups compared to OBS, though neither adjuvant therapy was superior to the other. However, in grade 3 tumors, the CHEMO+/−RAD group had superior PFS compared to both RAD (HR 0.25; 95% CI: 0.12–0.52) and OBS cohorts (HR = 0.10, 95% CI: 0.03–0.32). Overall survival did not differ by treatment.
In early-stage EEC with LVSI, adjuvant therapy improved PFS compared to observation alone. In those with grade 3 EEC, adjuvant chemotherapy with or without radiation improved PFS compared to observation or radiation alone.
•In this cohort of early-stage endometrioid endometrial cancer cases with LVSI, 28% who underwent observation alone recurred.•Adjuvant therapy (radiation or chemotherapy) improved progression-free survival in early-stage endometrial cancer with LVSI•In high-grade tumors with LVSI, chemotherapy +/- radiation improved PFS compared to radiation or observation</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31948730</pmid><doi>10.1016/j.ygyno.2019.12.028</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-5130-4763</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0090-8258 |
| ispartof | Gynecologic oncology, 2020-03, Vol.156 (3), p.568-574 |
| issn | 0090-8258 1095-6859 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7388269 |
| source | MEDLINE; Access via ScienceDirect (Elsevier) |
| subjects | Adjuvant treatment Adult Aged Aged, 80 and over Carcinoma, Endometrioid - drug therapy Carcinoma, Endometrioid - pathology Carcinoma, Endometrioid - radiotherapy Carcinoma, Endometrioid - surgery Chemoradiotherapy, Adjuvant Chemotherapy Chemotherapy, Adjuvant Cohort Studies Disease-Free Survival Endometrial cancer Endometrial Neoplasms - drug therapy Endometrial Neoplasms - pathology Endometrial Neoplasms - radiotherapy Endometrial Neoplasms - surgery Female Humans Hysterectomy Lymph Node Excision Lymphatic Metastasis Lymphovascular space invasion Middle Aged Neoplasm Grading Neoplasm Metastasis Neoplasm Staging Radiation Retrospective Studies Survival Rate Uterine cancer |
| title | Adjuvant therapy for early stage, endometrial cancer with lymphovascular space invasion: Is there a role for chemotherapy? |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-20T00%3A41%3A41IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Adjuvant%20therapy%20for%20early%20stage,%20endometrial%20cancer%20with%20lymphovascular%20space%20invasion:%20Is%20there%20a%20role%20for%20chemotherapy?&rft.jtitle=Gynecologic%20oncology&rft.au=Beavis,%20Anna%20L.&rft.date=2020-03-01&rft.volume=156&rft.issue=3&rft.spage=568&rft.epage=574&rft.pages=568-574&rft.issn=0090-8258&rft.eissn=1095-6859&rft_id=info:doi/10.1016/j.ygyno.2019.12.028&rft_dat=%3Cproquest_pubme%3E2341631498%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2341631498&rft_id=info:pmid/31948730&rft_els_id=S0090825819318499&rfr_iscdi=true |