Gynecological Cancer

PV QA 4 - Poster Viewing Q&A 4

TU_21_3527 - Outcomes after Adjuvant Therapy in High-Intermediate and High-risk Early-stage Uterine Carcinoma

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

Outcomes after Adjuvant Therapy in High-Intermediate and High-risk Early-stage Uterine Carcinoma
K. Tatebe, Y. Hasan, and C. H. Son; University of Chicago, Chicago, IL

Purpose/Objective(s): To evaluate outcomes after adjuvant treatment in high-intermediate or high-risk uterine cancer with an emphasis on vaginal brachytherapy (VBT) and chemotherapy (CT) vs. pelvic external beam radiotherapy (EBRT).

Materials/Methods: Patients in the National Cancer Database with Stage I-II uterine carcinoma were identified per GOG risk criteria: LVSI, grade 2-3, or outer myometrial invasion, with 1, 2, or 3 risk factors for patients age>70, 50-70, or <50 years old, respectively, if stage I. All stage I-II serous and clear cell cancers were included. Carcinosarcoma and patients undergoing observation or CT alone were excluded. All patients had 7th edition AJCC staging (2010-2013). Univariate analysis (UVA) was performed by log-rank testing to assess the association of individual factors with overall survival (OS). Multivariate analysis (MVA) was performed using the Cox proportional hazards model to assess independent association of VBT +/- CT and EBRT (with or without VBT boost) +/- CT with survival.

Results: A total of N=10,126 patients were included in the analysis (N=4,670 VBT, N=1,897 VBT+CT, N=2,705 EBRT, N=854 EBRT+CT). Median follow-up was 34 months and 3-year OS was 88%. UVA revealed that age, grade, histology, LVSI, comorbidity index, histology, insurance, race, and pathologic nodal evaluation were associated with survival. These factors, and FIGO stage, were included in the MVA. On MVA, worse survival was associated with: age > 70, HR 3.24 (95% CI: 2.05-5.13, p<0.001); LVSI, HR 1.79 (95% CI: 1.58-2.02, p<0.001); high grade, HR 3.08 (95% CI: 2.46-3.85, p<0.001); comorbidity index, HR 1.24 (95% CI: 1.09-1.42, p=0.001); black race, HR 1.22 (95% CI: 1.02-1.45, p=0.030); and serous histology, HR 1.50 (95% CI: 1.25-1.81, p<0.001). VBT+CT provided a small survival benefit compared to VBT (HR 0.80, 95% CI: 0.66-0.97, p=0.020) with no significant benefit to EBRT+CT compared to VBT (HR 0.91, 95% CI: 0.73-1.13, p=0.385), and no difference for EBRT compared to VBT (HR 1.01). On subset analysis of high-risk groups (high-grade endometrioid, serous carcinoma, clear cell carcinoma, or those without lymph node dissection), only serous carcinoma patients experienced a benefit from VBT+CT compared to VBT (N=1,462; HR 0.53, 95% CI: 0.36-0.78, p=0.002). There was no difference in outcome by treatment type in the other high-risk subsets. When analysis was limited to patients receiving only VBT+CT vs. EBRT, the latter was associated with worse survival (N=4,602, HR 1.24, 95% CI: 1.01-1.53, p=0.042), although on subset analysis, it was only those with serous histology who benefited from VBT+CT (N=1,002; HR 1.77, 95% CI: 1.18-2.65, p=0.006).

Conclusion: Early stage uterine serous carcinomas may benefit from the addition of chemotherapy to RT. However, there were no high-risk subsets of patients with endometrioid carcinoma that demonstrated a benefit to VBT+CT compared to EBRT alone. These findings should be confirmed with other prospective studies, including final published results from GOG 249.

Author Disclosure: K. Tatebe: Employee; Advocate Good Samaritan Hospital. Project Lead; Northwestern Trauma and Surgical Initiative. Y. Hasan: None. C.H. Son: Employee; Northwestern University.

Ken Tatebe, MD, PhD

University of Chicago Medicine

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