Gynecological Cancer

PV QA 4 - Poster Viewing Q&A 4

TU_20_3514 - Patterns of Recurrence and Survival Rates in Endometrial Cancer According to ESMO-ESGO-ESTRO Risk Classification

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

Patterns of Recurrence and Survival Rates in Endometrial Cancer According to ESMO-ESGO-ESTRO Risk Classification
S. Yuce Sari1, M. Gultekin2, S. Rahatli3, O. Altundag3, A. Turker4, A. Kars4, K. Yuce5, A. Ayhan6, G. Ozyigit2, and F. Yildiz2; 1Hacettepe University Faculty of Medicine, ANKARA, Turkey, 2Hacettepe University, School of Medicine, Department of Radiation Oncology, Ankara, Turkey, 3Baskent University Medical School, Department of Medical Oncology, Ankara, Turkey, 4Hacettepe University Medical School, Department of Medical Oncology, Ankara, Turkey, 5Hacettepe University Medical School, Ankara, Turkey, 6Baskent University Medical School, Ankara, Turkey

Purpose/Objective(s): To evaluate the patterns of recurrence and survival according to ESMO-ESGO-ESTRO risk classification in patients with endometrial cancer after adjuvant external radiotherapy (ERT) and/or brachytherapy (BRT) +/- chemotherapy (CT).

Materials/Methods: We retrospectively evaluated 384 endometrial cancer patients who received adjuvant treatment between October 1996 and November 2015. Patients were classified as low risk (LR), intermediate risk (IR), high-intermediate risk (HIR) and high risk (HR). Staging surgery is routinely performed in endometrial cancer in our center. We administer BRT in uterus-confined disease with ≥50% myometrial invasion and/or grade 3 histology, and ERT+/-BRT in the presence of cervical stromal invasion or disease beyond the uterus.

Results: Median age was 59 years. Forty-seven (12%) patients had LR, 85 (22%) IR, 88 (23%) HIR, and 164 (43%) HR disease. Histopathology was endometrioid in 340, and serous papillary, clear cell or carcinosarcoma in 44 patients. Lymph node dissection (LND) was performed in 368 patients, and the median number of dissected LNs was 38. 16 patients from other centers had not undergone LND. Characteristics of patients are given in Table 1. Median follow-up after surgery was 69 months. The 2- and 5-year overall survival (OS) and recurrence-free survival (RFS) rate was 96% and 87%, and 92% and 71%, respectively. The respective rates for OS were 96% and 92% in LR, 98% and 90% in IR, 94% and 88% in HIR, and 95% and 83% in HR disease (p=0.076); and 96% and 92% in LR, 94% and 90% in IR, 93% and 87% in HIR, and 90% and 79% in HR disease for RFS (p=0.013). Statistical difference was found between LR and HIR, and LR and HR for OS, and between LR and HIR, LR and HR, and IR and HR for RFS. No difference was found between HIR and HR disease in terms of OS and RFS. In all, 44 (12%) patients developed recurrence (local and/or regional and/or distant), and median time to recurrence was 22 months (4-106 months). No difference was found among the risk groups in terms of local-regional recurrence (p=0.017). However, the rate of distant metastasis was significantly higher in the HR group (p=0.007). When the 368 patients with complete surgical staging were evaluated separately, the results were similar in terms of OS and RFS.

Conclusion: In the presence of adequate surgical staging and optimal adjuvant treatment, high OS and RFS rates can be achieved even in the HR group. The main problem in this group is distant metastasis. Vaginal cuff BRT alone seems adequate for the HIR group after complete staging surgery.
Characteristic LR (%) IR (%) HIR (%) HR (%) p value
LN dissection Present Absent 40 (85) 7 (15) 81 (95) 4 (5) 87 (99) 1 (1) 160 (98) 4 (2) 0.001
Number of LNs dissected <20 ≥20 9 (23) 30 (77) 22 (28) 56 (72) 16 (20) 64 (80) 27 (17) 127 (83) 0.3
Adjuvant treatment BRT alone ERT+/- BRT CT+ERT+/-BRT CT+BRT
45 (96) 2 (4) 0 (0) 0 (0)
79 (93) 5 (6) 0 (0) 1 (1) 83 (94) 4 (5) 0 (0) 1 (1) 42 (26) 52 (32) 57 (35) 13 (8) <0.001
Chemotherapy Present Absent 0 (0) 47 (100) 1 (1) 84 (99) 1 (1) 87 (99) 70 (43) 94 (57) <0.001

Author Disclosure: S. Yuce Sari: None. M. Gultekin: None. S. Rahatli: None. A. Turker: None. A. Kars: None. A. Ayhan: None.

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