Gynecological Cancer

PV QA 4 - Poster Viewing Q&A 4

TU_20_3519 - Are All High-Intermediate Risk Early Stage Endometrioid Carcinomas of the Uterus Created Equal?

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

Are All High-Intermediate Risk Early Stage Endometrioid Carcinomas of the Uterus Created Equal?
J. E. Leeman1, Z. S. Zumsteg2, M. A. Kollmeier3, G. Gardner3, N. Abu-Rustum3, and K. M. Alektiar3; 1Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, 2Cedars-Sinai Medical Center, Los Angeles, CA, 3Memorial Sloan Kettering Cancer Center, New York, NY

Purpose/Objective(s): The designation of high-intermediate risk in early stage endometrioid carcinoma of the uterus was supposed to identify patients who are at the highest risk of recurrence. The purpose of this study is to determine if the risk of relapse for some patients with high-intermediate risk endometrial carcinoma is similar to that of low-intermediate risk patients.

Materials/Methods: We identified patients from our institutional database with intermediate risk endometrioid endometrial adenocarcinoma who were treated with adjuvant radiotherapy from 1992 to 2009. Rates of vaginal, pelvic, paraaortic and distant recurrence and disease free survival and overall survival were estimated using the Kaplan-Meier method and compared with log-rank testing.

Results: 603 patients were identified with intermediate risk endometrioid endometrial carcinoma. Of these, 206 (34%) were high-intermediate risk and 397 (66%) were low-intermediate risk. Comparison of the risk of relapse between high-intermediate and low-intermediate risk groups was limited to patients with FIGO 2009 stage IA grade 1-3 and stage IB grade 1-2, because no patients with stage IB grade 3 or stage II cancers were low-intermediate risk. Of the 206 patients with high-intermediate risk, 144 (70%) were either stage IA (n = 68) or IB grade 1,2 (n =76). The actuarial risks of recurrence (any) at 5 years among these groups is shown in table 1. Within the high-intermediate risk group stage IA grade 1-3 and stage IB grade 1-2, 119/144 (83%) were treated with IVRT alone. In this subset, the 5 year risks of vaginal, pelvic, paraaortic and distant recurrence were 2.2 +/-1.5%, 3.6 +/- 1.8%, 1.9 +/- 1.3%, 7.8 +/- 2.7%. The disease free survival was 88.3 +/- 3.2% and the overall survival was 86.4 +/- 3.5%.

Conclusion: Based on this study, risk of relapse is not high across the board in high-intermediate risk patients. In fact, a significant subset (70%) of patients with high-intermediate risk endometrioid adenocarcinoma has similar risk of relapse to patients with low-intermediate risk disease. Furthermore, many patients within that subset (119/144; 83%) can be treated with IVRT alone.
Low-int risk Hi-int risk p-value
Stage IA Grade 1-3 6.7% (95%CI 3.9- 9.5%) (n=362) 9.7 % (95%CI 2.1-17.3%) (n=68) 0.50
Stage IB Grade 1-2 5.8% (95%CI 0-13.8%) (n=35) 8.3% (95%CI 1.3-15.3) (n=76) 0.37
Table 1. Five year actuarial rates of recurrence (any) in patients with intermediate risk endometrioid adenocarcinoma.

Author Disclosure: J.E. Leeman: None. Z.S. Zumsteg: None. M.A. Kollmeier: None. G. Gardner: None. N. Abu-Rustum: None.

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