Gynecological Cancer

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TU_19_3509 - Vaginal Brachytherapy for Stage I-II Non-endometrioid Endometrial Cancer Using a Low-dose Scheme

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

Vaginal Brachytherapy for Stage I-II Non-endometrioid Endometrial Cancer Using a Low-dose Scheme
D. L. Buscariollo1, G. Alban2, T. Cheng1, I. Buzurovic1, D. Yerramilli3, J. Pretz1, B. Krechmer1, M. King1, and L. J. Lee1; 1Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, 2BRIGHAM AND WOMEN'S HOSPITAL, BOSTON, MA, 3Harvard Radiation Oncology Program, Boston, MA

Purpose/Objective(s): To evaluate outcomes for women with FIGO stage I-II non-endometrioid endometrial adenocarcinoma treated with adjuvant vaginal brachytherapy (VB) using a low-dose scheme with or without adjuvant chemotherapy (CT).

Materials/Methods: We retrospectively identified 122 women with FIGO stage I-II non-endometrioid endometrial cancer (serous carcinoma [SC], clear cell carcinoma [CC], mixed histology [MH, endometrioid and SC or CC components], carcinosarcoma [CS]) who received VB to 24 Gy in 6 fractions from 2005 – 2017. Dose was prescribed to the cylinder surface of the full vaginal length. CT imaging was performed prior to each fraction to confirm cylinder diameter and insertion depth. Women with < 6 months follow-up from VB completion were excluded (n = 16). Rates of vaginal relapse (VR), pelvic relapse (PR), distant metastasis including para-aortic relapse (DM), recurrence-free survival (RFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Univariate analyses (UVA) were performed using logrank test or Cox proportional hazards. Multivariable analyses (MVA) using Cox proportional hazards modeling with backwards selection was used to identify independent predictors of RFS.

Results: Characteristics of the 106 eligible patients are summarized in Table 1. At a median follow up of 49 months (r, 9 – 119) from surgery, 26 women developed recurrence at a median of 39 months (r, 12 – 119), and 14 died of disease. The 5-year rates of VR, PR, DM, RFS and OS were: 7%, 8%, 21%, 74% and 83%, respectively. On UVA, age, histology, lymphovascular invasion (LVI), stage and %MMI were associated with RFS (all p < 0.05). By histology, the 5-year RFS rates were 77%, 68%, 88% and 56% for SC, CC, MH and CS, respectively (p = 0.046). On MVA including stage, histology and LVI, only stage remained significantly associated with RFS (hazard ratio [HR] 2.8 [95%CI: 0.96 – 7.39] for IB vs IA; HR 4.9 for II vs IA [95%CI: 1.34 – 14.77]; p=0.018). 5-year PR was higher for women with CS compared to other high-risk histologies (20% vs 6%; p = 0.017), while VR and DM did not significantly differ.

Conclusion: Clinical outcomes for patients with early-stage, non-endometrioid endometrial cancer varied significantly by histologic subtype. Women with CS had significantly higher rates of pelvic relapse after VB, compared to those with other high-risk histologies.
Univariate P
Age (med, range) 66 yr (40-93) 0.029
BMI (med, range) 28 (20-53) 0.352
FIGO 2009 Stage IA IB II : 80% (85) 14% (15) 6% (6) 0.004
Histology Serous carcinoma (SC) Clear cell carcinoma (CC) Mixed histology (endometrioid and SC/CC) Carcinosarcoma (CS) : 47% (50) 10% (11) 27% (29) 15% (16) 0.046
No. of pelvic LN (med, range) 13 (0-44) 0.560
No. of para-aortic LN (med, range) 0 (0-14) 0.788
%MMI (med, range) 10% (0-99) 0.044
LVI 13% (14) 0.001
Positive pelvic washings 12% (13) 0.100
Adjuvant chemotherapy SC CC MH CS 75% (79) 90%(45) 73%(8) 63%(10) 55%(16) 0.197
Patterns of failure Vaginal Pelvic Distant Combined local-regional & distant : 6% (6) 7% (7) 20% (21) 7% (7) NA

Author Disclosure: D.L. Buscariollo: None. G. Alban: None. I. Buzurovic: None. D. Yerramilli: None. B. Krechmer: None. M. King: None. L.J. Lee: Employee; Brigham and Women's Physician Organization. Research Grant; Bridge Expansion Grant, Astra Zeneca, Joint Center of Radiation Therapy, Dana-Farber Cancer Institute.

Daniela Buscariollo, MD

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