Gynecological Cancer

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TU_20_3513 - Outcomes Following Salvage Radiation Therapy for Recurrent Endometrial Cancer in Patients with No Prior Adjuvant Therapy -- An Institutional Review

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

Outcomes Following Salvage Radiation Therapy for Recurrent Endometrial Cancer in Patients with No Prior Adjuvant Therapy -- An Institutional Review
M. F. Gruner1, C. C. Vu2, K. Marvin3, H. Ye4, S. R. Nandalur5, and M. S. Jawad4; 1Oakland University William Beaumont School of Medicine, Royal Oak, MI, 2Dept. of Radiation Oncology, Beaumont Health, Royal Oak, MI, 3Beaumont Health System, Royal Oak, MI, 4Beaumont Health (Department of Radiation Oncology), Royal Oak, MI, 5Beaumont Health, Troy, MI

Purpose/Objective(s): Following definitive surgery, patients with early-stage, low-risk endometrial cancer meeting appropriate criteria undergo observation. However, there is limited data on clinical outcomes in patients who subsequently receive salvage radiotherapy (RT) for recurrent disease. The purpose of this study was to evaluate our single-institutional experience using salvage RT for recurrent endometrial cancer in patients who did not receive adjuvant RT after initial hysterectomy.

Materials/Methods: We retrospectively evaluated 25 women with recurrent endometrial cancer treated with salvage RT in our department from 2007-2017. All patients had undergone initial definitive hysterectomy at the time of diagnosis, without adjuvant therapy. Salvage RT included whole pelvis external beam RT, vaginal brachytherapy, or a combination of both. Clinical outcomes were analyzed using t-tests for continuous variables, χ2 for categorical variables, and Kaplan-Meier estimates. Acute (≤6 months post-RT) and chronic (> 6 months post-RT) GI/GU/GYN toxicities were graded according to CTCAEv3.0. P-values of <0.05 were considered significant.

Results: The median follow-up time was 1.9 years (range 0-11.1 years). Median age at recurrence was 65yo (48-85yo), and the median time to recurrence after surgery was 1.3 years (range 0.3-7.2 years). The median tumor size at recurrence was 3.5 cm (1-8.2 cm). The majority of patients had endometrioid adenocarcinoma histology (84%); the remainder included papillary, mixed mullerian, mucinous adenocarcinoma, or mixed histology. 72% were initially staged as FIGO IA, 20% FIGO IB, and 8% FIGO II. 92% of patients received pelvic external beam RT (median 45Gy, range 45-66.6Gy) and 76% of patients received vaginal cuff brachytherapy (median 30Gy, range 12-40Gy). 68% of patients received combined external beam pelvic RT and vaginal cuff brachytherapy. Median total EQD2 for all patients was 67.6Gy (37.5 – 81.8 Gy). There was only one local recurrence identified following salvage treatment, which occurred 13.5 months after completion of RT. The actuarial 2-year LC rate was 94%, 2-year DFS 90%, and 2-year overall survival 86%. There were few patients with acute GI and GU toxicities, all of which were grade 1. There was 1 patient with grade 2 diarrhea in the acute period. No grade 3 or higher acute toxicities were seen. Few patients developed grade 1 GI and GU toxicities in the chronic period. One patient developed grade 2 diarrhea and 1 had grade 2 urinary incontinence. 4 patients developed vaginal stenosis (grade 3 n=3, grade 3 n=1). There were no grade 4 or 5 chronic toxicities.

Conclusion: In this group of patients, salvage radiotherapy for recurrent endometrial cancer had excellent clinical outcomes with overall low and acceptable rates of acute and chronic toxicities.

Author Disclosure: M.F. Gruner: None. C.C. Vu: None. K. Marvin: None. H. Ye: None. S.R. Nandalur: None. M.S. Jawad: None.

Charles Vu, MD

William Beaumont Hospital

Disclosure:
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Beaumont Health: Resident Physician: Employee

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