Failure Patterns Of Type Ii Endometrial Cancer With And Without Adjuvant Rt

There is limited data describing survival endpoints and patterns of failure with and without adjuvant radiation therapy (RT) in woman with early stage Type II endometrial cancer. The purpose of this study is to elucidate these clinical outcomes and identify predictive factors. In this IRB-approved study, we reviewed our prospectively-maintained database of 1320 patients with endometrial cancer treated between 1988 and 2013. We identified 139 consecutive patients who underwent hysterectomy for 2009 FIGO stage I-II. Univariate and multivariate logistic regression modeling was used to determine significant predictors of outcome. Median follow-up for the study cohort was 34 months. Median age at time of surgery for the study cohort was 65 years (range: 36-90 years). All patients had hysterectomy and oophorectomy; 126 (91%) had lymph node evaluation; 75 (54%) had para-aortic dissection and 87 (63%) had omentectomy. The majority of patients, 83 (60%), had uterine serous carcinoma with 33 (24%) and 23 (17%) having clear cell and mixed histologies, respectively. Adjuvant RT alone was given in 40 patients (29%), 31 patients (22%) received adjuvant chemotherapy alone, 29 patients (21%) received both adjuvant chemotherapy and RT, and 39 patients (28%) did not receive adjuvant therapy. At the last known follow-up, 91 patients (65%) were alive. Rates for 5-year recurrence free survival (RFS), disease specific survival (DSS) and overall survival (OS) were 71.3%, 79.9% and 73.6% respectively. A total of 33 patients (24%) had recurrences with 16 located in the vagina, 15 in the pelvis and 23 distantly. Sixty-nine patients (50%) received adjuvant RT; 8 of these patients had disease recurrence and all 8 were distant. In the 70 patients (50%) that did not receive RT, 25 had disease recurrence; 15 were distant and 10 were locoregional. On multivariate analysis, lower uterine segment involvement (LUS) (HR 4.6, p<0.001), percent myometrial invasion (HR 6.7, p = 0.003), number of lymph nodes examined (as a continuous variable HR 1.1, p = 0.01), lymphovascular space involvement (LVSI) (HR 3.6, p = 0.005), and RT (HR 0.13, p<0.001) predicted for RFS. LUS (HR 6.2, p<0.001) and LVSI (HR 4.6, p<0.001) were significant predictors for disease specific survival (DSS). Age-adjusted Charlson Comorbidity Score (HR 1.2, p = 0.003), LVSI (HR 3.1, p = 0.003), and RT (HR 0.43, p = 0.01) were retained in the multivariate model for OS. Adjuvant RT appears to reduce the risk of local-regional failure and improve OS in this cohort of patients with early stage Type II endometrial cancer. However, distant failure is a challenge for women with type II endometrial cancer. Further investigation into optimal adjuvant systemic therapy in these patients appears justified.