Overall and cancer specific survival following radical or adjuvant (chemo)radiotherapy in a retrospective cohort of elderly patients with endometrial cancer

To report the overall survival and cancer specific survival outcomes of elderly women aged >70 years who received radical or adjuvant (chemo)radiotherapy for endometrial cancer, we conducted a retrospective review of 93 patients from the West of Scotland Cancer Network (WoSCAN) who received pelvic (+/- para-aortic) radiotherapy over a 5-year period (January 2011 to December 2015, inclusive). Association of treatment type and other variables with overall survival (OS) and cancer specific survival (CSS) were analysed using log rank tests and Cox proportional hazards models. Median age of the study population was 74 years (range 70-90 years); over 50% of patients were aged >75 years, and over 25% were >80 years. The majority of patients had endometrioid endometrial cancer (75.3%), and 24.7% had a high-risk histological subtype. Stage distribution was as follows: I/II (40.9%); III/IV (41.9%); recurrent disease (17.2%). Radiotherapy was predominantly delivered in the adjuvant setting (61.3%); intent was primary (22.6%) or salvage (16.1%) in the remaining patients. Chemotherapy was administered to almost 50% of the cohort, mainly in conjunction with adjuvant radiotherapy. After median follow up of 96 months, 5-year OS and CSS were 50.5% and CSS 59.3% for the entire series, 57.9% and 62.8% in the adjuvant group, 23.8% and 35.7% in the primary group, and 60.0% and 80.0% in the salvage group, respectively. Age >80 years and primary radiotherapy were statistically significant predictors of poorer survival, adjusting for pathology, stage and grade (hazard ratio (HR) 2.06, 95% Confidence Interval (CI) (1.11-3.80), p = 0.021; and HR 2.42 (CI 1.28-4.57), p = 0.006 respectively). In summary, poorer OS was associated with use of (chemo)radiotherapy as primary treatment of endometrial cancer and/or in women aged >80 years, suggesting that careful risk/benefit analysis is required in these two groups.