Adjuvant Treatment after Surgery in Stage IIIA Endometrial Adenocarcinoma

作者：Yoon Mee Sun; Huh Seung Jae; Kim Hak Jae; Kim Young Seok; Kim Yong Bae; Kim Joo Young; Lee Jong Hoon; Kim Hun Jung; Cha Jihye; Kim Jin Hee; Kim Juree; Yoon Won Sup; Choi Jin Hwa; Chun Mison; Choi Youngmin; Lee Kang Kyoo; Kim Myungsoo; Jeong Jae Uk; Chang Sei Kyung^*; Park Won^*

来源：Cancer Research and Treatment, 2016, 48(3): 1074-1083.

DOI：10.4143/crt.2015.356

• Endometrial neoplasms
• Adjuvant radiotherapy
• Adjuvant chemoradiotherapy

Purpose
We evaluated the role of adjuvant therapy in stage IIIA endometrioid adenocarcinoma patients who underwent surgery followed by radiotherapy (RT) alone or chemoradiotherapy (CTRT) according to risk group.
Materials and Methods
A multicenter retrospective study was conducted including patients with surgical stage IIIA endometrial cancer treated by radical surgery and adjuvant RT or CTRT. Disease-free survival (DFS) and overall survival (OS) were analyzed.
Results
Ninety-three patients with stage IIIA disease were identified. Nineteen patients (20.4%) experienced recurrence, mostly distant metastasis (17.2%). Combined CTRT did not affect DFS (74.1% vs. 82.4%, p=0.130) or OS (96.3% vs. 91.9%, p=0.262) in stage IIIA disease compared with RT alone. Patients with age >= 60 years, grade G2/3, and lymphovascular space involvement had a significantly worse DFS and those variables were defined as risk factors. The high-risk group showed a significant reduction in 5-year DFS (>= 2 risk factors) (49.0% vs. 88.0%, p < 0.001) compared with the low-risk group (< 2). Multivariate analysis confirmed that more than one risk factor was the only predictor of worse DFS (hazard ratio, 5.45; 95% confidence interval, 2.12 to 13.98; p < 0.001). Of patients with no risk factors, a subset treated with RT alone showed an excellent 5-year DFS and OS (93.8% and 100%, respectively).
Conclusion
We identified a low-risk subset of stage IIIA endometrioid adenocarcinoma patients who might be reasonable candidates for adjuvant RT alone. Further randomized studies are needed to determine which subset might benefit from combined CTRT.

• 出版日期2016-7