title: Improved survival endpoints with adjuvant radiation treatment in patients with high-risk early-stage endometrial carcinoma.
abstract: OBJECTIVE
  To determine the impact of adjuvant radiation treatment (RT) on recurrence-free survival (RFS), disease-specific survival (DSS), and overall survival (OS) in patients with high-risk 2009 International Federation of Gynecology and Obstetrics stage I-II endometrial carcinoma.
  
  
  METHODS
  We identified 382 patients with high-risk EC who underwent hysterectomy. RFS, DSS, and OS were calculated from the date of hysterectomy by use of the Kaplan-Meier method. Cox regression modeling was used to explore the risks associated with various factors on survival endpoints.
  
  
  RESULTS
  The median follow-up time for the study cohort was 5.4 years. The median age was 71 years. All patients underwent hysterectomy and salpingo-oophorectomy, 93% had peritoneal cytology, and 85% underwent lymphadenectomy. Patients with endometrioid histology constituted 72% of the study cohort, serous in 16%, clear cell in 7%, and mixed histology in 4%. Twenty-three percent of patients had stage II disease. Adjuvant management included RT alone in 220 patients (57%), chemotherapy alone in 25 patients (7%), and chemoradiation therapy in 27 patients (7%); 110 patients (29%) were treated with close surveillance. The 5-year RFS, DSS, and OS were 76%, 88%, and 73%, respectively. On multivariate analysis, adjuvant RT was a significant predictor of RFS (P<.001) DSS (P<.001), and OS (P=.017). Lymphovascular space involvement was a significant predictor of RFS and DSS (P<.001). High tumor grade was a significant predictor for RFS (P=.038) and DSS (P=.025). Involvement of the lower uterine segment was also a predictor of RFS (P=.049). Age at diagnosis and lymphovascular space involvement were significant predictors of OS: P<.001 and P=.002, respectively.
  
  
  CONCLUSIONS
  In the treatment of patients with high-risk features, our study suggests that adjuvant RT significantly improves recurrence-free, disease-specific, and overall survival in patients with early-stage endometrial carcinoma. Furthermore, adjuvant RT is an independent predictor for RFS, DSS, and OS in this group of patients. These findings need validation from a prospective randomized study.
authors.affiliation: Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan. Electronic address: melshai1@hfhs.org.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Elshaikh
authors.affiliation: Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan.
authors.forename: Sean
authors.initials: S
authors.lastname: Vance
authors.affiliation: Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan.
authors.forename: Jaipreet S
authors.initials: JS
authors.lastname: Suri
authors.affiliation: Public Health Science, Henry Ford Hospital, Detroit, Michigan.
authors.forename: Meredith
authors.initials: M
authors.lastname: Mahan
authors.affiliation: Division of Gynecologic Oncology, Department of Women's Health Services, Henry Ford Hospital, Detroit, Michigan.
authors.forename: Adnan
authors.initials: A
authors.lastname: Munkarah
mesh_terms: D000368:Aged; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D010052:Ovariectomy; D018714:Radiotherapy, Adjuvant / Q000401:mortality; D012189:Retrospective Studies