title: Adjuvant radiation in early stage, unfavorable histology endometrial carcinoma is associated with improved local control and survival.
abstract: OBJECTIVE
  Unfavorable histology endometrial carcinomas confer worse prognosis. We determined the association of adjuvant radiation on local recurrence and survival for unfavorable, early stage endometrial cancer.
  
  
  METHODS
  We retrospectively identified 125 patients who had a hysterectomy for early stage (FIGO IA), unfavorable histology (clear cell, papillary serous or grade 3 endometrioid), endometrial carcinoma treated between 1992 and 2011. Patients were restaged according to current FIGO 2009 guidelines. Primary endpoint was local control and secondary endpoints were distant recurrence and overall survival.
  
  
  RESULTS
  The median age of the cohort was 67 years old with a mean follow up 152 months. Adjuvant radiation was delivered in 60 patients (48%). There were a total of 24 recurrences; 5 had local-regional recurrences, 4 local and distant recurrence, 12 distant only recurrences, and 3 had unspecified recurrences. The 5-year local-regional control was 97.8% in patients who received radiation and 80.1% in patients who did not receive radiation (p=0.018). The 5-year overall survival rate was 68.1% if patients did not receive radiation and 84.9% if they did receive radiation (p=0.0062). On univariate analysis, only radiation (HR 0.12, 95% CI: 0.03 to 0.49, p-value=0.018) was associated with a significant increase in local relapse free survival.
  
  
  CONCLUSIONS
  Adjuvant radiation therapy was significantly associated with an improvement in local-regional control and overall survival in patients with unfavorable histology, early stage endometrial cancer.
authors.affiliation: Huntsman Cancer Institute, University of Utah, Department of Radiation Oncology, Salt Lake City, UT, USA.
authors.forename: David
authors.initials: D
authors.lastname: Ly
authors.affiliation: Intermountain Healthcare, Oncology Clinical Program, Salt Lake City, UT, USA.
authors.forename: Braden D
authors.initials: BD
authors.lastname: Rowley
authors.affiliation: Huntsman Cancer Institute, University of Utah, Division of Gynecological Oncology, Salt Lake City, UT, USA.
authors.forename: Mark K
authors.initials: MK
authors.lastname: Dodson
authors.affiliation: Huntsman Cancer Institute, University of Utah, Division of Gynecological Oncology, Salt Lake City, UT, USA.
authors.forename: Pat A
authors.initials: PA
authors.lastname: Soisson
authors.affiliation: Special Gynecology and Oncology, Riverton, UT, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Jolles
authors.affiliation: Huntsman Cancer Institute, University of Utah, Department of Radiation Oncology, Salt Lake City, UT, USA. Electronic address: David.gaffney@hci.utah.edu.
authors.forename: David K
authors.initials: DK
authors.lastname: Gaffney
authors.affiliation: Intermountain Medical Center, Radiation Oncology, Salt Lake City, UT, USA.
authors.forename: William T
authors.initials: WT
authors.lastname: Sause
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000532:radiotherapy*; D018262:Adenocarcinoma, Clear Cell / Q000473:pathology / Q000532:radiotherapy; D000231:Adenocarcinoma, Papillary / Q000473:pathology / Q000532:radiotherapy; D000368:Aged; D001918:Brachytherapy; D018269:Carcinoma, Endometrioid / Q000473:pathology / Q000532:radiotherapy; D015331:Cohort Studies; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Clear cell; Endometrial; Papillary serous; Radiation; Radiotherapy; Unfavorable histology