Survival analysis of endometrial cancer patients with cervical stromal involvement.
OBJECTIVE
Stage II endometrial cancer is relatively uncommon. There is no consensus for appropriate adjuvant therapy in endometrial cancer patients with cervical stromal involvement (International Federation of Gynecology and Obstetrics [FIGO] stage II). This study investigates how adjuvant treatments and tumor characteristics influence overall survival (OS) and disease-free survival (DFS) in stage II patients in order to establish better treatment guidelines.


METHODS
This multi-institution, Institutional Review Board approved, study is a retrospective review of 40 endometrial cancer patients with cervical stromal involvement treated from 1993 to 2009. Kaplan-Meier estimates were used to evaluate OS and DFS.


RESULTS
OS was 85% at three years and 67% at five years. There were no significant differences in age, histology, depth of invasion, comorbid conditions, surgical staging or recurrence between patients who received radiation therapy (RT) and those who did not. However, patients with FIGO grade 1 cancers were less likely to receive RT (p=0.007). Patients treated with RT had a similar 5 year OS (n=33, 69%) to those treated with surgery only (n=7, 60%, p=0.746). There were no OS differences when evaluating by grade, histology, or depth of invasion between patients who did and did not receive RT. Four patients recurred: three were locoregional failures only, and one failed locally and distant.


CONCLUSIONS
Patients receiving RT had higher grade tumors. Despite this, OS was comparable between the RT and the no RT cohorts. Local failure was the predominant pattern of failure. Endometrial cancer patients with cervical stromal involvement likely receive better locoregional control with the addition of adjuvant RT and we continue to advocate for RT in most cases.
Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah School of Medicine, Salt Lake City, UT, USA.
Jonathan E
JE
Frandsen
Department of Radiation Oncology, Intermountain Medical Center, Murray, UT, USA.
William T
WT
Sause
Department of Gynecological Oncology, Huntsman Cancer Hospital, University of Utah School of Medicine, Salt Lake City, UT, USA. ; Department of Gynecological Oncology, Intermountain Medical Center, Murray, UT, USA.
Mark K
MK
Dodson
Department of Gynecological Oncology, Huntsman Cancer Hospital, University of Utah School of Medicine, Salt Lake City, UT, USA. ; Department of Gynecological Oncology, Intermountain Medical Center, Murray, UT, USA.
Andrew P
AP
Soisson
Department of Radiation Oncology, Intermountain Medical Center, Murray, UT, USA.
Thomas W
TW
Belnap
Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah School of Medicine, Salt Lake City, UT, USA.
David K
DK
Gaffney
Adjuvant radiation therapy; Cervical involvement; Endometrial cancer; Survival outcome