title: Adjuvant vaginal brachytherapy decreases the risk of vaginal recurrence in patients with stage I non-invasive uterine papillary serous carcinoma. A multi-institutional study.
abstract: OBJECTIVE
  To investigate the impact of adjuvant vaginal brachytherapy on vaginal recurrence in stage I non-invasive uterine papillary serous carcinoma (UPSC).
  
  
  METHODS
  This is a retrospective multi-institutional study from 2000-2012. 103 patients who underwent surgical treatment with non-invasive stage IA UPSC were included.
  
  
  RESULTS
  85% and 55% underwent staging lymphadenectomy and omentectomy respectively. 28.2% (29/103) developed recurrence. Vaginal, pelvic and extra-pelvic recurrences developed in 7.8% (8/103), 3.9% (4/103) and 16.5% (17/103) respectively. Among patients who were observed or received only chemotherapy, the rate of vaginal recurrence was 10.9% (7/64) compared to 2.6% (1/39) among those who received vaginal brachytherapy +/- chemotherapy (p=0.035). The rate of vaginal recurrence was not different between those who were observed and those who received only chemotherapy (9.3% vs. 14.3%, p=0.27). The 5-year progression free survival (PFS) and overall survival (OS) for the entire cohort were 88.3% and 90.6%. Patients who underwent surgical staging had longer PFS (p=0.001) and OS (p=0.0005) compared to those who did not. In multivariable analysis controlling for age, histology, chemotherapy, brachytherapy, and staging lymphadenectomy, only lymphadenectomy was an independent predictor of PFS (HR 0.28, 95% CI 0.11-0.71, p=0.0037) and OS (HR 0.27, 95% CI 0.10-0.71, p=0.0035). Neither chemotherapy nor brachytherapy were predictors of PFS or OS.
  
  
  CONCLUSIONS
  This is the largest study reported in stage I non-invasive UPSC. The majority of recurrences were extra-pelvic. Vaginal brachytherapy has a significant role in reducing the risk of vaginal recurrence and surgical staging was the only predictor of outcome. Therefore, both should be considered in these patients.
authors.affiliation: Gynecologic Oncology Division, Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA. Electronic address: mahdih6281@gmail.com.
authors.forename: Haider
authors.initials: H
authors.lastname: Mahdi
authors.affiliation: Gynecologic Oncology Division, Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Rose
authors.affiliation: Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Elshaikh
authors.affiliation: Division of Gynecologic Oncology, Department of Women's Health, Obstetrics & Gynecology, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Adnan
authors.initials: A
authors.lastname: Munkarah
authors.affiliation: Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, USA.
authors.forename: Derek
authors.initials: D
authors.lastname: Isrow
authors.affiliation: Division of Gynecologic Oncology, University Hospitals, Cleveland, OH, USA.
authors.forename: Sareena
authors.initials: S
authors.lastname: Singh
authors.affiliation: Division of Gynecologic Oncology, University Hospitals, Cleveland, OH, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Waggoner
authors.affiliation: Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Rouba
authors.initials: R
authors.lastname: Ali-Fehmi
authors.affiliation: Division of Gynecologic Oncology, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Robort T
authors.initials: RT
authors.lastname: Morris
authors.affiliation: Department of Epidemiology, Case Western University, Cleveland, OH, USA.
authors.forename: Jarod
authors.initials: J
authors.lastname: Harding
authors.affiliation: Gynecologic Oncology Division, Ob/Gyn and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: DeBenardo
mesh_terms: D000230:Adenocarcinoma / Q000517:prevention & control / Q000556:secondary*; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D016889:Endometrial Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D008875:Middle Aged; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012306:Risk; D016019:Survival Analysis; D016896:Treatment Outcome; D014625:Vaginal Neoplasms / Q000517:prevention & control / Q000556:secondary*
keywords: Non-invasive uterine papillary serous carcinoma; Outcome; Stage I; Vaginal brachytherapy; Vaginal recurrence