title: Stage IIIC Endometrial Cancer: Relapse and Survival Outcomes in Women Treated With Pelvic or Extended Field Para-Aortic Nodal Radiation Therapy.
abstract: OBJECTIVE
  The optimal radiation (RT) volume for node-positive endometrial cancer is controversial. This study evaluates clinical outcomes in patients with stage IIIC, N1 endometrial cancer who received RT to the pelvis (PV RT) or pelvis plus para-aortic nodes (PV-PAN RT).
  
  
  METHODS
  Overall, there were 89 women with stage IIIC endometrial cancer. Of these, 57 women had N1-only disease, forming the study cohort. Clinicopathologic characteristics, recurrence rates, endometrial cancer-specific survival (ECSS), and overall survival (OS) were examined among patients treated with pelvic RT (n=23) compared with pelvic plus para-aortic RT (n=34). Multivariable analysis of ECSS and OS was performed using Cox regression modeling.
  
  
  RESULTS
  Median follow-up was 5.1 years. Adjuvant chemotherapy was used in 51/57 (89%) of N1 cases. Women with N1 disease who received PV-PAN RT compared with PV RT experienced lower recurrence (26% vs. 52%, P=0.06) and higher survival rates (5 y ECSS 81.5% vs. 47.0%, P=0.04 and OS 79.1% vs. 47.0%, P=0.01). On multivariable analysis, RT volume was not significantly associated with OS, whereas chemotherapy was associated with improved ECSS and OS.
  
  
  CONCLUSIONS
  RT conferred excellent local control, whereas chemotherapy was associated with improved survival in women with N1 endometrial cancer. Distant relapse remains the most common site of recurrence despite chemotherapy.
authors.affiliation: *Radiation Therapy Program, British Columbia Cancer Agency, Victoria ‡Radiation Therapy Program, British Columbia Cancer Agency †Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Caroline L
authors.initials: CL
authors.lastname: Holloway
authors.forename: Cheryl
authors.initials: C
authors.lastname: Alexander
authors.forename: Caroline
authors.initials: C
authors.lastname: Walter
authors.forename: Christina
authors.initials: C
authors.lastname: Aquino-Parsons
authors.forename: Pauline T
authors.initials: PT
authors.lastname: Truong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D016889:Endometrial Neoplasms / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy* / Q000628:therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011878:Radiotherapy / Q000379:methods*; D016896:Treatment Outcome