title: Effect of race and histology on patterns of failure in women with early stage endometrial cancer treated with high dose rate brachytherapy.
abstract: BACKGROUND
  Clinical trials have helped refine management of early stage endometrial cancer (EC). For patients with intermediate risk features, adjuvant radiation is considered, primarily vaginal cuff brachytherapy. For higher risk patients, there may be a role for chemotherapy and radiation. The purpose of this study is to examine patterns of failure for early stage EC patients treated with postoperative high dose rate brachytherapy.
  
  
  METHODS
  In this single institution retrospective cohort study, 208 women with early stage endometrial cancer who received definitive therapy between January 1, 2000 and January 1, 2013 were identified.
  
  
  RESULTS
  Median follow-up was 46.4 (range, 6.2-137.3) months. Thirteen (6.3%) patients developed with locoregional recurrent disease and 15 (7.2%) patients developed distant metastasis. Freedom from recurrence at 5 years was 88.6% for white patients and 60.5% for black patients (p=0.0093). Five year recurrence free survival (RFS) for white vs. black patients was 82.9% vs. 48.9% (p=0.0007). Five year overall survival (OS) was 86.8% for white patients and 59.5% for black patients (p=0.0023). Black patients with unfavorable histology treated with chemotherapy and vaginal brachytherapy had a 15% locoregional recurrence rate, more than double the rate of local recurrence compared to AA patients with endometrioid histology and white patients with any histology (6% locoregional recurrence rate).
  
  
  CONCLUSIONS
  Black women with unfavorable histology early stage EC experience increased rates of recurrence and worse survival compared to white patients. Patterns of failure in this group also indicate a high locoregional failure rate for the black patients with unfavorable histology (type II).
authors.affiliation: Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Radiation Oncology, Eskisehir Osmangazi University Hospital, Eskisehir, Turkey.
authors.forename: Alaattin
authors.initials: A
authors.lastname: Ozen
authors.affiliation: Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Aaron D
authors.initials: AD
authors.lastname: Falchook
authors.affiliation: Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Mahesh A
authors.initials: MA
authors.lastname: Varia
authors.affiliation: Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Paola
authors.initials: P
authors.lastname: Gehrig
authors.affiliation: Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: ellen_jones@med.unc.edu.
authors.forename: Ellen L
authors.initials: EL
authors.lastname: Jones
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People; D001918:Brachytherapy / Q000379:methods*; D059248:Chemoradiotherapy; D015331:Cohort Studies; D016889:Endometrial Neoplasms / Q000188:drug therapy / Q000208:ethnology* / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000208:ethnology* / Q000473:pathology*; D009367:Neoplasm Staging; D012189:Retrospective Studies; D017211:Treatment Failure; D044465:White People
keywords: Endometrial cancer; Failure patterns; Racial disparities