Adjuvant Treatment after Surgery in Stage IIIA Endometrial Adenocarcinoma.
OBJECTIVE
We evaluated the role of adjuvant therapy in stage IIIA endometrioid adenocarcinoma patients who underwent surgery followed by radiotherapy (RT) alone or chemoradiotherapy (CTRT) according to risk group.


METHODS
A multicenter retrospective study was conducted including patients with surgical stage IIIA endometrial cancertreated by radical surgery and adjuvant RT or CTRT. Disease-free survival (DFS) and overall survival (OS) were analyzed.


RESULTS
Ninety-three patients with stage IIIA disease were identified. Nineteen patients (20.4%) experienced recurrence, mostly distant metastasis (17.2%). Combined CTRT did not affect DFS (74.1% vs. 82.4%, p=0.130) or OS (96.3% vs. 91.9%, p=0.262) in stage IIIA disease compared with RT alone. Patients with age ≥ 60 years, grade G2/3, and lymphovascular space involvement had a significantly worse DFS and those variables were defined as risk factors. The high-risk group showed a significant reduction in 5-year DFS (≥ 2 risk factors) (49.0% vs. 88.0%, p < 0.001) compared with the low-risk group (< 2). Multivariate analysis confirmed that more than one risk factor was the only predictor of worse DFS (hazard ratio, 5.45; 95% confidence interval, 2.12 to 13.98; p < 0.001). Of patients with no risk factors, a subset treated with RT alone showed an excellent 5-year DFS and OS (93.8% and 100%, respectively).


CONCLUSIONS
We identified a low-risk subset of stage IIIA endometrioid adenocarcinoma patients who might be reasonable candidates for adjuvant RT alone. Further randomized studies are needed to determine which subset might benefit from combined CTRT.
Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea.
Mee Sun
MS
Yoon
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Seung Jae
SJ
Huh
Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea.
Hak Jae
HJ
Kim
Department of Radiation Oncology, Asan Medical Center, Seoul, Korea.
Young Seok
YS
Kim
Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea.
Yong Bae
YB
Kim
Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Joo-Young
JY
Kim
Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
Jong-Hoon
JH
Lee
Department of Radiation Oncology, Inha University School of Medicine, Incheon, Korea.
Hun Jung
HJ
Kim
Department of Radiation Oncology, Yonsei University Wonju College of Medicine, Wonju, Korea.
Jihye
J
Cha
Department of Radiation Oncology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
Jin Hee
JH
Kim
Department of Radiation Oncology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea.
Juree
J
Kim
Department of Radiation Oncology Korea University College of Medicine, Seoul, Korea.
Won Sup
WS
Yoon
Department of Radiation Oncology, Chung-Ang University Hospital, Seoul, Korea.
Jin Hwa
JH
Choi
Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea.
Mison
M
Chun
Department of Radiation Oncology, Dong-A University School of Medicine, Busan, Korea.
Youngmin
Y
Choi
Department of Radiation Oncology, University of Wonkwang School of Medicine, Iksan, Korea.
Kang Kyoo
KK
Lee
Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.
Myungsoo
M
Kim
Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea.
Jae-Uk
JU
Jeong
Department of Radiation Oncology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
Sei Kyung
SK
Chang
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Won
W
Park
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018269:Carcinoma, Endometrioid / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant / Q000379:methods; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D000074868:Salpingo-oophorectomy; D017211:Treatment Failure
Adjuvant chemoradiotherapy; Adjuvant radiotherapy; Endometrial neoplasms