Utility of radiation therapy for early-stage uterine papillary serous carcinoma.
Early-stage uterine papillary serous carcinoma (UPSC) has a poor prognosis and high recurrence rate. While adjuvant chemotherapy is generally recommended, the role of radiation is uncertain. We examined the association between vaginal brachytherapy and whole pelvic radiation and survival in women treated with and without adjuvant chemotherapy.



The National Cancer Data Base was used to identify women with stage I-II UPSC treated between 1998 and 2012. Trends in use of chemotherapy, brachytherapy, and external beam radiation over time were examined. The association between these treatments and mortality were examined using multivariable Cox proportional hazards models.



A total of 7325 patients were identified. Overall, 2779 (37.9%) received chemotherapy. The use of vaginal brachytherapy increased from 7.2% in 1998 to 29.1% in 2012 (P<0.0001), while use of external beam radiation decreased from 18.2% to 11.7% over the same period (P<0.0001). Use of chemotherapy was associated with a 22% reduction in mortality (HR=0.78; 95% CI, 0.69-0.88). While brachytherapy was associated with decreased mortality (HR=0.67; 95% CI, 0.57-0.78), use of external beam radiation was not associated with survival (HR=1.03; 95% CI, 0.92-1.17). Stratified by stage, use of chemotherapy was associated with decreased mortality for women with stage IB and II tumors, but not for stage IA neoplasms. Vaginal brachytherapy was associated with reduced mortality for stage IA and II neoplasms.



For women with early-stage UPSC, chemotherapy is associated with improved survival. Vaginal brachytherapy was also associated with improved survival, however, there was little benefit to use of external beam radiation.
Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States.
Stephanie
S
Cham
Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States.
Yongmei
Y
Huang
Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States; Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, United States; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, United States; New York Presbyterian Hospital, United States.
Ana I
AI
Tergas
Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, United States; New York Presbyterian Hospital, United States.
June Y
JY
Hou
Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, United States; New York Presbyterian Hospital, United States.
William M
WM
Burke
Department of Radiation Oncology, Columbia University College of Physicians and Surgeons, United States; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, United States; New York Presbyterian Hospital, United States.
Israel
I
Deutsch
Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States; Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, United States.
Cande V
CV
Ananth
Department of Medicine, Columbia University College of Physicians and Surgeons, United States; Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, United States; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, United States; New York Presbyterian Hospital, United States.
Alfred I
AI
Neugut
Department of Medicine, Columbia University College of Physicians and Surgeons, United States; Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, United States; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, United States; New York Presbyterian Hospital, United States.
Dawn L
DL
Hershman
Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, United States; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, United States; New York Presbyterian Hospital, United States. Electronic address: jw2459@columbia.edu.
Jason D
JD
Wright
D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000706:statistics & numerical data; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D018283:Cystadenocarcinoma, Papillary / Q000188:drug therapy / Q000453:epidemiology / Q000532:radiotherapy*; D018284:Cystadenocarcinoma, Serous / Q000188:drug therapy / Q000453:epidemiology / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011878:Radiotherapy / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014594:Uterine Neoplasms / Q000188:drug therapy / Q000453:epidemiology / Q000532:radiotherapy*
Chemotherapy; Endometrial cancer; Radiation; Uterine cancer; Uterine papillary serous carcinoma