Patterns of Recurrence, Long-term Survival and Toxicity Analysis of Endometrial Adenocarcinoma Patients Reclassified under the Recent ESMO-ESGO-ESTRO Stratification

Seven-Year Results from a Single Institution

Uday P. Kumar, Prahlad H. Yathiraj, Krishna T. Sharan, Asha Kamath, Anshul Singh, S. Anusha Reddy, Priyanka Alurkar, Donald J. Fernandes, Vidyasagar S. Mamidipudi

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Abstract

Aim The aim of this study was to report the patterns of recurrence, locoregional control, and survival of patients diagnosed with endometrial adenocarcinomas over a 7-year period after reclassifying them under the recent ESMO-ESGO-ESTRO (European Society of Medical Oncology/European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology) consensus classification. Methods Archives of a single institution from 2008 to 2014 were studied and patients with stages I-II endometrial adenocarcinoma were reclassified as per the new classification for uniformity. On magnetic resonance imaging, if found to be stage I, total abdominal hysterectomy with bilateral salpingo-oophorectomy alone was performed. The indications for adjuvant external beam radiotherapy (EBRT) and vaginal brachytherapy (VBT) were based on standard recommendations. Survival was calculated from Kaplan-Meier curves, and toxicity was recorded using Common Terminology Criteria for Adverse Events version 3. Results Of the 132 patients registered, 101 patients were included for analysis. A total of 18 patients have died, and information on outcome is available for 84% of patients. Five patients were metastatic at presentation. Five patients received definitive EBRT + intracavitary brachytherapy because of surgical inoperability, four of whom are disease-free locoregionally with median overall survival of 33.8 months. Of the 91 patients operated on, the incidence of low, intermediate, high-intermediate, and high risk was 34%, 29%, 2%, and 19%, whereas 16% were stage III. The overall recurrence rates were 10%, 15%, and 23% for low, intermediate, and high risk, respectively. With median follow-up of 32 months (range, 2-93 months), the disease-free survival for low, intermediate, and high risk and stage III were 92%, 81%, and 64% and 55%, whereas the mean survival for the same groups were 53, 44, and 34 and 22 months, respectively (P = 0.047). External beam radiotherapy resulted in significantly higher proctitis than VBT alone (P = 0.02). The median time to cystitis, proctitis, and enteritis were 27, 19, and 28 months, respectively. Conclusions Recurrence rates, survival rates, and the patterns of recurrence are comparable with published literature and partly validates the ESMO-ESGO-ESTRO consensus statement. Addition of EBRT significantly increases risk of late proctitis as compared with VBT alone.

Original languageEnglish
Pages (from-to)854-860
Number of pages7
JournalInternational Journal of Gynecological Cancer
Volume28
Issue number5
DOIs
Publication statusPublished - 01-06-2018

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Medical Oncology
Survival Analysis
Adenocarcinoma
Radiotherapy
Recurrence
Brachytherapy
Proctitis
Survival
Cystitis
Enteritis
Ovariectomy
Hysterectomy
Terminology
Disease-Free Survival
Survival Rate
Magnetic Resonance Imaging
Incidence

All Science Journal Classification (ASJC) codes

  • Oncology
  • Obstetrics and Gynaecology

Cite this

@article{178facc7ce9c427a91cde337a1a03ef6,
title = "Patterns of Recurrence, Long-term Survival and Toxicity Analysis of Endometrial Adenocarcinoma Patients Reclassified under the Recent ESMO-ESGO-ESTRO Stratification: Seven-Year Results from a Single Institution",
abstract = "Aim The aim of this study was to report the patterns of recurrence, locoregional control, and survival of patients diagnosed with endometrial adenocarcinomas over a 7-year period after reclassifying them under the recent ESMO-ESGO-ESTRO (European Society of Medical Oncology/European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology) consensus classification. Methods Archives of a single institution from 2008 to 2014 were studied and patients with stages I-II endometrial adenocarcinoma were reclassified as per the new classification for uniformity. On magnetic resonance imaging, if found to be stage I, total abdominal hysterectomy with bilateral salpingo-oophorectomy alone was performed. The indications for adjuvant external beam radiotherapy (EBRT) and vaginal brachytherapy (VBT) were based on standard recommendations. Survival was calculated from Kaplan-Meier curves, and toxicity was recorded using Common Terminology Criteria for Adverse Events version 3. Results Of the 132 patients registered, 101 patients were included for analysis. A total of 18 patients have died, and information on outcome is available for 84{\%} of patients. Five patients were metastatic at presentation. Five patients received definitive EBRT + intracavitary brachytherapy because of surgical inoperability, four of whom are disease-free locoregionally with median overall survival of 33.8 months. Of the 91 patients operated on, the incidence of low, intermediate, high-intermediate, and high risk was 34{\%}, 29{\%}, 2{\%}, and 19{\%}, whereas 16{\%} were stage III. The overall recurrence rates were 10{\%}, 15{\%}, and 23{\%} for low, intermediate, and high risk, respectively. With median follow-up of 32 months (range, 2-93 months), the disease-free survival for low, intermediate, and high risk and stage III were 92{\%}, 81{\%}, and 64{\%} and 55{\%}, whereas the mean survival for the same groups were 53, 44, and 34 and 22 months, respectively (P = 0.047). External beam radiotherapy resulted in significantly higher proctitis than VBT alone (P = 0.02). The median time to cystitis, proctitis, and enteritis were 27, 19, and 28 months, respectively. Conclusions Recurrence rates, survival rates, and the patterns of recurrence are comparable with published literature and partly validates the ESMO-ESGO-ESTRO consensus statement. Addition of EBRT significantly increases risk of late proctitis as compared with VBT alone.",
author = "Kumar, {Uday P.} and Yathiraj, {Prahlad H.} and Sharan, {Krishna T.} and Asha Kamath and Anshul Singh and Reddy, {S. Anusha} and Priyanka Alurkar and Fernandes, {Donald J.} and Mamidipudi, {Vidyasagar S.}",
year = "2018",
month = "6",
day = "1",
doi = "10.1097/IGC.0000000000001252",
language = "English",
volume = "28",
pages = "854--860",
journal = "International Journal of Gynecological Cancer",
issn = "1048-891X",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Patterns of Recurrence, Long-term Survival and Toxicity Analysis of Endometrial Adenocarcinoma Patients Reclassified under the Recent ESMO-ESGO-ESTRO Stratification

T2 - Seven-Year Results from a Single Institution

AU - Kumar, Uday P.

AU - Yathiraj, Prahlad H.

AU - Sharan, Krishna T.

AU - Kamath, Asha

AU - Singh, Anshul

AU - Reddy, S. Anusha

AU - Alurkar, Priyanka

AU - Fernandes, Donald J.

AU - Mamidipudi, Vidyasagar S.

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Aim The aim of this study was to report the patterns of recurrence, locoregional control, and survival of patients diagnosed with endometrial adenocarcinomas over a 7-year period after reclassifying them under the recent ESMO-ESGO-ESTRO (European Society of Medical Oncology/European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology) consensus classification. Methods Archives of a single institution from 2008 to 2014 were studied and patients with stages I-II endometrial adenocarcinoma were reclassified as per the new classification for uniformity. On magnetic resonance imaging, if found to be stage I, total abdominal hysterectomy with bilateral salpingo-oophorectomy alone was performed. The indications for adjuvant external beam radiotherapy (EBRT) and vaginal brachytherapy (VBT) were based on standard recommendations. Survival was calculated from Kaplan-Meier curves, and toxicity was recorded using Common Terminology Criteria for Adverse Events version 3. Results Of the 132 patients registered, 101 patients were included for analysis. A total of 18 patients have died, and information on outcome is available for 84% of patients. Five patients were metastatic at presentation. Five patients received definitive EBRT + intracavitary brachytherapy because of surgical inoperability, four of whom are disease-free locoregionally with median overall survival of 33.8 months. Of the 91 patients operated on, the incidence of low, intermediate, high-intermediate, and high risk was 34%, 29%, 2%, and 19%, whereas 16% were stage III. The overall recurrence rates were 10%, 15%, and 23% for low, intermediate, and high risk, respectively. With median follow-up of 32 months (range, 2-93 months), the disease-free survival for low, intermediate, and high risk and stage III were 92%, 81%, and 64% and 55%, whereas the mean survival for the same groups were 53, 44, and 34 and 22 months, respectively (P = 0.047). External beam radiotherapy resulted in significantly higher proctitis than VBT alone (P = 0.02). The median time to cystitis, proctitis, and enteritis were 27, 19, and 28 months, respectively. Conclusions Recurrence rates, survival rates, and the patterns of recurrence are comparable with published literature and partly validates the ESMO-ESGO-ESTRO consensus statement. Addition of EBRT significantly increases risk of late proctitis as compared with VBT alone.

AB - Aim The aim of this study was to report the patterns of recurrence, locoregional control, and survival of patients diagnosed with endometrial adenocarcinomas over a 7-year period after reclassifying them under the recent ESMO-ESGO-ESTRO (European Society of Medical Oncology/European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology) consensus classification. Methods Archives of a single institution from 2008 to 2014 were studied and patients with stages I-II endometrial adenocarcinoma were reclassified as per the new classification for uniformity. On magnetic resonance imaging, if found to be stage I, total abdominal hysterectomy with bilateral salpingo-oophorectomy alone was performed. The indications for adjuvant external beam radiotherapy (EBRT) and vaginal brachytherapy (VBT) were based on standard recommendations. Survival was calculated from Kaplan-Meier curves, and toxicity was recorded using Common Terminology Criteria for Adverse Events version 3. Results Of the 132 patients registered, 101 patients were included for analysis. A total of 18 patients have died, and information on outcome is available for 84% of patients. Five patients were metastatic at presentation. Five patients received definitive EBRT + intracavitary brachytherapy because of surgical inoperability, four of whom are disease-free locoregionally with median overall survival of 33.8 months. Of the 91 patients operated on, the incidence of low, intermediate, high-intermediate, and high risk was 34%, 29%, 2%, and 19%, whereas 16% were stage III. The overall recurrence rates were 10%, 15%, and 23% for low, intermediate, and high risk, respectively. With median follow-up of 32 months (range, 2-93 months), the disease-free survival for low, intermediate, and high risk and stage III were 92%, 81%, and 64% and 55%, whereas the mean survival for the same groups were 53, 44, and 34 and 22 months, respectively (P = 0.047). External beam radiotherapy resulted in significantly higher proctitis than VBT alone (P = 0.02). The median time to cystitis, proctitis, and enteritis were 27, 19, and 28 months, respectively. Conclusions Recurrence rates, survival rates, and the patterns of recurrence are comparable with published literature and partly validates the ESMO-ESGO-ESTRO consensus statement. Addition of EBRT significantly increases risk of late proctitis as compared with VBT alone.

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U2 - 10.1097/IGC.0000000000001252

DO - 10.1097/IGC.0000000000001252

M3 - Article

VL - 28

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EP - 860

JO - International Journal of Gynecological Cancer

JF - International Journal of Gynecological Cancer

SN - 1048-891X

IS - 5

ER -