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The influence of radiation modality and lymph node dissection on survival in early-stage endometrial cancer.

Publication ,  Journal Article
Chino, JP; Jones, E; Berchuck, A; Secord, AA; Havrilesky, LJ
Published in: Int J Radiat Oncol Biol Phys
April 1, 2012

BACKGROUND: The appropriate uses of lymph node dissection (LND) and adjuvant radiation therapy (RT) for Stage I endometrial cancer are controversial. We explored the impact of specific RT modalities (whole pelvic RT [WPRT], vaginal brachytherapy [VB]) and LND status on survival. MATERIALS AND METHODS: The Surveillance Epidemiology and End Results dataset was queried for all surgically treated International Federation of Gynecology and Obstetrics (FIGO) Stage I endometrial cancers; subjects were stratified into low, intermediate and high risk cohorts using modifications of Gynecologic Oncology Group (GOG) protocol 99 and PORTEC (Postoperative Radiation Therapy in Endometrial Cancer) trial criteria. Five-year overall survival was estimated, and comparisons were performed via the log-rank test. RESULTS: A total of 56,360 patients were identified: 70.4% low, 26.2% intermediate, and 3.4% high risk. A total of 41.6% underwent LND and 17.6% adjuvant RT. In low-risk disease, LND was associated with higher survival (93.7 LND vs. 92.7% no LND, p < 0.001), whereas RT was not (91.6% RT vs. 92.9% no RT, p = 0.23). In intermediate-risk disease, LND (82.1% LND vs. 76.5% no LND, p < 0.001) and RT (80.6% RT vs. 74.9% no RT, p < 0.001) were associated with higher survival without differences between RT modalities. In high-risk disease, LND (68.8% LND vs. 54.1% no LND, p < 0.001) and RT (66.9% RT vs. 57.2% no RT, p < 0.001) were associated with increased survival; if LND was not performed, VB alone was inferior to WPRT (p = 0.01). CONCLUSION: Both WPRT and VB alone are associated with increased survival in the intermediate-risk group. In the high-risk group, in the absence of LND, only WPRT is associated with increased survival. LND was also associated with increased survival.

Duke Scholars

Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

April 1, 2012

Volume

82

Issue

5

Start / End Page

1872 / 1879

Location

United States

Related Subject Headings

  • Survival Analysis
  • SEER Program
  • Risk
  • Radiotherapy, Adjuvant
  • Radiotherapy
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Neoplasm Invasiveness
  • Neoplasm Grading
  • Middle Aged
 

Citation

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Chino, J. P., Jones, E., Berchuck, A., Secord, A. A., & Havrilesky, L. J. (2012). The influence of radiation modality and lymph node dissection on survival in early-stage endometrial cancer. Int J Radiat Oncol Biol Phys, 82(5), 1872–1879. https://doi.org/10.1016/j.ijrobp.2011.03.054
Chino, Junzo P., Ellen Jones, Andrew Berchuck, Angeles Alvarez Secord, and Laura J. Havrilesky. “The influence of radiation modality and lymph node dissection on survival in early-stage endometrial cancer.Int J Radiat Oncol Biol Phys 82, no. 5 (April 1, 2012): 1872–79. https://doi.org/10.1016/j.ijrobp.2011.03.054.
Chino JP, Jones E, Berchuck A, Secord AA, Havrilesky LJ. The influence of radiation modality and lymph node dissection on survival in early-stage endometrial cancer. Int J Radiat Oncol Biol Phys. 2012 Apr 1;82(5):1872–9.
Chino, Junzo P., et al. “The influence of radiation modality and lymph node dissection on survival in early-stage endometrial cancer.Int J Radiat Oncol Biol Phys, vol. 82, no. 5, Apr. 2012, pp. 1872–79. Pubmed, doi:10.1016/j.ijrobp.2011.03.054.
Chino JP, Jones E, Berchuck A, Secord AA, Havrilesky LJ. The influence of radiation modality and lymph node dissection on survival in early-stage endometrial cancer. Int J Radiat Oncol Biol Phys. 2012 Apr 1;82(5):1872–1879.
Journal cover image

Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

April 1, 2012

Volume

82

Issue

5

Start / End Page

1872 / 1879

Location

United States

Related Subject Headings

  • Survival Analysis
  • SEER Program
  • Risk
  • Radiotherapy, Adjuvant
  • Radiotherapy
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Neoplasm Invasiveness
  • Neoplasm Grading
  • Middle Aged