Adjuvant therapy for early stage, endometrial cancer with lymphovascular space invasion: Is there a role for chemotherapy?

Anna L. Beavis, Ting Tai Yen, Rebecca L. Stone, Stephanie L. Wethington, Caitlin Carr, Ji Son, Laura Chambers, Chad M. Michener, Stephanie Ricci, Wesley C. Burkett, Debra L. Richardson, Allison Stuart Staley, Susie Ahn, Paola A. Gehrig, Diogo Torres, Sean C. Dowdy, Mackenzie W. Sullivan, Susan C. Modesitt, Catherine Watson, Ashely VeadeJessie Ehrisman, Laura Havrilesky, Angeles Alvarez Secord, Amy Loreen, Kaitlyn Griffin, Amanda Jackson, Akila N. Viswanathan, Leah R. Jager, Amanda N. Fader

Research output: Contribution to journalArticle

Abstract

Objectives: Lymphovascular space invasion (LVSI) is an independent risk factor for recurrence and poor survival in early-stage endometrioid endometrial cancer (EEC), but optimal adjuvant treatment is unknown. We aimed to compare the survival of women with early-stage EEC with LVSI treated postoperatively with observation (OBS), radiation (RAD, external beam and/or vaginal brachytherapy), or chemotherapy (CHEMO)+/−RAD. Methods: This was a multi-institutional, retrospective cohort study of women with stage I or II EEC with LVSI who underwent hysterectomy+/−lymphadenectomy from 2005 to 2015 and received OBS, RAD, or CHEMO+/−RAD postoperatively. Progression-free survival and overall survival were evaluated using Kaplan-Meier estimates and Cox proportional hazards models. Results: In total, 478 women were included; median age was 64 years, median follow-up was 50.3 months. After surgery, 143 (30%) underwent OBS, 232 (48.5%) received RAD, and 103(21.5%) received CHEMO+/−RAD (95% of whom received RAD). Demographics were similar among groups, but those undergoing OBS had lower stage and grade. A total of 101 (21%) women recurred. Progression-free survival (PFS) was improved in both CHEMO+/−RAD (HR = 0.18, 95% CI: 0.09–0.39) and RAD (HR = 0.31, 95% CI: 0.18–0.54) groups compared to OBS, though neither adjuvant therapy was superior to the other. However, in grade 3 tumors, the CHEMO+/−RAD group had superior PFS compared to both RAD (HR 0.25; 95% CI: 0.12–0.52) and OBS cohorts (HR = 0.10, 95% CI: 0.03–0.32). Overall survival did not differ by treatment. Conclusions: In early-stage EEC with LVSI, adjuvant therapy improved PFS compared to observation alone. In those with grade 3 EEC, adjuvant chemotherapy with or without radiation improved PFS compared to observation or radiation alone.

Original languageEnglish (US)
Pages (from-to)568-574
Number of pages7
JournalGynecologic oncology
Volume156
Issue number3
DOIs
StatePublished - Mar 2020

Keywords

  • Adjuvant treatment
  • Chemotherapy
  • Endometrial cancer
  • Lymphovascular space invasion
  • Radiation
  • Uterine cancer

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

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  • Cite this

    Beavis, A. L., Yen, T. T., Stone, R. L., Wethington, S. L., Carr, C., Son, J., Chambers, L., Michener, C. M., Ricci, S., Burkett, W. C., Richardson, D. L., Staley, A. S., Ahn, S., Gehrig, P. A., Torres, D., Dowdy, S. C., Sullivan, M. W., Modesitt, S. C., Watson, C., ... Fader, A. N. (2020). Adjuvant therapy for early stage, endometrial cancer with lymphovascular space invasion: Is there a role for chemotherapy? Gynecologic oncology, 156(3), 568-574. https://doi.org/10.1016/j.ygyno.2019.12.028