Multi-institutional Analysis of Vaginal Brachytherapy Alone for Women With Stage II Endometrial Carcinoma

Matthew M. Harkenrider, Brendan Martin, Karina Nieto, Christina Small, Ibrahim Aref, David Bergman, Anupama Chundury, Mohamed A. Elshaikh, David Gaffney, Anuja Jhingran, Larissa Lee, Ima Paydar, Kisuk Ra, Julie Schwarz, Cameron Thorpe, Akila Viswanathan, William Small

Research output: Contribution to journalArticle

Abstract

Purpose: To investigate the survival endpoints in women with International Federation of Gynecology and Obstetrics (FIGO) stage II endometrial cancer who received adjuvant vaginal brachytherapy (VBT) alone using multi-institutional pooled data. Methods and Materials: We performed a multi-institutional analysis of surgically staged patients with FIGO stage II endometrioid-type endometrial cancer treated with VBT alone. Patient, tumor, and treatment characteristics were collected and analyzed. Univariable and multivariable frailty survival models were performed to assess clinicopathologic risk factors for recurrence and death. Results: One hundred six patients were included (92 VBT alone and 14 VBT with chemotherapy) with median follow-up of 39.0 months. Pelvic node dissection was performed in 89.6% of patients. One hundred four patients (98.1%) and 2 patients (1.9%) had microscopic and macroscopic cervical stromal invasion, respectively. Grade 1 or 2 disease occurred in 88.6% of patients. For patients treated with VBT without chemotherapy, the 5-year estimates of vaginal failure, pelvic nodal failure, and distant metastases were 2.6%, 4.2%, and 7.2%, respectively. Five-year progression-free survival and overall survival were 74.0% and 76.2%, respectively. On univariable and multivariable models for progression-free survival, increasing age and lack of pelvic node resection were hazardous (P <.05). Conclusions: Vaginal and pelvic failure rates were low in this selected population of stage II patients receiving adjuvant VBT without external beam radiation therapy. It is reasonable to consider adjuvant VBT alone in selected patients with grade 1 or 2 disease and microscopic cervical stromal invasion who underwent pelvic lymphadenectomy.

Original languageEnglish (US)
JournalInternational Journal of Radiation Oncology Biology Physics
DOIs
StateAccepted/In press - Jan 1 2018

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Brachytherapy
Endometrial Neoplasms
cancer
gynecology
federations
chemotherapy
Gynecology
progressions
Obstetrics
Disease-Free Survival
Survival
grade
Drug Therapy
dissection
metastasis
Lymph Node Excision
death
Dissection
radiation therapy
Radiotherapy

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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Multi-institutional Analysis of Vaginal Brachytherapy Alone for Women With Stage II Endometrial Carcinoma. / Harkenrider, Matthew M.; Martin, Brendan; Nieto, Karina; Small, Christina; Aref, Ibrahim; Bergman, David; Chundury, Anupama; Elshaikh, Mohamed A.; Gaffney, David; Jhingran, Anuja; Lee, Larissa; Paydar, Ima; Ra, Kisuk; Schwarz, Julie; Thorpe, Cameron; Viswanathan, Akila; Small, William.

In: International Journal of Radiation Oncology Biology Physics, 01.01.2018.

Research output: Contribution to journalArticle

Harkenrider, MM, Martin, B, Nieto, K, Small, C, Aref, I, Bergman, D, Chundury, A, Elshaikh, MA, Gaffney, D, Jhingran, A, Lee, L, Paydar, I, Ra, K, Schwarz, J, Thorpe, C, Viswanathan, A & Small, W 2018, 'Multi-institutional Analysis of Vaginal Brachytherapy Alone for Women With Stage II Endometrial Carcinoma', International Journal of Radiation Oncology Biology Physics. https://doi.org/10.1016/j.ijrobp.2018.04.049
Harkenrider, Matthew M. ; Martin, Brendan ; Nieto, Karina ; Small, Christina ; Aref, Ibrahim ; Bergman, David ; Chundury, Anupama ; Elshaikh, Mohamed A. ; Gaffney, David ; Jhingran, Anuja ; Lee, Larissa ; Paydar, Ima ; Ra, Kisuk ; Schwarz, Julie ; Thorpe, Cameron ; Viswanathan, Akila ; Small, William. / Multi-institutional Analysis of Vaginal Brachytherapy Alone for Women With Stage II Endometrial Carcinoma. In: International Journal of Radiation Oncology Biology Physics. 2018.
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abstract = "Purpose: To investigate the survival endpoints in women with International Federation of Gynecology and Obstetrics (FIGO) stage II endometrial cancer who received adjuvant vaginal brachytherapy (VBT) alone using multi-institutional pooled data. Methods and Materials: We performed a multi-institutional analysis of surgically staged patients with FIGO stage II endometrioid-type endometrial cancer treated with VBT alone. Patient, tumor, and treatment characteristics were collected and analyzed. Univariable and multivariable frailty survival models were performed to assess clinicopathologic risk factors for recurrence and death. Results: One hundred six patients were included (92 VBT alone and 14 VBT with chemotherapy) with median follow-up of 39.0 months. Pelvic node dissection was performed in 89.6{\%} of patients. One hundred four patients (98.1{\%}) and 2 patients (1.9{\%}) had microscopic and macroscopic cervical stromal invasion, respectively. Grade 1 or 2 disease occurred in 88.6{\%} of patients. For patients treated with VBT without chemotherapy, the 5-year estimates of vaginal failure, pelvic nodal failure, and distant metastases were 2.6{\%}, 4.2{\%}, and 7.2{\%}, respectively. Five-year progression-free survival and overall survival were 74.0{\%} and 76.2{\%}, respectively. On univariable and multivariable models for progression-free survival, increasing age and lack of pelvic node resection were hazardous (P <.05). Conclusions: Vaginal and pelvic failure rates were low in this selected population of stage II patients receiving adjuvant VBT without external beam radiation therapy. It is reasonable to consider adjuvant VBT alone in selected patients with grade 1 or 2 disease and microscopic cervical stromal invasion who underwent pelvic lymphadenectomy.",
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T1 - Multi-institutional Analysis of Vaginal Brachytherapy Alone for Women With Stage II Endometrial Carcinoma

AU - Harkenrider, Matthew M.

AU - Martin, Brendan

AU - Nieto, Karina

AU - Small, Christina

AU - Aref, Ibrahim

AU - Bergman, David

AU - Chundury, Anupama

AU - Elshaikh, Mohamed A.

AU - Gaffney, David

AU - Jhingran, Anuja

AU - Lee, Larissa

AU - Paydar, Ima

AU - Ra, Kisuk

AU - Schwarz, Julie

AU - Thorpe, Cameron

AU - Viswanathan, Akila

AU - Small, William

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Purpose: To investigate the survival endpoints in women with International Federation of Gynecology and Obstetrics (FIGO) stage II endometrial cancer who received adjuvant vaginal brachytherapy (VBT) alone using multi-institutional pooled data. Methods and Materials: We performed a multi-institutional analysis of surgically staged patients with FIGO stage II endometrioid-type endometrial cancer treated with VBT alone. Patient, tumor, and treatment characteristics were collected and analyzed. Univariable and multivariable frailty survival models were performed to assess clinicopathologic risk factors for recurrence and death. Results: One hundred six patients were included (92 VBT alone and 14 VBT with chemotherapy) with median follow-up of 39.0 months. Pelvic node dissection was performed in 89.6% of patients. One hundred four patients (98.1%) and 2 patients (1.9%) had microscopic and macroscopic cervical stromal invasion, respectively. Grade 1 or 2 disease occurred in 88.6% of patients. For patients treated with VBT without chemotherapy, the 5-year estimates of vaginal failure, pelvic nodal failure, and distant metastases were 2.6%, 4.2%, and 7.2%, respectively. Five-year progression-free survival and overall survival were 74.0% and 76.2%, respectively. On univariable and multivariable models for progression-free survival, increasing age and lack of pelvic node resection were hazardous (P <.05). Conclusions: Vaginal and pelvic failure rates were low in this selected population of stage II patients receiving adjuvant VBT without external beam radiation therapy. It is reasonable to consider adjuvant VBT alone in selected patients with grade 1 or 2 disease and microscopic cervical stromal invasion who underwent pelvic lymphadenectomy.

AB - Purpose: To investigate the survival endpoints in women with International Federation of Gynecology and Obstetrics (FIGO) stage II endometrial cancer who received adjuvant vaginal brachytherapy (VBT) alone using multi-institutional pooled data. Methods and Materials: We performed a multi-institutional analysis of surgically staged patients with FIGO stage II endometrioid-type endometrial cancer treated with VBT alone. Patient, tumor, and treatment characteristics were collected and analyzed. Univariable and multivariable frailty survival models were performed to assess clinicopathologic risk factors for recurrence and death. Results: One hundred six patients were included (92 VBT alone and 14 VBT with chemotherapy) with median follow-up of 39.0 months. Pelvic node dissection was performed in 89.6% of patients. One hundred four patients (98.1%) and 2 patients (1.9%) had microscopic and macroscopic cervical stromal invasion, respectively. Grade 1 or 2 disease occurred in 88.6% of patients. For patients treated with VBT without chemotherapy, the 5-year estimates of vaginal failure, pelvic nodal failure, and distant metastases were 2.6%, 4.2%, and 7.2%, respectively. Five-year progression-free survival and overall survival were 74.0% and 76.2%, respectively. On univariable and multivariable models for progression-free survival, increasing age and lack of pelvic node resection were hazardous (P <.05). Conclusions: Vaginal and pelvic failure rates were low in this selected population of stage II patients receiving adjuvant VBT without external beam radiation therapy. It is reasonable to consider adjuvant VBT alone in selected patients with grade 1 or 2 disease and microscopic cervical stromal invasion who underwent pelvic lymphadenectomy.

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