Significant pelvic recurrence in high-risk pathologic stage I–IV endometrial carcinoma patients after adjuvant chemotherapy alone: implications for adjuvant radiation therapy

Mundt, Arno J; McBride, Russell; Rotmensch, Jacob; Waggoner, Steven E; Yamada, S.Diane; Connell, Philip P

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Volume 50, Issue 5 , Pages 1145-1153, 1 August 2001

Significant pelvic recurrence in high-risk pathologic stage I–IV endometrial carcinoma patients after adjuvant chemotherapy alone: implications for adjuvant radiation therapy

Presented at the 42nd Annual Meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO), Boston, Massachusetts, October 22–26, 2000.

Arno J Mundt, M.D.
- Department of Radiation and Cellular Oncology, University of Chicago Hospitals, Chicago, IL, USA
- Reprint requests to: Arno J. Mundt, M.D., Department of Radiation and Cellular Oncology, University of Chicago Hospitals, MC 9006, 5758 S. Maryland Ave, Chicago, IL 60637. Tel: (773) 702-4751; Fax: (773) 702-0610
Russell McBride, B.A.
- Department of Radiation and Cellular Oncology, University of Chicago Hospitals, Chicago, IL, USA
Jacob Rotmensch, M.D.
- Department of Radiation and Cellular Oncology, University of Chicago Hospitals, Chicago, IL, USA
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago Hospitals, Chicago, IL, USA
Steven E Waggoner, M.D.
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago Hospitals, Chicago, IL, USA
S.Diane Yamada, M.D.
- Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, University of Chicago Hospitals, Chicago, IL, USA
Philip P Connell, M.D.
- Department of Radiation and Cellular Oncology, University of Chicago Hospitals, Chicago, IL, USA

Accepted 14 March 2001.

Abstract

To evaluate the risk of pelvic recurrence (PVR) in high-risk pathologic Stage I–IV endometrial carcinoma patients after adjuvant chemotherapy alone.

Between 1992 and 1998, 43 high-risk endometrial cancer patients received adjuvant chemotherapy. All patients underwent primary surgery consisting of total abdominal hysterectomy and bilateral salpingo-oophorectomy. No patients received preoperative radiation therapy (RT). Regional lymph nodes and peritoneal cytology were sampled in 62.8% and 83.7% of cases, respectively. Most patients had Stage III–IV disease (83.7%) or unfavorable histology tumors (74.4%). None had evidence of extra-abdominal disease. All patients received 4–6 cycles of chemotherapy as the sole adjuvant therapy, consisting primarily of cisplatin and doxorubicin. Recurrent disease sites were divided into pelvic (vaginal, nonvaginal) and extrapelvic (para-aortic, upper abdomen, liver, and extra-abdominal). Median follow-up was 27 months (range, 2–96 months).

Twenty-nine women (67.4%) relapsed. Seventeen (39.5%) recurred in the pelvis and 23 (55.5%) in extrapelvic sites. The 3-year actuarial PVR rate was 46.5%. The most significant factors correlated with PVR were cervical involvement (CI) (p = 0.01) and adnexal (p = 0.05) involvement. Of the 17 women who developed a PVR, 8 relapsed in the vagina, 3 in the nonvaginal pelvis, and 6 in both. The 3-year vaginal and nonvaginal PVR rates were 37.8% and 26%, respectively. The most significant factor correlated with vaginal PVR was CI (p = 0.0007). Deep myometrial invasion (p = 0.02) and lymph nodal involvement (p = 0.03) were both correlated with nonvaginal PVR. Nine of the 29 relapsed patients (31%) developed PVR as their only (6) or first site (3) of recurrence. Factors associated with a higher rate of PVR (as the first or only site) were CI and Stage I–II disease.

PVR is common in high-risk pathologic Stage I–IV endometrial cancer patients after adjuvant chemotherapy alone. These results support the continued use of locoregional RT in patients undergoing adjuvant chemotherapy. Further studies are needed to test the addition of chemotherapy to locoregional RT.