Abstract
Increasing body mass index (BMI) is associated with increased prevalence of endometrial carcinoma (EC). We sought to investigate the significance of BMI as a prognostic factor for tumor recurrence and survival in women with early stage endometrial carcinoma who were treated with adjuvant HDR vaginal cuff brachytherapy. In our prospectively-maintained database of patients with endometrial cancer, we identified 141 patients who underwent surgical staging between 1990 and 2010 for FIGO stage I-II and received adjuvant high-dose-rate vaginal cuff brachytherapy. Their medical records were retrospectively reviewed in this IRB-approved study. Height and weight data were available at time of hysterectomy from which BMI was calculated (<30, ≥30 - <38 and ≥38). Following a univariate analysis, multivariable modeling was done using Cox regression analysis. Median followup was 48 months (range 13-245), median age was 62 years (range 39-91) and median BMI is 33.7 (range 19.7 - 63.6). There were 126 patients (89.4%) with endometrioid histology, 96 patients (68%) with stage IA, 38 patients 27% with stage IB and 7 (5%) with stage II. Median brachytherapy dose was 37.5 Gy to the surface of a vaginal cylinder in 5 fractions. Only 13 patients (9.2%) received adjuvant chemotherapy. There were only 6 patients with recurrences including only one patient with isolated vaginal cuff recurrence. Due to small number of events and based on exploratory analysis, body mass index (as a continuous variable or categorical) was not a significant predictor of recurrence-free, or disease-specific survival. BMI ≥38 and older age were the only independent predictor of OS (p=0.02 and <0.001, respectively). Five-year recurrence-free, disease-specific and overall survival for the study cohort was 93.2%, 96.3% and 89%, respectively. In our study, vaginal cuff control was excellent with vaginal brachytherapy. Body mass index was not a predictor of tumor recurrence or disease-specific survival in patients with early stage endometrial carcinoma who underwent surgical staging followed by adjuvant vaginal cuff HDR brachytherapy.
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