Patterns of Recurrence After Adjuvant Vaginal Cuff Brachytherapy and Chemotherapy in Early-Stage Uterine Serous Carcinoma

Abstract

Adjuvant vaginal cuff brachytherapy (VB) and chemotherapy are commonly utilized in women with early-stage uterine serous carcinoma (USC). We sought to characterize predictors of survival endpoints and recurrence patterns in this rare population who received similar adjuvant treatments.We queried our prospectively maintained database for patients with 2009 FIGO stages I-II USC who underwent adequate surgical staging at our institution and received adjuvant chemotherapy with carboplatin and paclitaxel along with VB. We excluded women with synchronous malignancies. Overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) were assessed by Kaplan-Meier and log-rank tests. Univariate (UVA) and multivariate analyses (MVA) were performed to identify statistically significant predictors of survival endpoints. Variables with P < 0.1 on UVA were included in a MVA and any variable with P < 0.05 was considered statistically significant.We identified 77 women who met our inclusion criteria who underwent surgical staging between 1991 and 2018. The median follow-up time was 36 months (range 6-125). The median age was 66 years. Of the cohort, 70% were FIGO stage IA, 17% were stage IB, and 13% were stage II. The median number of dissected lymph nodes was 22. There were 10 women (13%) diagnosed with a recurrence with a median time to recurrence of 12.0 months. The main site of initial recurrence was distant in seven patients (70%). For the entire cohort, 5-year OS, DSS, and RFS were 83% (95% Confidence Interval [CI] 0.68-0.91), 92% (95% CI 0.78-0.97), and 83% (95% CI 0.71-0.91), respectively. The sole independent predictor of 5-year DSS was the presence of positive peritoneal cytology (Hazard Ratio 0.03, 95% CI 0.00-0.72, P = 0.03).Although 5-year survival outcomes were promising in this cohort, this study suggests that the predominant pattern of relapse in early-stage USC treated with adjuvant chemotherapy and VB is distant, calling for the optimization of systemic therapy. Positive peritoneal cytology is an independent predictor of worse DSS. Multi-institutional pooled analyses are warranted to confirm our study results.A.E. Cook: None. A.I. Ghanem: None. M. Hijaz: None. C. Burmeister: None. M.A. Elshaikh: None.