Radiotherapy in Medically Inoperable Patients with Endometrial Carcinoma

Abstract

<h3>Purpose/Objective(s)</h3> Upfront radiotherapy with or without brachytherapy is considered standard of care for patients with endometrial carcinoma that are unable to undergo surgical intervention. Here, we compare the cancer-free (CFS), cancer-specific (CSS), and overall (OS) survival between patients with low-risk and high-risk endometrial carcinoma managed with definitive-intent radiation therapy. <h3>Materials/Methods</h3> This is a single-institutional retrospective analysis of medically-inoperable patients with biopsy-proven endometrial carcinoma managed with upfront, definitive radiotherapy at UMass Memorial Medical Center between May 2010 and October 2021. Fifty-five cases were included for analysis. Patients were stratified as low-risk endometrial carcinoma (LREC: Uterine-confined grade 1/2 endometrioid adenocarcinoma) or high-risk endometrial carcinoma (HREC: Stage III/IV and/or grade 3 endometrioid carcinoma, or any stage serous or clear cell carcinoma or carcinosarcoma). CFS, CSS, OS and grade ≥3 toxicities were reported for patients with LREC and HREC. <h3>Results</h3> Median age was 66 (range: 42-86) with median follow-up being 44 months (range: 4-135). Twelve patients (22%) were diagnosed with HREC. Six patients (11%) were treated with high dose rate (HDR) brachytherapy alone and forty-nine patients (89%) were treated with HDR brachytherapy and external beam radiation therapy (EBRT). Twelve patients (22%) were treated with radiation and chemotherapy. The 2-year CFS was 82% for LREC patients and 80% for HREC patients (log rank p = 0.0654). The 2-year CSS was 100% for both LREC and HREC patients. The 2-year OS was 92% for LREC and 80% for HREC patients (log p = 0.0064). There were no acute grade ≥3 toxicities. There were 3 late grade ≥3 toxicities due to endometrial bleeding and gastrointestinal side effects. <h3>Conclusion</h3> For medically inoperable patients with endometrial carcinoma, upfront radiotherapy provided excellent CFS, CSS and OS. CSS and OS were higher in patients with LREC than those with HREC. Toxicities were limited in both cohorts.