Abstract
Simple SummaryEndometrial cancer is the most common cancers of the female genital tract. However, the optimal adjuvant treatment for stage IB endometrial cancer is not well-defined. We aimed to study the benefit of modern adjuvant radiotherapy for women with stage IB endometrial cancer. We found that adjuvant external-beam radiotherapy significantly improved survival in patients with stage IB endometrial cancer. However, the benefit of adjuvant radiotherapy varied among the patients, suggesting that the treatment should be individualized.The optimal adjuvant treatment for stage IB endometrial cancer remains undefined. We investigated the benefit of modern adjuvant radiotherapy for women with stage IB endometrial cancer. We retrospectively reviewed patients with surgically staged, pure stage IB endometrioid adenocarcinoma (2010 to 2018). Adjuvant modern radiotherapy consists of external-beam radiotherapy (EBRT) by intensity, volumetric-modulated arc radiotherapy, or image-guided vaginal brachytherapy (VBT). The study included 180 stage IB patients. Patients with grade 3 diseases had frequent aggressive histology patterns (lymphovascular space invasion (LVSI); low uterine segment involvement) and experienced significantly shorter recurrence-free survival (RFS) and overall survival (OS) than patients with grade 1/2 diseases. Adjuvant modern radiotherapy decreased the incidence of acute/chronic grade ≥2 gastrointestinal toxicity. In IB grade 1/2 patients, EBRT significantly lengthened survival (RFS/OS); patients with age >60 years, myometrial invasion beyond the outer third, or LVSI benefited the most from EBRT. EBRT also significantly improved survival (RFS/OS) in IB grade 3 patients, where patients with bulky tumors or LVSI benefited the most from EBRT. Therefore, EBRT may be beneficial for all stage IB patients.
Highlights
Endometrial cancer is the most common malignancy of the female genital tract, with a continuously increasing incidence rate [1]
We identified a total of 1273 patients with surgically staged endometrial cancer, of whom 203 had Federation of Gynecology and Obstetrics (FIGO) stage IB disease according to the 2009 International FIGO staging system for endometrial cancer [2]
Lymphovascular space invasion (LVSI) was present in nearly half (45%) of the tumors, and abnormal peritoneal washing cytology was found in 13% of the total patients
Summary
Endometrial cancer is the most common malignancy of the female genital tract, with a continuously increasing incidence rate [1]. Several landmark clinical trials have attempted to identify women at risk for recurrence, so that the optimal treatment paradigm could be determined Both the GOG-99 and PORTEC-1 studies, including stage IB patients, demonstrated benefits for adjuvant external beam radiotherapy (EBRT) on local control and disease-free survival, with further analysis confirming the beneficial necessity of EBRT in IB grade 3 patients [4,5]. The PORTEC-2 study suggested that vaginal brachytherapy (VBT) alone may be the standard treatment option in IB grade 1/2 patients, with fewer toxic effects than the EBRT group at the cost of higher local recurrence (vaginal or pelvic) [6] These findings indicate that in certain IB grade 1/2 patients with unfavorable risk factors, instead of receiving VBT alone, they may benefit more from EBRT
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