Binnur DÖNMEZ YILMAZ, Özge KANDEMİR GÜRSEL

Effect of Risk Factors on Local and Systemic Control inStage 1 Endometrial Cancer

This study aims to evaluate the treatment outcomes according to the risk groups of patients with Stage 1 endometrial cancer and to investigate the effects of the risks associated with the disease in the control of the disease.METHODSThree hundred and ninety patients who were treated with the indication of endometrial cancer in our clinic were evaluated with the approval of the ethics committee. The data of 114 patients who were evaluated retrospectively between 2014-2018.RESULTSIn patients with a median age of 58 (35-89) years, histological distribution of pathologies revealed the presence of cases of the 107 endometrioid adenocarcinoma (93%), two serous (1.7%), two clear cells (1.7%), one mucinous (0.8%) carcinomas and two (1.7%) carcinosarcoma. High risk was detected in 14 (12.28%), high to intermediate risk in nine (7%), intermediate risk in 35 (30.7%), and low-risk in 56 p (49%) patients. Recurrence developed in five (4%) patients whose survival was found to be statistically significantly lower than those without recurrence (logrank: 41.74 p=0.0001). Five -year survival rate was 95% and the mean (±SD) survival time was 78.46±1.27 months.CONCLUSIONIn the treatment of Stage 1 endometrial cancer, the survival rates achieved in our disease-recurrence group was statistically significantly lower than those who did not develop recurrences (logrank: 41.74 p=0.0001).

PDF

___

1. Cancer Statistics Turkey 2015. Available at: https:// hsgm.saglik.gov.tr/depo/birimler/kanser-db/istatistik/ Trkiye_Kanser_statistikleri_2015.pdf. Accessed Aug 20, 2020.
2. American College of Obstetricians and Gynecologists. ACOG practice bulletin, clinical management guidelines for obstetrician-gynecologists, number 65, August 2005: management of endometrial cancer. Obstet Gynecol 2005;106(2):413–25.
3. Kong A, Johnson N, Kitchener HC, Lawrie TA. Adjuvant radiotherapy for stage I endometrial cancer. Cochrane Database Syst Rev 2012;(3):CD003916.
4. Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB. Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer 1987;60(8 Suppl):2035–41.
5. Keys HM, Roberts JA, Brunetto VL, Zaino RJ, Spirtos NM, Bloss JD, et al. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study. Gynecol Oncol 2004;92(3):744–51.
6. Colombo N, Creutzberg C, Amant F, Bosse T, González-Martín A, Ledermann J, et al. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: Diagnosis, Treatment and Follow-up. Int J Gynecol Cancer 2016;26(1):2–30.
7. Cancer Genome Atlas Research Network, Kandoth C, Schultz N, Cherniack AD, Akbani R, Liu Y, et al. Integrated genomic characterization of endometrial carcinoma. Nature 2013;497(7447):67–73.
8. ASTEC study group, Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet 2009;373(9658):125–36.
9. Creutzberg CL, Nout RA, Lybeert ML, Wárlám-Rodenhuis CC, Jobsen JJ, Mens JW, et al. Fifteen-year radiotherapy outcomes of the randomized PORTEC-1 trial for endometrial carcinoma. Int J Radiat Oncol Biol Phys 2011;81(4):631–8.
10.Benedetti Panici P, Basile S, Maneschi F, Alberto Lissoni A, Signorelli M, Scambia Get al. Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst 2008;100(23):1707–16.
11.Kim HS, Suh DH, Kim MK, Chung HH, Park NH, Song YS. Systematic lymphadenectomy for survival in patients with endometrial cancer: a meta-analysis. Jpn J Clin Oncol 2012;42(5):405–12.
12.Lutman CV, Havrilesky LJ, Cragun JM, Secord AA, Calingaert B, Berchuck A, et al. Pelvic lymph node count is an important prognostic variable for FIGO stage I and II endometrial carcinoma with high-risk histology. Gynecol Oncol 2006;102(1):92–7.
13.Bosse T, Peters EE, Creutzberg CL, Jürgenliemk-Schulz IM, Jobsen JJ, Mens JW, et al. Substantial lymph-vascular space invasion (LVSI) is a significant risk factor for recurrence in endometrial cancer--A pooled analysis of PORTEC 1 and 2 trials. Eur J Cancer 2015;51(13):1742–50.
14.Greven K, Winter K, Underhill K, Fontenesci J, Cooper J, Burke T. Final analysis of RTOG 9708: adjuvant postoperative irradiation combined with cisplatin/paclitaxel chemotherapy following surgery for patients with high-risk endometrial cancer. Gynecol Oncol 2006;103(1):155–9.
15.Sorbe B, Nordström B, Mäenpää J, Kuhelj J, Kuhelj D, Okkan S, et al. Intravaginal brachytherapy in FIGO stage I low-risk endometrial cancer: a controlled randomized study. Int J Gynecol Cancer 2009;19(5):873– 8.
16.Homesley HD, Filiaci V, Gibbons SK, Long HJ, Cella D, Spirtos NM, et al. A randomized phase III trial in advanced endometrial carcinoma of surgery and volume directed radiation followed by cisplatin and doxorubicin with or without paclitaxel: A Gynecologic Oncology Group study. Gynecol Oncol 2009;112(3):543–52.
17.Harkenrider MM, Adams W, Block AM, Kliethermes S, Small W Jr, Grover S. Improved overall survival with adjuvant radiotherapy for high-intermediate and high risk Stage I endometrial cancer. Radiother Oncol 2017;122(3):452–57.
18.Nout RA, Smit VT, Putter H, Jürgenliemk-Schulz IM, Jobsen JJ, Lutgens LC, et al. Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): an open-label, non-inferiority, randomised trial. Lancet 2010;375(9717):816–23.