Abstract
Objective
Adjuvant radiotherapy improves locoregional control of stage III endometrial cancer (EC), but its role was challenged after Gynecologic Oncology Group (GOG) 122 demonstrated survival benefit with chemotherapy. This study describes the trends in adjuvant radiotherapy utilization for stage III endometrial cancer and assesses its association with survival outcomes.
Methods
We extracted 6913 patients with stage III endometrioid subtype EC (EEC) from the Surveillance, Epidemiology, and End Result (SEER) 18 Registry Research Database treated between 2004 and 2012. We retrospectively reviewed patient demographics, tumor characteristics, and clinical parameters. Temporal trend of radiation use was assessed by linear regression. Univariate Cox regression analysis followed by a multivariate modeling was used to analyze the impact of radiation on survival.
Results
Patients not receiving adjuvant radiotherapy and those receiving vaginal brachytherapy (VBT) alone in stage III EEC increased over study period (1.42%/year and 0.73%/year, respectively), but those with external beam radiation (EBRT) and combination radiotherapy decreased (−1.42%/year and −0.73%/year, respectively). Age, stage, grade, degree of lymph node dissection, and radiation utilization were found to impact overall and cancer-specific survival on multivariate analysis. Survival was improved with use of EBRT (HR 0.65, 95% CI 0.58–0.73, P < 0.001), VBT (HR 0.62, 95% CI 0.49–0.78, P < 0.001), and combination radiotherapy (HR 0.56, 95% CI 0.48–0.64, P < 0.001).
Conclusion
Based upon this analysis, omission of adjuvant radiation therapy has become more prevalent in stage III EEC patients, and this was associated with worse survival. Appropriate incorporation of radiotherapy in the management of these patients should be further explored in prospective studies.
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