Evaluation of Prognosticators and Treatment-Related Side Effects in Patients Irradiated Postoperatively for Endometrial Cancer
Abstract
:Simple Summary
Abstract
1. Introduction
2. Results
2.1. Patient Cohort and Treatment
2.2. Outcomes
2.3. Prognosticators
2.4. Toxicity
3. Discussion
4. Materials and Methods
4.1. Patients
4.2. Brachytherapy and Teletherapy
4.3. Follow-Up and Toxicity Scoring
4.4. Statistics
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Patient and Disease Characteristics, N (%) | 203 |
---|---|
Age, median (min–max) | 69.5 years (41.2–89.0) |
Behavioral factors | |
Smoking w/o regular alcohol | 25 (12.3) |
Alcohol abuse w/o smoking | 3 (1.5) |
Smoking and alcohol abuse | 1 (0.5) |
Neither smoking nor regular alcohol | 174 (85.7) |
T category | |
pT1a | 30 (14.8) |
pT1b | 104 (51.2) |
pT1c | 14 (6.9) |
pT2 | 30 (14.9) |
pT3 | 18 (8.9s) |
pT4 | 2 (0.9) |
ypT1a | 1 (0.5) |
ypT1b | 1 (0.5) |
ypT2 | 1 (0.5) |
ypT3 | 2 (0.9) |
Nodal status | |
pN0 | 104 (88.1) |
pN+ | 14 (11.9) |
FIGO classification | |
I | 148 (72.9) |
II | 24 (11.8) |
III | 29 (14.3) |
IV | 2 (1.0) |
Former history of endometrial cancer | |
Yes | 3 (1.5) |
Chemotherapy | |
Adjuvant | |
Yes | 34 (16.7) |
Carboplatin/Paclitaxel | 30 (88.2) |
Cisplatin/Doxorubicin | 4 (11.8) |
Incomplete | 7 (20.6) |
Perioperative | |
Yes | 5 (2.5) |
Carboplatin/Paclitaxel | 5 (100) |
Incomplete | 1 (20) |
Radiotherapy | |
Brachytherapy | 184 (90.6) |
Dose, median (min–max) | 20 Gy (10–20) |
Incomplete | 2 (1.1) |
Total dose 20 Gy, single fraction 5 Gy | 161 (87.5) |
Total dose 15 Gy, single fraction 2.5 Gy | 23 (12.5) |
Irradiation of >the upper third of the vagina | 159 (86.4) |
Irradiation of ≤the upper third of the vagina | 25 (13.6) |
Teletherapy | 19 (9.4) |
Radiotherapy technique | |
3D conformal radiotherapy | 7 (36.9) |
IMRT | 2 (10.5) |
VMAT | 10 (52.6) |
Dose, median (min–max) | 50.4 Gy (39.6–60) |
Incomplete | 2 (10.5) |
Surgery | |
Modality | |
Laparoscopic transvaginal hysterectomy and adnexectomy | 51 (25.1) |
Laparotomy, hysterectomy and adnexectomy | 152 (74.9) |
Lymphadenectomy | |
Yes | 118 (58.1) |
Pelvic | 10 (8.5) |
Pelvic + para-aortic | 108 (91.5) |
No | 85 (41.9) |
Histology | |
Endometrioid adenocarcinoma | 176 (86.7) |
Serous carcinoma | 13 (6.5) |
Small cell carcinoma | 1 (0.5) |
Clear cell carcinoma | 7 (3.4) |
Endometrioid adenocarcinoma with squamous differentiation | 1 (0.5) |
Squamous cell carcinoma | 1 (0.5) |
Tubulo-papillary adenocarcinoma | 1 (0.5) |
Undifferentiated carcinoma | 1 (0.5) |
Dedifferentiated carcinoma | 2 (0.9) |
Grading | |
G1 | 17 (8.4) |
G2 | 126 (62.1) |
G3 | 60 (29.5) |
Lymphatic vessel invasion | |
Yes | 16 (7.9) |
No | 187 (92.1) |
Venous invasion | |
Yes | 8 (3.9) |
No | 195 (96.1) |
Body mass index | |
<25 | 40 (19.7) |
≥25 | 136 (67.0) |
Not available | 27 (13.3) |
Charlson Comorbidity Index | |
1–3 | 38 (18.7) |
4–6 | 151 (74.4) |
7–10 | 14 (6.9) |
Variable | LRFS | PFS | OS | CSS | ||||
---|---|---|---|---|---|---|---|---|
Hazard Ratio (95% CI) | p Value | Hazard Ratio (95% CI) | p Value | Hazard Ratio (95% CI) | P Value | Hazard Ratio (95% CI) | p Value | |
Age (203), per year | 1.03 (0.98–1.09) | 0.23 | 1.07 (1.03–1.11) | <0.01 | 1.08 (1.03–1.13) | <0.01 | 1.01 (0.96–1.07) | 0.63 |
BMI | ||||||||
≥25 (136) vs. <25 (40) | 0.52 (0.19–1.40) | 0.19 | 0.68 (0.34–1.37) | 0.28 | 0.41 (0.18–0.91) | 0.03 | 0.36 (0.12–1.04) | 0.06 |
≥30 (76) vs. <30 (100) | 0.26 (0.07–0.89) | 0.03 | 0.72 (0.37–1.38) | 0.32 | 0.72 (0.32–1.63) | 0.43 | 0.52 (0.16–1.65) | 0.26 |
FIGO classification | ||||||||
FIGO ≥ III (31) vs. ≤II (172) | 1.65 (0.54–5.05) | 0.38 | 1.75 (0.86–3.57) | 0.12 | 1.24 (0.47–3.27) | 0.67 | 1.49 (0.42–5.35) | 0.54 |
Histology | ||||||||
Non endometrioid (27) vs. endometrioid (176) | 2.51 (0.88–7.12) | 0.08 | 2.02 (0.99–4.12) | 0.05 | 2.27 (0.96–5.38) | 0.06 | 3.52 (1.18–10.53) | 0.02 |
N stage | ||||||||
N+ (14) vs. N0 (104) | 2.98 (0.79–11.25) | 0.11 | 2.68 (1.06–6.62) | 0.04 | 1.91 (0.53–6.86) | 0.31 | 2.61 (0.69–9.85) | 0.16 |
Grading | ||||||||
G3 (60) vs. G2 (126) | 2.44 (0.93–6.43) | 0.07 | 2.65 (1.42–4.93) | <0.01 | 2.70 (1.25–5.82) | 0.01 | 5.21 (1.71–15.92) | <0.01 |
G3 (60) vs. G1 + G2 (143) | 2.73 (1.04–7.20) | 0.04 | 2.97 (1.59–5.53) | <0.01 | 3.01 (1.40–6.49) | <0.01 | 5.79 (1.90–17.67) | <0.01 |
Lymphatic vessel invasion | ||||||||
L1 (16) vs. L0 (187) | 2.19 (0.50–9.62) | 0.30 | 2.75 (1.15–6.58) | 0.02 | 3.01 (1.03–8.81) | 0.04 | 2.98 (0.65–13.58) | 0.16 |
Adjuvant chemotherapy | ||||||||
Yes (39) vs. No (164) | 1.61 (0.57–4.58) | 0.37 | 1.64 (0.84–3.23) | 0.23 | 1.72 (0.75–3.95) | 0.20 | 3.10 (1.07–8.99) | 0.04 |
Charlson Comorbidity Index | ||||||||
>5 (50) vs. ≤5 (153) | 1.04 (0.34–3.20) | 0.94 | 2.35 (1.27–4.36) | <0.01 | 3.13 (1.49–6.60) | <0.01 | 0.98 (0.27–3.53) | 0.99 |
Brachytherapy | ||||||||
> upper third of the vaginaYes (159) vs. no (25) | 0.99 (0.13–7.67) | 0.99 | 0.99 (0.23–4.21) | 0.99 | 1.04 (0.14–7.91) | 0.97 | 0.62 (0.08–4.98) | 0.65 |
Lymphadenectomy | ||||||||
Yes (118) vs. no (85) | 1.04 (0.38–2.82) | 0.94 | 0.72 (0.39–1.32) | 0.29 | 0.58 (0.28–1.22) | 0.15 | 2.14 (0.60–7.69) | 0.24 |
Radiotherapy technique | ||||||||
Brachytherapy (184) vs. Teletherapy (19) | 23.04 (0.01–>100) * | 0.42 | 0.40 (0.19–0.87)) | 0.02 | 0.34 (0.14–0.84) | 0.02 | 0.51 (0.11–2.31) | 0.39 |
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Leu, M.; Possiel, J.; Schirmer, M.A.; Hille, A.; Rieken, S.; Dröge, L.H. Evaluation of Prognosticators and Treatment-Related Side Effects in Patients Irradiated Postoperatively for Endometrial Cancer. Cancers 2020, 12, 3613. https://doi.org/10.3390/cancers12123613
Leu M, Possiel J, Schirmer MA, Hille A, Rieken S, Dröge LH. Evaluation of Prognosticators and Treatment-Related Side Effects in Patients Irradiated Postoperatively for Endometrial Cancer. Cancers. 2020; 12(12):3613. https://doi.org/10.3390/cancers12123613
Chicago/Turabian StyleLeu, Martin, Jacqueline Possiel, Markus A. Schirmer, Andrea Hille, Stefan Rieken, and Leif Hendrik Dröge. 2020. "Evaluation of Prognosticators and Treatment-Related Side Effects in Patients Irradiated Postoperatively for Endometrial Cancer" Cancers 12, no. 12: 3613. https://doi.org/10.3390/cancers12123613