Vaginal brachytherapy + chemo tied to OS benefit in uterine serous carcinoma

  • Tatebe K & et al.
  • Gynecol Oncol
  • 11 Oct 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • Adjuvant vaginal brachytherapy (VBT)+chemotherapy (CT) and external beam radiotherapy (EBRT) yielded similar 5-year OS in an overall cohort of patients with early-stage endometrial cancer.
  • VBT+CT showed an OS advantage only in patients with serous histology.

Why this matters

  • Patient selection using risk features may identify those likely to benefit most from chemotherapy.

Study design

  • 4602 high-intermediate risk patients with early-stage endometrial cancer undergoing surgery received either VBT+CT or EBRT.
  • Funding: None disclosed.

Key results

  • Median follow-up duration was 34 months.
  • 5-year OS in patients with endometrioid, serous, and clear cell histology was 79.3%, 69.9%, and 73.9%, respectively (P=.028).
  • Overall, EBRT was associated with worse 3-year OS (89.6% vs 87.8%; HR, 1.24; P=.044) and similar 5-year OS (78.1% vs 76.7%; P=.17) vs VBT+CT.
  • In subanalysis:
    • Only patients with serous carcinoma showed poorer OS with EBRT vs VBT+CT (n=1002; HR, 1.76; P=.006).
    • EBRT improved survival in patients with high-grade endometrioid histology without lymph node dissection (HR, 0.35; 95% CI, 0.16-0.73); the presence of lymphovascular space invasion further improved OS (HR, 0.14; 95% CI, 0.03-0.63).
  • No OS difference was observed between the 2 treatments in patients with clear cell histology (HR, 0.94; 95% CI, 0.31-2.81).

Limitations

  • Retrospective design.