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KMID : 0939920160480031074
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대한암학회지
2016 Volume.48 No. 3 p.1074 ~ p.1083
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Adjuvant Treatment after Surgery in Stage IIIA Endometrial Adenocarcinoma
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Yoon Mee-Sun
Huh Seung-Jae
Kim Hak-Jae
Kim Young-Seok
Kim Yong-Bae
Kim Joo-Young
Lee Jong-Hoon
Kim Hun-Jung
Cha Ji-Hye
Kim Jin-Hee
Kim Ju-Ree
Yoon Won-Sup
Choi Jin-Hwa
Chun Mi-Son
Choi Young-Min
Lee Kang-Kyoo
Kim Myung-Soo
Jeong Jae-Uk
Chang Sei-Kyung
Park Won
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Abstract
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Purpose: We evaluated the role of adjuvant therapy in stage IIIA endometrioid adenocarcinoma patients who underwent surgery followed by radiotherapy (RT) alone or chemoradiotherapy (CTRT) according to risk group.
Materials and Methods: A multicenter retrospective study was conducted including patients with surgical stage IIIA endometrial cancertreated by radical surgery and adjuvant RT or CTRT. Disease-free survival (DFS) and overall survival (OS) were analyzed.
Results: Ninety-three patients with stage IIIA disease were identified. Nineteen patients (20.4%) experienced recurrence, mostly distant metastasis (17.2%). Combined CTRT did not affect DFS (74.1% vs. 82.4%, p=0.130) or OS (96.3% vs. 91.9%, p=0.262) in stage IIIA disease compared with RT alone. Patients with age ≥ 60 years, grade G2/3, and lymphovascular space involvement had a significantly worse DFS and those variables were defined as risk factors. The high-risk group showed a significant reduction in 5-year DFS (≥ 2 risk factors) (49.0% vs. 88.0%, p < 0.001) compared with the low-risk group (< 2). Multivariate analysis confirmed that more than one risk factor was the only predictor of worse DFS (hazard ratio, 5.45; 95% confidence interval, 2.12 to 13.98; p < 0.001). Of patients with no risk factors, a subset treated with RT alone showed an excellent 5-year DFS and OS (93.8% and 100%, respectively).
Conclusion: We identified a low-risk subset of stage IIIA endometrioid adenocarcinoma patients who might be reasonable candidates for adjuvant RT alone. Further randomized studies are needed to determine which subset might benefit from combined CTRT.
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KEYWORD
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Endometrial neoplasms, Adjuvant radiotherapy, Adjuvant chemoradiotherapy
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