Clinical outcome of pathologic Stage IIA endometrial adenocarcinoma after intravaginal brachytherapy alone

We studied the impact of different prognostic factors on the clinical outcome for the patients with pathologic Stage IIA endometrial adenocarcinoma who had surgical staging (SS) and received adjuvant high-dose-rate intravaginal brachytherapy (IVB) alone.

Sixty-one patients with Stage IIA endometrial adenocarcinoma were retrospectively studied. Cox proportional hazards regression was used to study prognostic factors.

All the patients underwent SS between July 1994 and December 2005. The median age was 64 years (range, 46-71 years). The median number of lymph nodes sampled was 8 (range, 7-12). All the patients received adjuvant IVB to doses of 35-36Gy in four to five fractions prescribed to the surface. The myometrial invasion was <50% in 33 patients and > or =50% for 28 patients. The lymphovascular invasion (LVI) and the lower uterine segment involvement were identified in 18% and 61%, respectively. At a median followup of 64 months (range, 8-153 months), there were 7 patients who developed recurrences. On univariate analysis, the only factor significantly predictive for locoregional recurrence was LVI (p=0.01). In regard to overall survival (OS), factors that were significantly predictive on univariate analysis were LVI (p=0.03), tumor grade (p=0.04), and depth of myometrial invasion (p=0.04). The 5-year rates of vaginal and pelvic recurrences were 1.7% and 8.2%, respectively. The 5-year local control and OS rates were both 87%.

Our results suggest excellent local control with adjuvant IVB alone for selected patients with Stage IIA endometrial adenocarcinoma. The patients with positive LVI and deep myometrial invasion have a worse locoregional control and OS despite SS and adjuvant IVB.