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Published on: September 12, 2019
Treatment Outcomes and Prognostic Factors of Metastasis-Directed Radiation Therapy for Oligometastatic Endometrial
1Department of Radiation Oncology, Yonsei Cancer Center & Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Purpose:
To evaluate outcomes and prognostic factors associated with metastasis-directed radiation therapy (MDRT) for oligometastatic endometrial cancer.
Methods And Materials:
We retrospectively analyzed 101 patients (203 lesions) with ≤5 metastatic lesions treated with MDRT between 2015 and 2025. Oligometastatic states were classified according to the European Society for Radiotherapy and Oncology-European Organisation for Research and Treatment of Cancer framework. Endpoints were overall survival (OS), progression-free survival (PFS), and local failure-free survival. Prognostic factors were assessed using multivariable Cox regression, and toxicities were graded using the National Cancer Institute Common Terminology Criteria for Adverse Events v5.0.
Results:
At a median follow-up of 36.4 months, 3-year OS, PFS, and 2-year local failure-free survival rates were 76.3%, 24.5%, and 64.7%, respectively. Multivariable analyses revealed that favorable oligometastatic disease classification, endometrioid histology, favorable radiation therapy (RT) response, and maximum dose ≥40 Gy (equivalent dose in 2 Gy fractions, α/β = 10) were independently associated with improved OS. All factors, except for histology, were significant for PFS. In a propensity-matched analysis, repeated MDRT for recurrent oligometastases showed a trend toward improved OS compared with a single course. One grade 3 event occurred with no grade ≥4 toxicity.
Conclusions:
MDRT yielded favorable outcomes in oligometastatic endometrial cancer. Oligometastatic classification, histology, and RT response were major prognostic factors. MDRT may be a viable option within a multidisciplinary framework for de novo and recurrent oligometastases, but validation in prospective multicenter studies is warranted.
Insights
Metastasis-directed radiation therapy (MDRT) shows promising outcomes for oligometastatic endometrial cancer. Key prognostic factors include disease classification, histology, and radiation response, suggesting MDRT
Area of Science:
- Gynecologic Oncology
- Radiation Oncology
- Medical Physics
Background:
- Endometrial cancer with limited metastatic spread (oligometastases) presents unique treatment challenges.
- Metastasis-directed radiation therapy (MDRT) is an emerging strategy for managing oligometastatic disease.
Purpose of the Study:
- To evaluate the outcomes and identify prognostic factors for patients with oligometastatic endometrial cancer treated with MDRT.
Main Methods:
- Retrospective analysis of 101 patients with ≤5 metastatic lesions treated with MDRT.
- Classification of oligometastatic states using the ESTRO-EORTC framework.
- Assessment of overall survival (OS), progression-free survival (PFS), local failure-free survival, and toxicities (CTCAE v5.0).
Main Results:
- 3-year OS and PFS rates were 76.3% and 24.5%, respectively.
- Favorable oligometastatic classification, endometrioid histology, positive RT response, and higher radiation dose (≥40 Gy) were associated with improved OS and PFS.
- Repeated MDRT for recurrent oligometastases showed a trend toward improved OS.
Conclusions:
- MDRT demonstrates favorable outcomes in oligometastatic endometrial cancer.
- Oligometastatic classification, histology, and RT response are significant prognostic factors.
- MDRT is a potential option for de novo and recurrent oligometastases, requiring prospective validation.