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Published on: September 12, 2019
Improved Overall Survival Associated With Vaginal Cuff Brachytherapy Boost for Stage II Endometrioid Endometrial
Mariam Atobiloye1, Jackson Howell2, Jessica Cruttenden2
1University of Utah, School of Medicine, Salt Lake City, Utah.
Purpose:
Treatment of International Federation of Gynecology and Obstetrics (FIGO, 2009) stage II endometrial cancers (ECs) typically involves total hysterectomy and bilateral salpingo-oophorectomy followed by adjuvant radiation and/or chemotherapy. Existing guidelines recommend whole pelvis radiation therapy (WPRT); however, vaginal cuff brachytherapy (VCB) has conditional support as a boost. We sought to evaluate if there is improved overall survival (OS) associated with WPRT + VCB over WPRT alone for patients with FIGO (2009) stage II endometrioid EC and assess patterns of care. We hypothesize that WPRT + VCB will be associated with improved survival.
Methods And Materials:
The 2023 National Cancer Database was queried for patients with endometrioid ECs who underwent hysterectomy with complete surgical staging, consistent with T2N0M0, and were treated adjuvantly with WPRT + VCB or WPRT alone. Patients were excluded if risk factor information (eg, lymphovascular invasion, peritoneal cytology, myometrial invasion, and surgical margins) was incomplete. Logistic regression analysis was used to determine the propensity for each treatment method. Kaplan-Meier and landmark analyses for OS and univariate and multivariable (MVA) Cox proportional hazards models were used to evaluate (1) the entire cohort and (2) a propensity score-matched subgroup.
Results:
Of 1782 patients included in this analysis, 670 received WPRT alone, and 1112 received WPRT + VCB. Median follow-up was 6.5 years. Logistic regression analysis revealed that few demographic or pathologic features were predictive of the adjuvant regimen received. WPRT + VCB was associated with an OS advantage (MVA: hazard ratio 0.68 [95% CI, 0.55-0.83]; P < .001). After propensity score matching, the OS benefit associated with WPRT + VCB was maintained (MVA: hazard ratio 0.61 [95% CI, 0.47-0.79]; P < .001).
Conclusions:
This National Cancer Database analysis suggests that adjuvant treatment with WPRT + VCB is associated with improved OS compared to WPRT alone in patients with FIGO 2009 stage II endometrioid EC. Given the limitations of such database analyses, further exploration in molecularly defined cohorts is warranted.
