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08-07-2017 | Uterine cancer | Article

Tailoring Adjuvant Radiotherapy in Endometrial Cancer

Journal: Indian Journal of Gynecologic Oncology

Authors: Kailash Narayan, Ming Yin Lin, David Bernshaw, Pearly Khaw, Srinivas Kondalsamy-Chennakesvan

Publisher: Springer India

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Abstract

Objectives

The aim of this study was to examine the patterns of failure following adjuvant radiotherapy in patients with endometrial cancer according to: (a) the extent of the disease present at the time of primary surgery, (b) according to risk groups as agreed upon in the ESMO–ESGO–ESTRO consensus conference on endometrial cancer (Colombo et al. in Int J Gynecol Cancer Off J Int Gynecol Cancer Soc 26:2–30, 2016).

Methods and Materials

One thousand two hundred and seven newly diagnosed endometrial cancer patients with endometrioid/serous, clear cell and serous histology, treated by primary surgery and presented to The Peter MacCallum Cancer Centre, between January 1996 and December 2014 for adjuvant radiotherapy, were analysed for patterns of any failure to study the efficacy of adjuvant radiotherapy.

Results

Nine hundred and eight (75%) patients were alive at the last observation date, 826 without any evidence of disease. Two hundred and sixty-one patients have died, 147 (12%) from recurrent cancer. The median follow-up time was 5.4 years. 53% patients had LVSI, and 18% patients had positive nodes. 19% patients developed metastases. Pelvic, para-aortic and distant relapses were observed in 13, 11 and 8.5%, respectively.

Conclusion

Vaginal vault brachytherapy was a very efficient form of radiotherapy that provided 99% control of disease at the vaginal vault in intermediate- and high-intermediate-risk patients in FIGO stages 1 and 2. In stage 3 and 4 patient, adjuvant pelvic radiotherapy and extended field radiotherapy provided a good pelvic and para-aortic control. Patients with lymphovascular space invasion recur more diffusely and at multi-sites.
Literature
1.
Colombo N, Creutzberg C, Amant F, Bosse T, Gonzalez-Martin A, Ledermann J, et al. ESMO–ESGO–ESTRO consensus conference on endometrial cancer: diagnosis, treatment and follow-up. Int J Gynecol Cancer. 2016;26:2–30.CrossRefPubMed
2.
American College of O, Gynecologists. ACOG practice bulletin, clinical management guidelines for obstetrician–gynecologists, number 65, August 2005: management of endometrial cancer. Obstet Gynecol. 2005;2005(106):413–25.
3.
Creasman W. Revised FIGO staging for carcinoma of the endometrium. Int J Gynaecol. 2009;105:109.CrossRef
4.
Rungruang B, Olawaiye AB. Comprehensive surgical staging for endometrial cancer. Rev Obstet Gynecol. 2012;5:28–34.PubMedPubMedCentral
5.
Eifel PJ. The value of pelvic radiation therapy after hysterectomy for early endometrial cancer. Oncology. 2013;27:990–9.PubMed
6.
Klopp A, Smith BD, Alektiar K, Cabrera A, Damato AL, Erickson B, et al. The role of postoperative radiation therapy for endometrial cancer: executive summary of an American Society for Radiation Oncology evidence-based guideline. Pract Radiat Oncol. 2014;4:137–44.CrossRefPubMed
7.
Meyer LA, Bohlke K, Powell MA, Fader AN, Franklin GE, Lee LJ, et al. Postoperative radiation therapy for endometrial cancer: American Society of Clinical Oncology clinical practice guideline endorsement of the American Society for Radiation Oncology evidence-based guideline. J Clin Oncol. 2015;33:2908–13.CrossRefPubMed
8.
Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB. Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer. 1987;60:2035–41.CrossRefPubMed
9.
Creasman WT, DeGeest K, DiSaia PJ, Zaino RJ. Significance of true surgical pathologic staging: A Gynecologic Oncology Group Study. Am J Obstet Gynecol. 1999;181:31–4.CrossRefPubMed
10.
Narayan K, Fisher RJ, Bernshaw D. Patterns of failure and prognostic factor analyses in locally advanced cervical cancer patients staged by magnetic resonance imaging and treated with curative intent. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2008;18:525–33.CrossRef
11.
Narayan K, Rejeki V, Herschtal A, Bernshaw D, Quinn M, Jobling T, et al. Prognostic significance of several histological features in intermediate and high-risk endometrial cancer patients treated with curative intent using surgery and adjuvant radiotherapy. J Med Imaging Radiat Oncol. 2009;53:107–13.CrossRefPubMed
12.
Narayan K, Khaw P, Bernshaw D, Mileshkin L, Kondalsamy-Chennakesavan S. Prognostic significance of lymphovascular space invasion and nodal involvement in intermediate- and high-risk endometrial cancer patients treated with curative intent using surgery and adjuvant radiotherapy. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2012;22:260–6.CrossRef
13.
Rajasooriyar C, Bernshaw D, Kondalsamy-Chennakesavan S, Mileshkin L, Narayan K. The survival outcome and patterns of failure in node positive endometrial cancer patients treated with surgery and adjuvant radiotherapy with curative intent. J Gynecol Oncol. 2014;25:313–9.CrossRefPubMedPubMedCentral
14.
Narayan K, Fisher RJ, Bernshaw D, Shakher R, Hicks RJ. Patterns of failure and prognostic factor analyses in locally advanced cervical cancer patients staged by positron emission tomography and treated with curative intent. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2009;19:912–8.CrossRef
15.
Haymans O, Fallais C, Hustinx R. Intratissular lymphaticovenous anastomoses demonstrated by perioperative intramuscular injection of 99mTc-Colloids. Lymphat Res Biol. 2006;4:5.
16.
Gadducci A, Greco C. The evolving role of adjuvant therapy in endometrial cancer. Crit Rev Oncol Hematol. 2011;78:79–91.CrossRefPubMed
17.
Sedlis A, Bundy BN, Rotman MZ, Lentz SS, Muderspach LI, Zaino RJ. A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: a Gynecologic Oncology Group Study. Gynecol Oncol. 1999;73:177–83.CrossRefPubMed
18.
Kong A, Johnson N, Kitchener HC, Lawrie TA. Adjuvant radiotherapy for stage I endometrial cancer: an updated Cochrane systematic review and meta-analysis. J Natl Cancer Inst. 2012;104:1625–34.CrossRefPubMed
19.
Gupta V, McGunigal M, Prasad-Hayes M, Kalir T, Liu J. Adjuvant radiation therapy is associated with improved overall survival in high-intermediate risk stage I endometrial cancer: a national cancer data base analysis. Gynecol Oncol. 2017;144:119–24.CrossRefPubMed
20.
Abu-Rustum NR. Update on sentinel node mapping in uterine cancer: 10-year experience at Memorial Sloan-Kettering Cancer Center. J Obstet Gynaecol Res. 2014;40:327–34.CrossRefPubMed
21.
Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet. 2009;373:125–36.CrossRefPubMed
22.
Townamchai K, Lee L, Viswanathan AN. A novel low dose fractionation regimen for adjuvant vaginal brachytherapy in early stage endometrioid endometrial cancer. Gynecol Oncol. 2012;127:351–5.CrossRefPubMedPubMedCentral
23.
Sorbe B, Straumits A, Karlsson L. Intravaginal high-dose-rate brachytherapy for stage I endometrial cancer: a randomized study of two dose-per-fraction levels. Int J Radiat Oncol Biol Phys. 2005;62:1385–9.CrossRefPubMed
24.
Leak LV. Studies on the permeability of lymphatic capillaries. J Cell Biol. 1971;50:300–23.CrossRefPubMedPubMedCentral
25.
Padera TP, Kadambi A, di Tomaso E, Carreira CM, Brown EB, Boucher Y, et al. Lymphatic metastasis in the absence of functional intratumor lymphatics. Science. 2002;296:1883–6.CrossRefPubMed
26.
Alektiar KM, McKee A, Lin O, Venkatraman E, Zelefsky MJ, Mychalczak BR, et al. The significance of the amount of myometrial invasion in patients with Stage IB endometrial carcinoma. Cancer. 2002;95:316–21.CrossRefPubMed
27.
Gumbiner BM. Cell adhesion: the molecular basis of tissue architecture and morphogenesis. Cell. 1996;84:345–57.CrossRefPubMed
28.
Meng W, Takeichi M. Adherens junction: molecular architecture and regulation. Cold Spring Harb Perspect Biol. 2009;1:a002899.CrossRefPubMedPubMedCentral
29.
Crosby LM, Waters CM. Epithelial repair mechanisms in the lung. Am J Physiol Lung Cell Mol Physiol. 2010;298:L715–31.CrossRefPubMedPubMedCentral
30.
Morison NB, Kaitu’u-Lino TJ, Fraser IS, Salamonsen LA. Stimulation of epithelial repair is a likely mechanism for the action of mifepristone in reducing duration of bleeding in users of progestogen-only contraceptives. Reproduction. 2008;136:267–74.CrossRefPubMed
31.
Baer PC, Bereiter-Hahn J. Epithelial cells in culture: injured or differentiated cells? Cell Biol Int. 2012;36:771–7.CrossRefPubMed
32.
Chui MH. Insights into cancer metastasis from a clinicopathologic perspective: epithelial–Mesenchymal transition is not a necessary step. Int J Cancer. 2013;132:1487–95.CrossRefPubMed
33.
Song YJ, Shin SH, Cho JS, Park MH, Yoon JH, Jegal YJ. The role of lymphovascular invasion as a prognostic factor in patients with lymph node-positive operable invasive breast cancer. J Breast Cancer. 2011;14:198–203.CrossRefPubMedPubMedCentral
34.
Desrosiers L, Fadare O, Xiao ZF, Dresser K, Wang SA. Lymphovascular space invasion does not predict vaginal relapses in stage I endometrioid adenocarcinoma of the endometrium. Ann Diagn Pathol. 2008;12:112–7.CrossRefPubMed
35.
Koelzer VH, Lugli A. The tumor border configuration of colorectal cancer as a histomorphological prognostic indicator. Front Oncol. 2014;4:29.PubMedPubMedCentral
36.
Khunamornpong S, Settakorn J, Sukpan K, Suprasert P, Lekawanvijit S, Siriaunkgul S. Prognostic value of pathological characteristics of invasive margins in early-stage squamous cell carcinomas of the uterine cervix. Asian Pac J Cancer Prev. 2013;14:5165–9.CrossRefPubMed
37.
Heaps JM, Fu YS, Montz FJ, Hacker NF, Berek JS. Surgical-pathologic variables predictive of local recurrence in squamous cell carcinoma of the vulva. Gynecol Oncol. 1990;38:309–14.CrossRefPubMed
38.
Horn LC, Fischer U, Raptis G, Bilek K, Hentschel B, Richter CE, et al. Pattern of invasion is of prognostic value in surgically treated cervical cancer patients. Gynecol Oncol. 2006;103:906–11.CrossRefPubMed
39.
Alexander-Sefre F, Singh N, Ayhan A, Thomas JM, Jacobs IJ. Clinical value of immunohistochemically detected lymphovascular invasion in endometrioid endometrial cancer. Gynecol Oncol. 2004;92:653–9.CrossRefPubMed
40.
Alexander-Sefre F, Nibbs R, Rafferty T, Ayhan A, Singh N, Jacobs I. Clinical value of immunohistochemically detected lymphatic and vascular invasions in clinically staged endometrioid endometrial cancer. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2009;19:1074–9.CrossRef
41.
Kukko HM, Koljonen VS, Tukiainen EJ, Haglund CH, Bohling TO. Vascular invasion is an early event in pathogenesis of Merkel cell carcinoma. Mod Pathol. 2010;23:1151–6.CrossRefPubMed
42.
Martin OA, Anderson RL, Narayan K, MacManus MP. Does the mobilization of circulating tumour cells during cancer therapy cause metastasis? Nat Rev Clin Oncol. 2017;14:32–44.CrossRefPubMed
43.
Kim HS, Suh DH, Kim MK, Chung HH, Park NH, Song YS. Systematic lymphadenectomy for survival in patients with endometrial cancer: a meta-analysis. Jpn J Clin Oncol. 2012;42:405–12.CrossRefPubMed