Multi-institutional analysis of vaginal brachytherapy alone for women with Stage II endometrial carcinoma
Menée à partir de données portant sur 106 patientes atteintes d'un cancer de l'endomètre de type endométrioïde et de stade II (durée médiane de suivi : 39 mois), cette étude analyse, en fonction du degré d'agressivité de la tumeur et du point de vue des taux de survie à 5 ans, la possibilité d'un traitement adjuvant par curiethérapie vaginale seule
Purpose : To investigate the survival endpoints in women with FIGO stage II endometrial cancer who received adjuvant vaginal cuff brachytherapy (VBT) alone using multi-institutional pooled data. Patients and Methods : We performed a multi-institutional analysis of surgically staged patients with FIGO stage II endometrioid-type endometrial cancer treated with VBT alone. Patient, tumor, and treatment characteristics were collected and analyzed. Univariable (UVA) and multivariable (MVA) frailty survival models were performed to assess clinicopathologic risk factors for recurrence and death. Results : 106 patients were included (92 VBT alone and 14 VBT with chemotherapy) with median follow up of 39.0 months. Pelvic node dissection was performed in 89.6% of patients. 104 patients (98.1%) and 2 patients (1.9%) had microscopic and macroscopic cervical stromal invasion, respectively. Grade 1 or 2 disease occurred in 88.6% of patients. For patients treated with VBT without chemotherapy, the 5-year estimates of vaginal failure, pelvic nodal failure, and distant metastases were 2.6%, 4.2%, and 7.2%, respectively. 5-year progression-free survival (PFS) and overall survival were 74.0% and 76.2%, respectively. On UVA & MVA for PFS, increasing age and lack of pelvic node dissection were hazardous (p<.05). Conclusion : Vaginal and pelvic failure rates were low in this selected population of Stage II patients receiving adjuvant VBT without EBRT. It is reasonable to consider adjuvant VBT alone in selected patients with grade 1-2 disease and microscopic cervical stromal invasion who underwent pelvic lymphadenectomy.