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Adjuvant therapy for early stage, endometrial cancer with lymphovascular space invasion: Is there a role for chemotherapy?
Beavis, Anna L; Yen, Ting-Tai; Stone, Rebecca L; Wethington, Stephanie L; Carr, Caitlin; Son, Ji; Chambers, Laura; Michener, Chad M; Ricci, Stephanie; Burkett, Wesley C; Richardson, Debra L; Staley, Allison-Stuart; Ahn, Susie; Gehrig, Paola A; Torres, Diogo; Dowdy, Sean C; Sullivan, Mackenzie W; Modesitt, Susan C; Watson, Catherine; Veade, Ashely; Ehrisman, Jessie; Havrilesky, Laura; Secord, Angeles Alvarez; Loreen, Amy; Griffin, Kaitlyn; Jackson, Amanda; Viswanathan, Akila N; Jager, Leah R; Fader, Amanda N.
Afiliación
  • Beavis AL; The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: abeavis2@jhmi.edu.
  • Yen TT; The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
  • Stone RL; The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
  • Wethington SL; The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
  • Carr C; Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA.
  • Son J; Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA.
  • Chambers L; Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA.
  • Michener CM; Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA.
  • Ricci S; Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA.
  • Burkett WC; Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
  • Richardson DL; Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
  • Staley AS; Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA.
  • Ahn S; Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA.
  • Gehrig PA; Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA.
  • Torres D; Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA.
  • Dowdy SC; Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA.
  • Sullivan MW; Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA, USA.
  • Modesitt SC; Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA, USA.
  • Watson C; Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA.
  • Veade A; Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA.
  • Ehrisman J; Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA.
  • Havrilesky L; Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA.
  • Secord AA; Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA.
  • Loreen A; Department of Obstetrics and Gynecology, University of Cincinnati Medical Center, Cincinnati, OH, USA.
  • Griffin K; Department of Obstetrics and Gynecology, University of Cincinnati Medical Center, Cincinnati, OH, USA.
  • Jackson A; Department of Obstetrics and Gynecology, University of Cincinnati Medical Center, Cincinnati, OH, USA.
  • Viswanathan AN; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA.
  • Jager LR; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
  • Fader AN; The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Gynecol Oncol ; 156(3): 568-574, 2020 03.
Article en En | MEDLINE | ID: mdl-31948730
OBJECTIVES: Lymphovascular space invasion (LVSI) is an independent risk factor for recurrence and poor survival in early-stage endometrioid endometrial cancer (EEC), but optimal adjuvant treatment is unknown. We aimed to compare the survival of women with early-stage EEC with LVSI treated postoperatively with observation (OBS), radiation (RAD, external beam and/or vaginal brachytherapy), or chemotherapy (CHEMO)+/-RAD. METHODS: This was a multi-institutional, retrospective cohort study of women with stage I or II EEC with LVSI who underwent hysterectomy+/-lymphadenectomy from 2005 to 2015 and received OBS, RAD, or CHEMO+/-RAD postoperatively. Progression-free survival and overall survival were evaluated using Kaplan-Meier estimates and Cox proportional hazards models. RESULTS: In total, 478 women were included; median age was 64 years, median follow-up was 50.3 months. After surgery, 143 (30%) underwent OBS, 232 (48.5%) received RAD, and 103(21.5%) received CHEMO+/-RAD (95% of whom received RAD). Demographics were similar among groups, but those undergoing OBS had lower stage and grade. A total of 101 (21%) women recurred. Progression-free survival (PFS) was improved in both CHEMO+/-RAD (HR = 0.18, 95% CI: 0.09-0.39) and RAD (HR = 0.31, 95% CI: 0.18-0.54) groups compared to OBS, though neither adjuvant therapy was superior to the other. However, in grade 3 tumors, the CHEMO+/-RAD group had superior PFS compared to both RAD (HR 0.25; 95% CI: 0.12-0.52) and OBS cohorts (HR = 0.10, 95% CI: 0.03-0.32). Overall survival did not differ by treatment. CONCLUSIONS: In early-stage EEC with LVSI, adjuvant therapy improved PFS compared to observation alone. In those with grade 3 EEC, adjuvant chemotherapy with or without radiation improved PFS compared to observation or radiation alone.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias Endometriales / Carcinoma Endometrioide Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Aged80 / Female / Humans / Middle aged Idioma: En Revista: Gynecol Oncol Año: 2020 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias Endometriales / Carcinoma Endometrioide Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Aged80 / Female / Humans / Middle aged Idioma: En Revista: Gynecol Oncol Año: 2020 Tipo del documento: Article Pais de publicación: Estados Unidos