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The survival outcome and patterns of failure in node positive endometrial cancer patients treated with surgery and adjuvant radiotherapy with curative intent.

Rajasooriyar C, Bernshaw D, Kondalsamy-Chennakesavan S, Mileshkin L, Narayan K - J Gynecol Oncol (2014)

Bottom Line: The number of positive nodes did not influence survival.Among the 54 patients relapsed, only three (6%) failed exclusively in the pelvis and the rest of the 94% failed in extrapelvic nodal or distant sites.Patients with grade 3 endometrioid, serous and clear cell histologies did not influence pelvic failure but had significant extrapelvic failures (p<0.001).

View Article: PubMed Central - PubMed

Affiliation: Peter MacCallum Cancer Centre and University of Melbourne, East Melbourne, VIC, Australia. rchrishanthi@hotmail.com.

ABSTRACT

Objective: The purpose of this study was to evaluate the patterns of failure, overall survival (OS), disease-free survival (DFS) and factors influencing outcome in endometrial cancer patients who presented with metastatic lymph nodes and were treated with curative intent.

Methods: One hundred and twenty-six patients treated between January 1996 to December 2008 with surgery and adjuvant radiotherapy were identified from our service's prospective database. Radiotherapy consisted of 45 Gy in 1.8 Gy fractions to the whole pelvis. The involved nodal sites were boosted to a total dose of 50.4 to 54 Gy.

Results: The 5-year OS rate was 61% and the 5-year DFS rate was 59%. Grade 3 endometrioid, serous, and clear cell histologies and involvement of upper para-aortic nodes had lower OS and DFS. The number of positive nodes did not influence survival. Among the histological groups, serous histology had the worst survival. Among the 54 patients relapsed, only three (6%) failed exclusively in the pelvis and the rest of the 94% failed in extrapelvic nodal or distant sites. Patients with grade 3 endometrioid, serous and clear cell histologies did not influence pelvic failure but had significant extrapelvic failures (p<0.001).

Conclusion: Majority of node positive endometrial cancer patients fail at extrapelvic sites. The most important factors influencing survival and extrapelvic failure are grade 3 endometrioid, clear cell and serous histologies and involvement of upper para-aortic nodes.

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Related in: MedlinePlus

(A) Overall survival, (B) disease-specific survival, and (C) disease-free survival estimates of high risk and low risk node positive endometrial cancer patients. CI, confidence interval; HR, hazard ratios.
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Figure 1: (A) Overall survival, (B) disease-specific survival, and (C) disease-free survival estimates of high risk and low risk node positive endometrial cancer patients. CI, confidence interval; HR, hazard ratios.

Mentions: Each high risk group was compared with the low risk group and found to have significant negative impact on OS (group 2, p=0.003; group 3, p=0.002; and group 4, p<0.001); DSS (group 2, p=0.001; group 3, p<0.001; and group 4, p=0.001); and DFS (group 2, p=0.002; group 3, p=0.023; and group 4, p<0.001). A comparison between the low risk vs. high risk groups (groups 2, 3, and 4 combined together) revealed that at 5 years, 78% were alive among the low risk group compared to 43% among high risk group. Similarly, 76% were without relapse at 5 years among the low risk group compared to 40% among high risk groups. The 5-year OS, DSS, and DFS among the low and high risk groups are shown in Fig. 1.


The survival outcome and patterns of failure in node positive endometrial cancer patients treated with surgery and adjuvant radiotherapy with curative intent.

Rajasooriyar C, Bernshaw D, Kondalsamy-Chennakesavan S, Mileshkin L, Narayan K - J Gynecol Oncol (2014)

(A) Overall survival, (B) disease-specific survival, and (C) disease-free survival estimates of high risk and low risk node positive endometrial cancer patients. CI, confidence interval; HR, hazard ratios.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4195302&req=5

Figure 1: (A) Overall survival, (B) disease-specific survival, and (C) disease-free survival estimates of high risk and low risk node positive endometrial cancer patients. CI, confidence interval; HR, hazard ratios.
Mentions: Each high risk group was compared with the low risk group and found to have significant negative impact on OS (group 2, p=0.003; group 3, p=0.002; and group 4, p<0.001); DSS (group 2, p=0.001; group 3, p<0.001; and group 4, p=0.001); and DFS (group 2, p=0.002; group 3, p=0.023; and group 4, p<0.001). A comparison between the low risk vs. high risk groups (groups 2, 3, and 4 combined together) revealed that at 5 years, 78% were alive among the low risk group compared to 43% among high risk group. Similarly, 76% were without relapse at 5 years among the low risk group compared to 40% among high risk groups. The 5-year OS, DSS, and DFS among the low and high risk groups are shown in Fig. 1.

Bottom Line: The number of positive nodes did not influence survival.Among the 54 patients relapsed, only three (6%) failed exclusively in the pelvis and the rest of the 94% failed in extrapelvic nodal or distant sites.Patients with grade 3 endometrioid, serous and clear cell histologies did not influence pelvic failure but had significant extrapelvic failures (p<0.001).

View Article: PubMed Central - PubMed

Affiliation: Peter MacCallum Cancer Centre and University of Melbourne, East Melbourne, VIC, Australia. rchrishanthi@hotmail.com.

ABSTRACT

Objective: The purpose of this study was to evaluate the patterns of failure, overall survival (OS), disease-free survival (DFS) and factors influencing outcome in endometrial cancer patients who presented with metastatic lymph nodes and were treated with curative intent.

Methods: One hundred and twenty-six patients treated between January 1996 to December 2008 with surgery and adjuvant radiotherapy were identified from our service's prospective database. Radiotherapy consisted of 45 Gy in 1.8 Gy fractions to the whole pelvis. The involved nodal sites were boosted to a total dose of 50.4 to 54 Gy.

Results: The 5-year OS rate was 61% and the 5-year DFS rate was 59%. Grade 3 endometrioid, serous, and clear cell histologies and involvement of upper para-aortic nodes had lower OS and DFS. The number of positive nodes did not influence survival. Among the histological groups, serous histology had the worst survival. Among the 54 patients relapsed, only three (6%) failed exclusively in the pelvis and the rest of the 94% failed in extrapelvic nodal or distant sites. Patients with grade 3 endometrioid, serous and clear cell histologies did not influence pelvic failure but had significant extrapelvic failures (p<0.001).

Conclusion: Majority of node positive endometrial cancer patients fail at extrapelvic sites. The most important factors influencing survival and extrapelvic failure are grade 3 endometrioid, clear cell and serous histologies and involvement of upper para-aortic nodes.

Show MeSH
Related in: MedlinePlus