Qu XM, et al. - In this multi-institutional review, experts evaluated the appropriateness of various adjuvant management strategies, including observation, in stage IA serous or clear cell endometrial cancer. Adjuvant radiotherapy (RT) and chemotherapy were related to better local control (LC) and disease-free survival (DFS) in stage IA serous or clear cell uterine cancer. They noted that observation could be appropriate in subjects who have had adequate surgical staging.

Methods

• Authors conducted the retrospective chart reviews for 414 consecutive patients who underwent hysterectomy for FIGO stage IA endometrial cancer with serous, clear cell or mixed histology between 2004 and 2015 in 6 North American centers.
• They analyzed the time-to-event outcomes by Kaplan-Meier estimates, log-rank test, univariable and multivariable cox proportional hazard regression models.

Results

• Observation (50%), chemotherapy and radiotherapy (RT) (27%), RT only (16%) and chemotherapy only (7%) were included in post-operative management.
• As per the data, a total of 178 RT patients received external beam (EBRT, 16%), vaginal vault brachytherapy (VVB, 56%) or both (28%).
• Five-year local control (LC), disease free survival (DFS) and cancer-specific survival (CSS) were 82% (95% confidence interval: 74–88), 70% (62–78) and 90% (82–94), respectively, among patients without any adjuvant treatment.
• With adequate surgical staging, CSS in patients without adjuvant treatment was improved (100% vs 87% (77–92), log-rank p=0.022).
• Results demonstrated that the adjuvant VVB was related to improved LC (5-year 96% (91–99) vs 84% (76–89), log-rank p=0.007) and DFS (5-year 79% (66–88) vs 71% (63–77), log-rank p=0.033).
• They noted that adjuvant chemotherapy was related to better LC (5-year 96% (90–98) vs 84% (77–89), log-rank p=0.014) and DFS (5-year 84% (74–91) vs 69% (61–76), log-rank p=0.009).
• Furthermore, adjuvant chemotherapy and VVB were associated with improved LC whereas adjuvant chemotherapy and age were significant for DFS, as observed in multivariable analysis.