Adjuvant vaginal brachytherapy alone for high risk localized endometrial cancer as defined by the three major randomized trials of adjuvant pelvic radiation

Susan A. McCloskey, Nana Tchabo, Harish K. Malhotra, Kunle Odunsi, Kerry Rodabaugh, Pankaj Singhal, Shashikant Lele, Wainwright Jaggernauth

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Objective. Controversy exists regarding optimal management of high risk localized endometrial cancer. Given that vaginal brachytherapy (VB) alone is used routinely at our institution, we retrospectively reviewed our outcomes among high risk patients defined according to the PORTEC, GOG 99, and/or Aalders randomized trials of pelvic radiation versus observation to determine if acceptable rates of locoregional control could be achieved with vaginal brachytherapy alone in this highest risk patient population. Methods. The Roswell Park Cancer Institute hospital tumor registry was used to identify all patients with Stage I or IIA endometrial cancer treated between January 1992 and June 2006. A total of 464 patients were identified. Of 261 patients who received post-operative RT, 225 received VB alone. Of those 225, 87 met the high risk criteria as designated by PORTEC (at least 2 of the following high risk features: age > 60, Grade 3, and/or myometrial invasion ≥ Occurrences of the mathematical operator '(=' were changed to 'Œ'. Please check.-->50%), GOG 99 (any age with 3 high risk features: Grade 2-3, > 66% myometrial invasion, and/or LVSI; age ≥ 50 with 2 high risk features; or age ≥ 70 with 1 high risk feature), and/or Aalders (Stage IC, Grade 3). Descriptive recurrence statistics are provided. Results. Among 87 high risk patients treated with VB alone, 36, 77, and 14 were high risk per PORTEC, GOG 99, and Aalders respectively. Forty (46%) underwent pelvic lymph node dissection. With a median follow-up of 52 months, 3 (3.4%) pelvic recurrences were observed including 1 vaginal recurrence, 1 pelvic recurrence, and 1 local recurrence involving both the vagina and pelvis. All 3 local recurrences were successfully salvaged with pelvic RT ± surgery. Conclusions. This represents one of the largest known series of high risk localized endometrial cancer treated with VB alone. The observed 3.4% locoregional recurrence compares favorably with the 5% locoregional recurrence noted among the highest risk patients receiving pelvic RT in the PORTEC, GOG 99, and Aalders randomized trials. In this single institution experience, the 3 local recurrences were salvaged. Based on these findings, we will continue to use VB alone in the adjuvant setting for patients with high risk localized endometrial cancer.

Original languageEnglish (US)
Pages (from-to)404-407
Number of pages4
JournalGynecologic Oncology
Volume116
Issue number3
DOIs
StatePublished - Mar 1 2010
Externally publishedYes

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Brachytherapy
Endometrial Neoplasms
Radiation
Recurrence
Cancer Care Facilities
Risk Management
Vagina
Lymph Node Excision
Pelvis
Registries
Observation

All Science Journal Classification (ASJC) codes

  • Obstetrics and Gynecology
  • Oncology

Cite this

McCloskey, Susan A. ; Tchabo, Nana ; Malhotra, Harish K. ; Odunsi, Kunle ; Rodabaugh, Kerry ; Singhal, Pankaj ; Lele, Shashikant ; Jaggernauth, Wainwright. / Adjuvant vaginal brachytherapy alone for high risk localized endometrial cancer as defined by the three major randomized trials of adjuvant pelvic radiation. In: Gynecologic Oncology. 2010 ; Vol. 116, No. 3. pp. 404-407.
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title = "Adjuvant vaginal brachytherapy alone for high risk localized endometrial cancer as defined by the three major randomized trials of adjuvant pelvic radiation",
abstract = "Objective. Controversy exists regarding optimal management of high risk localized endometrial cancer. Given that vaginal brachytherapy (VB) alone is used routinely at our institution, we retrospectively reviewed our outcomes among high risk patients defined according to the PORTEC, GOG 99, and/or Aalders randomized trials of pelvic radiation versus observation to determine if acceptable rates of locoregional control could be achieved with vaginal brachytherapy alone in this highest risk patient population. Methods. The Roswell Park Cancer Institute hospital tumor registry was used to identify all patients with Stage I or IIA endometrial cancer treated between January 1992 and June 2006. A total of 464 patients were identified. Of 261 patients who received post-operative RT, 225 received VB alone. Of those 225, 87 met the high risk criteria as designated by PORTEC (at least 2 of the following high risk features: age > 60, Grade 3, and/or myometrial invasion ≥ Occurrences of the mathematical operator '(=' were changed to 'Œ'. Please check.-->50{\%}), GOG 99 (any age with 3 high risk features: Grade 2-3, > 66{\%} myometrial invasion, and/or LVSI; age ≥ 50 with 2 high risk features; or age ≥ 70 with 1 high risk feature), and/or Aalders (Stage IC, Grade 3). Descriptive recurrence statistics are provided. Results. Among 87 high risk patients treated with VB alone, 36, 77, and 14 were high risk per PORTEC, GOG 99, and Aalders respectively. Forty (46{\%}) underwent pelvic lymph node dissection. With a median follow-up of 52 months, 3 (3.4{\%}) pelvic recurrences were observed including 1 vaginal recurrence, 1 pelvic recurrence, and 1 local recurrence involving both the vagina and pelvis. All 3 local recurrences were successfully salvaged with pelvic RT ± surgery. Conclusions. This represents one of the largest known series of high risk localized endometrial cancer treated with VB alone. The observed 3.4{\%} locoregional recurrence compares favorably with the 5{\%} locoregional recurrence noted among the highest risk patients receiving pelvic RT in the PORTEC, GOG 99, and Aalders randomized trials. In this single institution experience, the 3 local recurrences were salvaged. Based on these findings, we will continue to use VB alone in the adjuvant setting for patients with high risk localized endometrial cancer.",
author = "McCloskey, {Susan A.} and Nana Tchabo and Malhotra, {Harish K.} and Kunle Odunsi and Kerry Rodabaugh and Pankaj Singhal and Shashikant Lele and Wainwright Jaggernauth",
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Adjuvant vaginal brachytherapy alone for high risk localized endometrial cancer as defined by the three major randomized trials of adjuvant pelvic radiation. / McCloskey, Susan A.; Tchabo, Nana; Malhotra, Harish K.; Odunsi, Kunle; Rodabaugh, Kerry; Singhal, Pankaj; Lele, Shashikant; Jaggernauth, Wainwright.

In: Gynecologic Oncology, Vol. 116, No. 3, 01.03.2010, p. 404-407.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Adjuvant vaginal brachytherapy alone for high risk localized endometrial cancer as defined by the three major randomized trials of adjuvant pelvic radiation

AU - McCloskey, Susan A.

AU - Tchabo, Nana

AU - Malhotra, Harish K.

AU - Odunsi, Kunle

AU - Rodabaugh, Kerry

AU - Singhal, Pankaj

AU - Lele, Shashikant

AU - Jaggernauth, Wainwright

PY - 2010/3/1

Y1 - 2010/3/1

N2 - Objective. Controversy exists regarding optimal management of high risk localized endometrial cancer. Given that vaginal brachytherapy (VB) alone is used routinely at our institution, we retrospectively reviewed our outcomes among high risk patients defined according to the PORTEC, GOG 99, and/or Aalders randomized trials of pelvic radiation versus observation to determine if acceptable rates of locoregional control could be achieved with vaginal brachytherapy alone in this highest risk patient population. Methods. The Roswell Park Cancer Institute hospital tumor registry was used to identify all patients with Stage I or IIA endometrial cancer treated between January 1992 and June 2006. A total of 464 patients were identified. Of 261 patients who received post-operative RT, 225 received VB alone. Of those 225, 87 met the high risk criteria as designated by PORTEC (at least 2 of the following high risk features: age > 60, Grade 3, and/or myometrial invasion ≥ Occurrences of the mathematical operator '(=' were changed to 'Œ'. Please check.-->50%), GOG 99 (any age with 3 high risk features: Grade 2-3, > 66% myometrial invasion, and/or LVSI; age ≥ 50 with 2 high risk features; or age ≥ 70 with 1 high risk feature), and/or Aalders (Stage IC, Grade 3). Descriptive recurrence statistics are provided. Results. Among 87 high risk patients treated with VB alone, 36, 77, and 14 were high risk per PORTEC, GOG 99, and Aalders respectively. Forty (46%) underwent pelvic lymph node dissection. With a median follow-up of 52 months, 3 (3.4%) pelvic recurrences were observed including 1 vaginal recurrence, 1 pelvic recurrence, and 1 local recurrence involving both the vagina and pelvis. All 3 local recurrences were successfully salvaged with pelvic RT ± surgery. Conclusions. This represents one of the largest known series of high risk localized endometrial cancer treated with VB alone. The observed 3.4% locoregional recurrence compares favorably with the 5% locoregional recurrence noted among the highest risk patients receiving pelvic RT in the PORTEC, GOG 99, and Aalders randomized trials. In this single institution experience, the 3 local recurrences were salvaged. Based on these findings, we will continue to use VB alone in the adjuvant setting for patients with high risk localized endometrial cancer.

AB - Objective. Controversy exists regarding optimal management of high risk localized endometrial cancer. Given that vaginal brachytherapy (VB) alone is used routinely at our institution, we retrospectively reviewed our outcomes among high risk patients defined according to the PORTEC, GOG 99, and/or Aalders randomized trials of pelvic radiation versus observation to determine if acceptable rates of locoregional control could be achieved with vaginal brachytherapy alone in this highest risk patient population. Methods. The Roswell Park Cancer Institute hospital tumor registry was used to identify all patients with Stage I or IIA endometrial cancer treated between January 1992 and June 2006. A total of 464 patients were identified. Of 261 patients who received post-operative RT, 225 received VB alone. Of those 225, 87 met the high risk criteria as designated by PORTEC (at least 2 of the following high risk features: age > 60, Grade 3, and/or myometrial invasion ≥ Occurrences of the mathematical operator '(=' were changed to 'Œ'. Please check.-->50%), GOG 99 (any age with 3 high risk features: Grade 2-3, > 66% myometrial invasion, and/or LVSI; age ≥ 50 with 2 high risk features; or age ≥ 70 with 1 high risk feature), and/or Aalders (Stage IC, Grade 3). Descriptive recurrence statistics are provided. Results. Among 87 high risk patients treated with VB alone, 36, 77, and 14 were high risk per PORTEC, GOG 99, and Aalders respectively. Forty (46%) underwent pelvic lymph node dissection. With a median follow-up of 52 months, 3 (3.4%) pelvic recurrences were observed including 1 vaginal recurrence, 1 pelvic recurrence, and 1 local recurrence involving both the vagina and pelvis. All 3 local recurrences were successfully salvaged with pelvic RT ± surgery. Conclusions. This represents one of the largest known series of high risk localized endometrial cancer treated with VB alone. The observed 3.4% locoregional recurrence compares favorably with the 5% locoregional recurrence noted among the highest risk patients receiving pelvic RT in the PORTEC, GOG 99, and Aalders randomized trials. In this single institution experience, the 3 local recurrences were salvaged. Based on these findings, we will continue to use VB alone in the adjuvant setting for patients with high risk localized endometrial cancer.

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