Skip to main content
SpringerLink
Log in

Tailoring Adjuvant Radiotherapy in Endometrial Cancer

  • Original Article
  • Published:
Indian Journal of Gynecologic Oncology Aims and scope Submit manuscript

Abstract

Objectives

The aim of this study was to examine the patterns of failure following adjuvant radiotherapy in patients with endometrial cancer according to: (a) the extent of the disease present at the time of primary surgery, (b) according to risk groups as agreed upon in the ESMO–ESGO–ESTRO consensus conference on endometrial cancer (Colombo et al. in Int J Gynecol Cancer Off J Int Gynecol Cancer Soc 26:2–30, 2016).

Methods and Materials

One thousand two hundred and seven newly diagnosed endometrial cancer patients with endometrioid/serous, clear cell and serous histology, treated by primary surgery and presented to The Peter MacCallum Cancer Centre, between January 1996 and December 2014 for adjuvant radiotherapy, were analysed for patterns of any failure to study the efficacy of adjuvant radiotherapy.

Results

Nine hundred and eight (75%) patients were alive at the last observation date, 826 without any evidence of disease. Two hundred and sixty-one patients have died, 147 (12%) from recurrent cancer. The median follow-up time was 5.4 years. 53% patients had LVSI, and 18% patients had positive nodes. 19% patients developed metastases. Pelvic, para-aortic and distant relapses were observed in 13, 11 and 8.5%, respectively.

Conclusion

Vaginal vault brachytherapy was a very efficient form of radiotherapy that provided 99% control of disease at the vaginal vault in intermediate- and high-intermediate-risk patients in FIGO stages 1 and 2. In stage 3 and 4 patient, adjuvant pelvic radiotherapy and extended field radiotherapy provided a good pelvic and para-aortic control. Patients with lymphovascular space invasion recur more diffusely and at multi-sites.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Colombo N, Creutzberg C, Amant F, Bosse T, Gonzalez-Martin A, Ledermann J, et al. ESMO–ESGO–ESTRO consensus conference on endometrial cancer: diagnosis, treatment and follow-up. Int J Gynecol Cancer. 2016;26:2–30.

    Article  PubMed  Google Scholar 

  2. American College of O, Gynecologists. ACOG practice bulletin, clinical management guidelines for obstetrician–gynecologists, number 65, August 2005: management of endometrial cancer. Obstet Gynecol. 2005;2005(106):413–25.

    Google Scholar 

  3. Creasman W. Revised FIGO staging for carcinoma of the endometrium. Int J Gynaecol. 2009;105:109.

    Article  Google Scholar 

  4. Rungruang B, Olawaiye AB. Comprehensive surgical staging for endometrial cancer. Rev Obstet Gynecol. 2012;5:28–34.

    PubMed  PubMed Central  Google Scholar 

  5. Eifel PJ. The value of pelvic radiation therapy after hysterectomy for early endometrial cancer. Oncology. 2013;27:990–9.

    PubMed  Google Scholar 

  6. Klopp A, Smith BD, Alektiar K, Cabrera A, Damato AL, Erickson B, et al. The role of postoperative radiation therapy for endometrial cancer: executive summary of an American Society for Radiation Oncology evidence-based guideline. Pract Radiat Oncol. 2014;4:137–44.

    Article  PubMed  Google Scholar 

  7. Meyer LA, Bohlke K, Powell MA, Fader AN, Franklin GE, Lee LJ, et al. Postoperative radiation therapy for endometrial cancer: American Society of Clinical Oncology clinical practice guideline endorsement of the American Society for Radiation Oncology evidence-based guideline. J Clin Oncol. 2015;33:2908–13.

    Article  CAS  PubMed  Google Scholar 

  8. Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB. Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer. 1987;60:2035–41.

    Article  CAS  PubMed  Google Scholar 

  9. Creasman WT, DeGeest K, DiSaia PJ, Zaino RJ. Significance of true surgical pathologic staging: A Gynecologic Oncology Group Study. Am J Obstet Gynecol. 1999;181:31–4.

    Article  CAS  PubMed  Google Scholar 

  10. Narayan K, Fisher RJ, Bernshaw D. Patterns of failure and prognostic factor analyses in locally advanced cervical cancer patients staged by magnetic resonance imaging and treated with curative intent. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2008;18:525–33.

    Article  CAS  Google Scholar 

  11. Narayan K, Rejeki V, Herschtal A, Bernshaw D, Quinn M, Jobling T, et al. Prognostic significance of several histological features in intermediate and high-risk endometrial cancer patients treated with curative intent using surgery and adjuvant radiotherapy. J Med Imaging Radiat Oncol. 2009;53:107–13.

    Article  CAS  PubMed  Google Scholar 

  12. Narayan K, Khaw P, Bernshaw D, Mileshkin L, Kondalsamy-Chennakesavan S. Prognostic significance of lymphovascular space invasion and nodal involvement in intermediate- and high-risk endometrial cancer patients treated with curative intent using surgery and adjuvant radiotherapy. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2012;22:260–6.

    Article  Google Scholar 

  13. Rajasooriyar C, Bernshaw D, Kondalsamy-Chennakesavan S, Mileshkin L, Narayan K. The survival outcome and patterns of failure in node positive endometrial cancer patients treated with surgery and adjuvant radiotherapy with curative intent. J Gynecol Oncol. 2014;25:313–9.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Narayan K, Fisher RJ, Bernshaw D, Shakher R, Hicks RJ. Patterns of failure and prognostic factor analyses in locally advanced cervical cancer patients staged by positron emission tomography and treated with curative intent. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2009;19:912–8.

    Article  Google Scholar 

  15. Haymans O, Fallais C, Hustinx R. Intratissular lymphaticovenous anastomoses demonstrated by perioperative intramuscular injection of 99mTc-Colloids. Lymphat Res Biol. 2006;4:5.

    Google Scholar 

  16. Gadducci A, Greco C. The evolving role of adjuvant therapy in endometrial cancer. Crit Rev Oncol Hematol. 2011;78:79–91.

    Article  PubMed  Google Scholar 

  17. Sedlis A, Bundy BN, Rotman MZ, Lentz SS, Muderspach LI, Zaino RJ. A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: a Gynecologic Oncology Group Study. Gynecol Oncol. 1999;73:177–83.

    Article  CAS  PubMed  Google Scholar 

  18. Kong A, Johnson N, Kitchener HC, Lawrie TA. Adjuvant radiotherapy for stage I endometrial cancer: an updated Cochrane systematic review and meta-analysis. J Natl Cancer Inst. 2012;104:1625–34.

    Article  PubMed  Google Scholar 

  19. Gupta V, McGunigal M, Prasad-Hayes M, Kalir T, Liu J. Adjuvant radiation therapy is associated with improved overall survival in high-intermediate risk stage I endometrial cancer: a national cancer data base analysis. Gynecol Oncol. 2017;144:119–24.

    Article  PubMed  Google Scholar 

  20. Abu-Rustum NR. Update on sentinel node mapping in uterine cancer: 10-year experience at Memorial Sloan-Kettering Cancer Center. J Obstet Gynaecol Res. 2014;40:327–34.

    Article  PubMed  Google Scholar 

  21. Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet. 2009;373:125–36.

    Article  CAS  PubMed  Google Scholar 

  22. Townamchai K, Lee L, Viswanathan AN. A novel low dose fractionation regimen for adjuvant vaginal brachytherapy in early stage endometrioid endometrial cancer. Gynecol Oncol. 2012;127:351–5.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Sorbe B, Straumits A, Karlsson L. Intravaginal high-dose-rate brachytherapy for stage I endometrial cancer: a randomized study of two dose-per-fraction levels. Int J Radiat Oncol Biol Phys. 2005;62:1385–9.

    Article  PubMed  Google Scholar 

  24. Leak LV. Studies on the permeability of lymphatic capillaries. J Cell Biol. 1971;50:300–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Padera TP, Kadambi A, di Tomaso E, Carreira CM, Brown EB, Boucher Y, et al. Lymphatic metastasis in the absence of functional intratumor lymphatics. Science. 2002;296:1883–6.

    Article  CAS  PubMed  Google Scholar 

  26. Alektiar KM, McKee A, Lin O, Venkatraman E, Zelefsky MJ, Mychalczak BR, et al. The significance of the amount of myometrial invasion in patients with Stage IB endometrial carcinoma. Cancer. 2002;95:316–21.

    Article  PubMed  Google Scholar 

  27. Gumbiner BM. Cell adhesion: the molecular basis of tissue architecture and morphogenesis. Cell. 1996;84:345–57.

    Article  CAS  PubMed  Google Scholar 

  28. Meng W, Takeichi M. Adherens junction: molecular architecture and regulation. Cold Spring Harb Perspect Biol. 2009;1:a002899.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Crosby LM, Waters CM. Epithelial repair mechanisms in the lung. Am J Physiol Lung Cell Mol Physiol. 2010;298:L715–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Morison NB, Kaitu’u-Lino TJ, Fraser IS, Salamonsen LA. Stimulation of epithelial repair is a likely mechanism for the action of mifepristone in reducing duration of bleeding in users of progestogen-only contraceptives. Reproduction. 2008;136:267–74.

    Article  CAS  PubMed  Google Scholar 

  31. Baer PC, Bereiter-Hahn J. Epithelial cells in culture: injured or differentiated cells? Cell Biol Int. 2012;36:771–7.

    Article  PubMed  Google Scholar 

  32. Chui MH. Insights into cancer metastasis from a clinicopathologic perspective: epithelial–Mesenchymal transition is not a necessary step. Int J Cancer. 2013;132:1487–95.

    Article  CAS  PubMed  Google Scholar 

  33. Song YJ, Shin SH, Cho JS, Park MH, Yoon JH, Jegal YJ. The role of lymphovascular invasion as a prognostic factor in patients with lymph node-positive operable invasive breast cancer. J Breast Cancer. 2011;14:198–203.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Desrosiers L, Fadare O, Xiao ZF, Dresser K, Wang SA. Lymphovascular space invasion does not predict vaginal relapses in stage I endometrioid adenocarcinoma of the endometrium. Ann Diagn Pathol. 2008;12:112–7.

    Article  PubMed  Google Scholar 

  35. Koelzer VH, Lugli A. The tumor border configuration of colorectal cancer as a histomorphological prognostic indicator. Front Oncol. 2014;4:29.

    PubMed  PubMed Central  Google Scholar 

  36. Khunamornpong S, Settakorn J, Sukpan K, Suprasert P, Lekawanvijit S, Siriaunkgul S. Prognostic value of pathological characteristics of invasive margins in early-stage squamous cell carcinomas of the uterine cervix. Asian Pac J Cancer Prev. 2013;14:5165–9.

    Article  PubMed  Google Scholar 

  37. Heaps JM, Fu YS, Montz FJ, Hacker NF, Berek JS. Surgical-pathologic variables predictive of local recurrence in squamous cell carcinoma of the vulva. Gynecol Oncol. 1990;38:309–14.

    Article  CAS  PubMed  Google Scholar 

  38. Horn LC, Fischer U, Raptis G, Bilek K, Hentschel B, Richter CE, et al. Pattern of invasion is of prognostic value in surgically treated cervical cancer patients. Gynecol Oncol. 2006;103:906–11.

    Article  PubMed  Google Scholar 

  39. Alexander-Sefre F, Singh N, Ayhan A, Thomas JM, Jacobs IJ. Clinical value of immunohistochemically detected lymphovascular invasion in endometrioid endometrial cancer. Gynecol Oncol. 2004;92:653–9.

    Article  CAS  PubMed  Google Scholar 

  40. Alexander-Sefre F, Nibbs R, Rafferty T, Ayhan A, Singh N, Jacobs I. Clinical value of immunohistochemically detected lymphatic and vascular invasions in clinically staged endometrioid endometrial cancer. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2009;19:1074–9.

    Article  Google Scholar 

  41. Kukko HM, Koljonen VS, Tukiainen EJ, Haglund CH, Bohling TO. Vascular invasion is an early event in pathogenesis of Merkel cell carcinoma. Mod Pathol. 2010;23:1151–6.

    Article  PubMed  Google Scholar 

  42. Martin OA, Anderson RL, Narayan K, MacManus MP. Does the mobilization of circulating tumour cells during cancer therapy cause metastasis? Nat Rev Clin Oncol. 2017;14:32–44.

    Article  CAS  PubMed  Google Scholar 

  43. Kim HS, Suh DH, Kim MK, Chung HH, Park NH, Song YS. Systematic lymphadenectomy for survival in patients with endometrial cancer: a meta-analysis. Jpn J Clin Oncol. 2012;42:405–12.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia

    Kailash Narayan, Ming Yin Lin, David Bernshaw & Pearly Khaw

  2. Department of Gynaecology and Obstetrics, University of Melbourne, Melbourne, Australia

    Kailash Narayan

  3. Rural Clinical School, The University of Queensland, Brisbane, Australia

    Srinivas Kondalsamy-Chennakesvan

  4. Locked Bag 1, A’Beckett Street, Melbourne, VIC, 8006, Australia

    Kailash Narayan

Authors
  1. Kailash Narayan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ming Yin Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David Bernshaw
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pearly Khaw
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Srinivas Kondalsamy-Chennakesvan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kailash Narayan.

Ethics declarations

Conflict of interest

None of the authors have any conflict of personal or financial interest.

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 30 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Narayan, K., Lin, M.Y., Bernshaw, D. et al. Tailoring Adjuvant Radiotherapy in Endometrial Cancer. Indian J Gynecol Oncolog 15, 45 (2017). https://doi.org/10.1007/s40944-017-0136-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s40944-017-0136-y

Keywords

Search

Navigation