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Patterns of First Recurrence after Adjuvant Radiotherapy in Papillary Serous and Clear Cell Carcinoma of the Uterus
I. J. Radiation Oncology d Biology d Physics
S420
Volume 78, Number 3, Supplement, 2010
Results: Overall 12,433 patients with were identified; 10,997 with SCC and 1,436 with AC. Median follow-up was 44 months. The mean survival time among all patients was 83.5 months for AC versus 87.6 months for SCC, (p = 0.002). 3,380 patients were identified who received RT; 235 with AC and 3,145 with SCC. The mean survival time among these patients was 49.7 months versus 62.4 months for AC and SCC, respectively (p \0.001). 3,507 patients were identified who received primary surgery; 535 with AC and 2,972 with SCC. The mean survival time among these patients was 93 months for AC versus 90.8 months for SCC (p = 0.265). Conclusions: In this large population-based series, patients with invasive non-metastatic AC of the cervix had significantly worse survival compared to those with squamous cell histology. On subset analysis of patients with FIGO IB1-IVA treated with RT, AC histology was associated with a 12.7-month decrease in mean survival time. This finding may reflect an inherent difference in radiosensitivity between these histologies. Although current treatment recommendations for cervical AC mirror those of SCC, treatment aimed at either increasing radiosensitivity of the tumor or use of adjuvant chemotherapy may improve outcomes in these patients and should be investigated. Author Disclosure: S. Sura, None; M. Olsheski, None; J. Rineer, None; A. Surapaneni, None; A. Wortham, None; R. Sroufe, None; P. Han, None; K. Choi, None; M. Rotman, None; D. Schreiber, None.
2485
Patterns of First Recurrence after Adjuvant Radiotherapy in Papillary Serous and Clear Cell Carcinoma of the Uterus
S. R. Thomas, T. J. Kruser, V. Gondi, D. R. McHaffie, M. R. Straub, K. Bradley University of Wisconsin, Madison, WI Purpose/Objective(s): Papillary serous (PS) and clear cell (CC) carcinomas of the uterus comprise 15% or less of all endometrial cancers, and are known to confer a higher risk of local and distant relapse in comparison to endometrioid histology. This study reports the therapeutic details, patterns of failure, and outcomes in patients with PS and CC uterine cancer who had RT as a component of their care at a single institution. Materials/Methods: Following surgery, 67 patients with PS or CC carcinoma of the uterus received external beam RT (EBRT) and/or vaginal cuff brachytherapy (VCB) between September 1998 and January 2010. Patient and pathologic characteristics, treatment regimens, patterns of failure, and rates of relapse and salvage were retrospectively reviewed. First sites of recurrence were classified as pelvic/vaginal, abdomen or distant. Those with multiple sites of first recurrence were censored separately for each site. Time to first recurrence was estimated using Kaplan-Meier analysis, with comparisons made using log-rank statistic. Results: Median follow-up was 2.1 years (range, 0.2-7.9) and median age was 63 (range, 26-94). Distribution by stage was: IA 16%, IB 10%, IC 9%, IIA 3%, IIB 9%, IIIA 19%, IIIB 3%, IIIC 27%, IVA 0%, and IVB 3%. Radiation treatment was pelvic EBRT and VCB in 58%, pelvic EBRT alone in 21%, and VCB alone in 21%. Of those who received pelvic EBRT, 17% received concurrent chemotherapy and 13% (n = 7) also received whole abdominal irradiation (WAI). Pre-operative and adjuvant chemotherapy was administered to 7% and 44% of patients, respectively. For the entire cohort (n = 67) actuarial five-year relapse-free survival was 49.6% and overall survival was 59.2%. Among patients who received pelvic EBRT (n = 48), actuarial patterns of first relapse were analyzed. For stage I/II and III/IV patients, 2-year rates of relapse were 5.0% and 9.6% (p = 0.540) in the pelvis, 5.3% and 39.3% (p = 0.019) in the abdomen, and 5.9% and 27.5% (0.042) distantly, respectively. Of those who recurred, we documented salvage treatment in 43% and successful salvage in 7%. Conclusions: PS and CC carcinomas of the uterus are aggressive histologies associated with poor relapse-free survival rates. Among patients who received pelvic EBRT, observed pelvic relapse rates were low for both stage I/II and III/IV patients. As reported elsewhere, rates of abdominal and distant relapse were high for patients with stage III/IV disease. High pelvic control and low salvage rates in these patients receiving pelvic EBRT, however, suggest that the addition of pelvic EBRT to systemic chemotherapy deserves consideration. Author Disclosure: S.R. Thomas, None; T.J. Kruser, None; V. Gondi, None; D.R. McHaffie, None; M.R. Straub, None; K. Bradley, None.
2486
Risk Factors of Severe Late Complications in Patients with Uterine Cancer Treated with Postoperative Radiotherapy
G. Kasuya1, K. Ogawa1, Y. Nagai2, M. Shiraishi3, M. Hirakawa2, T. Toita1, Y. Kakinohana1, T. Nishimaki3, Y. Aoki2, S. Murayama1 1 Department of Radiology, Okinawa, Japan, 2Department of Gynecology, Okinawa, Japan, 3Department of Surgery, Okinawa, Japan
Purpose/Objective(s): To identify the incidences and the risk factors of severe radiation enterocolitis and/or severe leg edema in patients with uterine cervical cancer or uterine corpus cancer treated with postoperative radiotherapy. Materials/Methods: The records of 277 patients treated with radical hysterectomy and postoperative pelvic radiotherapy (uterine cervix: 101 patients; uterine corpus: 176 patients) were retrospectively reviewed. Most of the patients were treated with pelvic radiotherapy 5 days per week using daily fractions of 1.8 to 2 Gy. External beam radiotherapy was delivered using a 15 or 18 MV linear accelerator, and the median external beam radiation dose to the pelvis was 50 Gy (range, 10.8-68 Gy). The majority of the patients (85.1%) were treated with a total dose of 50 or 50.4 Gy. Thirty-one patients (11.2%) were treated with the para-aortic nodes in addition to pelvic field. Intracavitary brachytherapy (IB) was added in 17 patients (6.1%) and chemotherapy was supplemented in 38 patients (13.7%). The median duration of follow-up of all 277 patients was 79 months (range, 1 to 240 months). For statistical analyses, the chi-square test and logistic regression analysis were used to investigate the relationship between variables and the occurrence of severe radiation enterocolitis (requiring surgery) and severe leg edema (with secondary dysfunctions). A probability level of 0.05 was chosen for statistical significance. Statistical analysis was performed using the SPSS software package. Results: Thirty patients (10.8%) developed severe radiation enterocolitis and/or severe leg edema. Nineteen patients (6.1%) developed severe radiation enterocolitis with a median latency of 11.6 months, and ileum was the most frequently affected lesion.
S420
Volume 78, Number 3, Supplement, 2010
Results: Overall 12,433 patients with were identified; 10,997 with SCC and 1,436 with AC. Median follow-up was 44 months. The mean survival time among all patients was 83.5 months for AC versus 87.6 months for SCC, (p = 0.002). 3,380 patients were identified who received RT; 235 with AC and 3,145 with SCC. The mean survival time among these patients was 49.7 months versus 62.4 months for AC and SCC, respectively (p \0.001). 3,507 patients were identified who received primary surgery; 535 with AC and 2,972 with SCC. The mean survival time among these patients was 93 months for AC versus 90.8 months for SCC (p = 0.265). Conclusions: In this large population-based series, patients with invasive non-metastatic AC of the cervix had significantly worse survival compared to those with squamous cell histology. On subset analysis of patients with FIGO IB1-IVA treated with RT, AC histology was associated with a 12.7-month decrease in mean survival time. This finding may reflect an inherent difference in radiosensitivity between these histologies. Although current treatment recommendations for cervical AC mirror those of SCC, treatment aimed at either increasing radiosensitivity of the tumor or use of adjuvant chemotherapy may improve outcomes in these patients and should be investigated. Author Disclosure: S. Sura, None; M. Olsheski, None; J. Rineer, None; A. Surapaneni, None; A. Wortham, None; R. Sroufe, None; P. Han, None; K. Choi, None; M. Rotman, None; D. Schreiber, None.
2485
Patterns of First Recurrence after Adjuvant Radiotherapy in Papillary Serous and Clear Cell Carcinoma of the Uterus
S. R. Thomas, T. J. Kruser, V. Gondi, D. R. McHaffie, M. R. Straub, K. Bradley University of Wisconsin, Madison, WI Purpose/Objective(s): Papillary serous (PS) and clear cell (CC) carcinomas of the uterus comprise 15% or less of all endometrial cancers, and are known to confer a higher risk of local and distant relapse in comparison to endometrioid histology. This study reports the therapeutic details, patterns of failure, and outcomes in patients with PS and CC uterine cancer who had RT as a component of their care at a single institution. Materials/Methods: Following surgery, 67 patients with PS or CC carcinoma of the uterus received external beam RT (EBRT) and/or vaginal cuff brachytherapy (VCB) between September 1998 and January 2010. Patient and pathologic characteristics, treatment regimens, patterns of failure, and rates of relapse and salvage were retrospectively reviewed. First sites of recurrence were classified as pelvic/vaginal, abdomen or distant. Those with multiple sites of first recurrence were censored separately for each site. Time to first recurrence was estimated using Kaplan-Meier analysis, with comparisons made using log-rank statistic. Results: Median follow-up was 2.1 years (range, 0.2-7.9) and median age was 63 (range, 26-94). Distribution by stage was: IA 16%, IB 10%, IC 9%, IIA 3%, IIB 9%, IIIA 19%, IIIB 3%, IIIC 27%, IVA 0%, and IVB 3%. Radiation treatment was pelvic EBRT and VCB in 58%, pelvic EBRT alone in 21%, and VCB alone in 21%. Of those who received pelvic EBRT, 17% received concurrent chemotherapy and 13% (n = 7) also received whole abdominal irradiation (WAI). Pre-operative and adjuvant chemotherapy was administered to 7% and 44% of patients, respectively. For the entire cohort (n = 67) actuarial five-year relapse-free survival was 49.6% and overall survival was 59.2%. Among patients who received pelvic EBRT (n = 48), actuarial patterns of first relapse were analyzed. For stage I/II and III/IV patients, 2-year rates of relapse were 5.0% and 9.6% (p = 0.540) in the pelvis, 5.3% and 39.3% (p = 0.019) in the abdomen, and 5.9% and 27.5% (0.042) distantly, respectively. Of those who recurred, we documented salvage treatment in 43% and successful salvage in 7%. Conclusions: PS and CC carcinomas of the uterus are aggressive histologies associated with poor relapse-free survival rates. Among patients who received pelvic EBRT, observed pelvic relapse rates were low for both stage I/II and III/IV patients. As reported elsewhere, rates of abdominal and distant relapse were high for patients with stage III/IV disease. High pelvic control and low salvage rates in these patients receiving pelvic EBRT, however, suggest that the addition of pelvic EBRT to systemic chemotherapy deserves consideration. Author Disclosure: S.R. Thomas, None; T.J. Kruser, None; V. Gondi, None; D.R. McHaffie, None; M.R. Straub, None; K. Bradley, None.
2486
Risk Factors of Severe Late Complications in Patients with Uterine Cancer Treated with Postoperative Radiotherapy
G. Kasuya1, K. Ogawa1, Y. Nagai2, M. Shiraishi3, M. Hirakawa2, T. Toita1, Y. Kakinohana1, T. Nishimaki3, Y. Aoki2, S. Murayama1 1 Department of Radiology, Okinawa, Japan, 2Department of Gynecology, Okinawa, Japan, 3Department of Surgery, Okinawa, Japan
Purpose/Objective(s): To identify the incidences and the risk factors of severe radiation enterocolitis and/or severe leg edema in patients with uterine cervical cancer or uterine corpus cancer treated with postoperative radiotherapy. Materials/Methods: The records of 277 patients treated with radical hysterectomy and postoperative pelvic radiotherapy (uterine cervix: 101 patients; uterine corpus: 176 patients) were retrospectively reviewed. Most of the patients were treated with pelvic radiotherapy 5 days per week using daily fractions of 1.8 to 2 Gy. External beam radiotherapy was delivered using a 15 or 18 MV linear accelerator, and the median external beam radiation dose to the pelvis was 50 Gy (range, 10.8-68 Gy). The majority of the patients (85.1%) were treated with a total dose of 50 or 50.4 Gy. Thirty-one patients (11.2%) were treated with the para-aortic nodes in addition to pelvic field. Intracavitary brachytherapy (IB) was added in 17 patients (6.1%) and chemotherapy was supplemented in 38 patients (13.7%). The median duration of follow-up of all 277 patients was 79 months (range, 1 to 240 months). For statistical analyses, the chi-square test and logistic regression analysis were used to investigate the relationship between variables and the occurrence of severe radiation enterocolitis (requiring surgery) and severe leg edema (with secondary dysfunctions). A probability level of 0.05 was chosen for statistical significance. Statistical analysis was performed using the SPSS software package. Results: Thirty patients (10.8%) developed severe radiation enterocolitis and/or severe leg edema. Nineteen patients (6.1%) developed severe radiation enterocolitis with a median latency of 11.6 months, and ileum was the most frequently affected lesion.