Relapse Frequency and Pattern Following Adjuvant Radiotherapy for Intermediate and High-Intermediate Risk Endometrial Cancer Based on Retrospective ESGO-ESTRO-ESP Risk Classification
Background: The management of early-stage endometrial cancer (EC) consists of surgery followed by tailored adjuvant therapy, largely based on the risk of loco-regional recurrence. We evaluated the frequency and site of first relapse in patients who received vaginal brachytherapy (...
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IMR Press
2025-02-01
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| Series: | Clinical and Experimental Obstetrics & Gynecology |
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| Online Access: | https://www.imrpress.com/journal/CEOG/52/2/10.31083/CEOG25514 |
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| author | Kathryn Graham Laura Hannington Claire Duncanson Andrew Wilkinson Douglas Cartwright Rosie Harrand Ashleigh Kerr Nick Reed Azmat Sadozye |
| author_facet | Kathryn Graham Laura Hannington Claire Duncanson Andrew Wilkinson Douglas Cartwright Rosie Harrand Ashleigh Kerr Nick Reed Azmat Sadozye |
| author_sort | Kathryn Graham |
| collection | DOAJ |
| description | Background: The management of early-stage endometrial cancer (EC) consists of surgery followed by tailored adjuvant therapy, largely based on the risk of loco-regional recurrence. We evaluated the frequency and site of first relapse in patients who received vaginal brachytherapy (VBT) or pelvic external beam radiotherapy (EBRT) for early-stage EC. These data were stratified retrospectively according to the European Society of Gynaecological Oncology–European Society of Radiotherapy and Oncology–European Society of Pathology (ESGO-ESTRO-ESP, 2020) intermediate risk endometrial cancer (IR-EC) and high-intermediate risk endometrial cancer (HIR-EC) classifications. Methods: The central radiotherapy prescribing system within the West of Scotland Cancer Network was analyzed to identify International Federation of Gynaecology & Obstetrics (FIGO) Stage I–II EC patients who commenced VBT, at a dose of 2100 cGy for 3 fractions, and/or EBRT, at 4500 cGy for 25 fractions, between 1st January 2017 and 31st December 2019. Clinical follow-up was conducted until death or for a maximum of five years (data lock 31st December 2022). Imaging was performed if recurrence was suspected. Statistical analysis was implemented using R statistical software (v4.4.1). Results: In total, 282 patients were identified. The median age was 69 years (range: 37–92 years), and the median follow-up was 33 months (range: 0–68 months). Stage distribution: ⅠA (25.2%), ⅠB (57.4%), and Ⅱ (17.4%). The pathology subtype was predominantly endometrioid (93.6%), but 6.4% of patients had non-endometrioid histology with no myometrial invasion. IR-EC patients comprised 51.1% of the series; all received VBT and no adjuvant chemotherapy. The HIR-EC cohort comprised 48.9% of the series; just over half received EBRT, and adjuvant chemotherapy was delivered to 15.9%. By the end of the study, 37 (13.1%) patients had relapsed, and 41 (14.5%) had died, 22/41 (53.7%) of which were attributable to EC. Recurrences were documented in 11.1% of the IR-EC patients and 15.2% of the HIR-EC patients. Vaginal, pelvic, and distant relapses per risk group and treatment were: 2.1%, 7.6%, and 6.9% in IR-EC (VBT-treated), respectively; 3.1%, 16.9%, and 6.2% in the HIR-EC (VBT-treated), respectively; 0%, 6.9%, and 9.6% in the HIR-EC (EBRT-treated), respectively. None reached statistical significance (p = 0.34, Fisher’s exact test). Salvage therapy for locoregional recurrence was performed in 3.5% (10/282) of patients, and virtually all pelvic relapses were symptomatic. Conclusions: Vaginal relapse rates were very low (1.8%). However, pelvic recurrences occurred in 16.9% of the HIR-EC (VBT-treated) patients, suggesting that external beam radiotherapy should be considered to optimize loco-regional control in this group. |
| format | Article |
| id | doaj-art-0de73cbec52a46ec86cb815a27acbc29 |
| institution | OA Journals |
| issn | 0390-6663 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | IMR Press |
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| series | Clinical and Experimental Obstetrics & Gynecology |
| spelling | doaj-art-0de73cbec52a46ec86cb815a27acbc292025-08-20T02:11:05ZengIMR PressClinical and Experimental Obstetrics & Gynecology0390-66632025-02-015222551410.31083/CEOG25514S0390-6663(24)02517-XRelapse Frequency and Pattern Following Adjuvant Radiotherapy for Intermediate and High-Intermediate Risk Endometrial Cancer Based on Retrospective ESGO-ESTRO-ESP Risk ClassificationKathryn Graham0Laura Hannington1Claire Duncanson2Andrew Wilkinson3Douglas Cartwright4Rosie Harrand5Ashleigh Kerr6Nick Reed7Azmat Sadozye8Clinical Oncology, Beatson West of Scotland Cancer Centre, G12 0YN Glasgow, UKClinical Oncology, Beatson West of Scotland Cancer Centre, G12 0YN Glasgow, UKClinical Oncology, Beatson West of Scotland Cancer Centre, G12 0YN Glasgow, UKClinical Oncology, Beatson West of Scotland Cancer Centre, G12 0YN Glasgow, UKDepartment of Medical Oncology, Beatson West of Scotland Cancer Centre, G12 0YN Glasgow, UKClinical Oncology, Beatson West of Scotland Cancer Centre, G12 0YN Glasgow, UKClinical Oncology, Beatson West of Scotland Cancer Centre, G12 0YN Glasgow, UKClinical Oncology, Beatson West of Scotland Cancer Centre, G12 0YN Glasgow, UKClinical Oncology, Beatson West of Scotland Cancer Centre, G12 0YN Glasgow, UKBackground: The management of early-stage endometrial cancer (EC) consists of surgery followed by tailored adjuvant therapy, largely based on the risk of loco-regional recurrence. We evaluated the frequency and site of first relapse in patients who received vaginal brachytherapy (VBT) or pelvic external beam radiotherapy (EBRT) for early-stage EC. These data were stratified retrospectively according to the European Society of Gynaecological Oncology–European Society of Radiotherapy and Oncology–European Society of Pathology (ESGO-ESTRO-ESP, 2020) intermediate risk endometrial cancer (IR-EC) and high-intermediate risk endometrial cancer (HIR-EC) classifications. Methods: The central radiotherapy prescribing system within the West of Scotland Cancer Network was analyzed to identify International Federation of Gynaecology & Obstetrics (FIGO) Stage I–II EC patients who commenced VBT, at a dose of 2100 cGy for 3 fractions, and/or EBRT, at 4500 cGy for 25 fractions, between 1st January 2017 and 31st December 2019. Clinical follow-up was conducted until death or for a maximum of five years (data lock 31st December 2022). Imaging was performed if recurrence was suspected. Statistical analysis was implemented using R statistical software (v4.4.1). Results: In total, 282 patients were identified. The median age was 69 years (range: 37–92 years), and the median follow-up was 33 months (range: 0–68 months). Stage distribution: ⅠA (25.2%), ⅠB (57.4%), and Ⅱ (17.4%). The pathology subtype was predominantly endometrioid (93.6%), but 6.4% of patients had non-endometrioid histology with no myometrial invasion. IR-EC patients comprised 51.1% of the series; all received VBT and no adjuvant chemotherapy. The HIR-EC cohort comprised 48.9% of the series; just over half received EBRT, and adjuvant chemotherapy was delivered to 15.9%. By the end of the study, 37 (13.1%) patients had relapsed, and 41 (14.5%) had died, 22/41 (53.7%) of which were attributable to EC. Recurrences were documented in 11.1% of the IR-EC patients and 15.2% of the HIR-EC patients. Vaginal, pelvic, and distant relapses per risk group and treatment were: 2.1%, 7.6%, and 6.9% in IR-EC (VBT-treated), respectively; 3.1%, 16.9%, and 6.2% in the HIR-EC (VBT-treated), respectively; 0%, 6.9%, and 9.6% in the HIR-EC (EBRT-treated), respectively. None reached statistical significance (p = 0.34, Fisher’s exact test). Salvage therapy for locoregional recurrence was performed in 3.5% (10/282) of patients, and virtually all pelvic relapses were symptomatic. Conclusions: Vaginal relapse rates were very low (1.8%). However, pelvic recurrences occurred in 16.9% of the HIR-EC (VBT-treated) patients, suggesting that external beam radiotherapy should be considered to optimize loco-regional control in this group.https://www.imrpress.com/journal/CEOG/52/2/10.31083/CEOG25514endometrial cancervaginal brachytherapyexternal beam radiotherapyrelapsesalvagefollow up |
| spellingShingle | Kathryn Graham Laura Hannington Claire Duncanson Andrew Wilkinson Douglas Cartwright Rosie Harrand Ashleigh Kerr Nick Reed Azmat Sadozye Relapse Frequency and Pattern Following Adjuvant Radiotherapy for Intermediate and High-Intermediate Risk Endometrial Cancer Based on Retrospective ESGO-ESTRO-ESP Risk Classification Clinical and Experimental Obstetrics & Gynecology endometrial cancer vaginal brachytherapy external beam radiotherapy relapse salvage follow up |
| title | Relapse Frequency and Pattern Following Adjuvant Radiotherapy for Intermediate and High-Intermediate Risk Endometrial Cancer Based on Retrospective ESGO-ESTRO-ESP Risk Classification |
| title_full | Relapse Frequency and Pattern Following Adjuvant Radiotherapy for Intermediate and High-Intermediate Risk Endometrial Cancer Based on Retrospective ESGO-ESTRO-ESP Risk Classification |
| title_fullStr | Relapse Frequency and Pattern Following Adjuvant Radiotherapy for Intermediate and High-Intermediate Risk Endometrial Cancer Based on Retrospective ESGO-ESTRO-ESP Risk Classification |
| title_full_unstemmed | Relapse Frequency and Pattern Following Adjuvant Radiotherapy for Intermediate and High-Intermediate Risk Endometrial Cancer Based on Retrospective ESGO-ESTRO-ESP Risk Classification |
| title_short | Relapse Frequency and Pattern Following Adjuvant Radiotherapy for Intermediate and High-Intermediate Risk Endometrial Cancer Based on Retrospective ESGO-ESTRO-ESP Risk Classification |
| title_sort | relapse frequency and pattern following adjuvant radiotherapy for intermediate and high intermediate risk endometrial cancer based on retrospective esgo estro esp risk classification |
| topic | endometrial cancer vaginal brachytherapy external beam radiotherapy relapse salvage follow up |
| url | https://www.imrpress.com/journal/CEOG/52/2/10.31083/CEOG25514 |
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