Robert Foerster, Presenter: Nothing to Disclose

Robert Kluck, Abstract Co-Author: Nothing to Disclose

Stefan Rieken, Abstract Co-Author: Nothing to Disclose

Juergen Debus MD, PhD, Abstract Co-Author: Nothing to Disclose

Katja Lindel, Abstract Co-Author: Nothing to Disclose

Purpose/Objective(s): Endometrial cancer is the most common gynecologic malignancy. While therapy guidelines are widely established for endometrioid carcinomas, optimal treatment of subgroups with highly malignant histologies remains unclear. The purpose of this retrospective analysis was to determine the meaning of adjuvant radiotherapy (RT) for clinical outcome and to define prognostic factors.Materials/Methods: 380 patients (pts) underwent adjuvant radiotherapy (RT) for endometrial carcinomas at the University Hospital Heidelberg, Germany, from 2004 until 2012. Median age at diagnosis was 66 years. The majority were early stage carcinomas (FIGO I 68.7%, FIGO II 13.6%, FIGO III 16.3%, FIGO IV 1.4%). 96.9% underwent lymphadenectomy (LNE) and 3.6% received additional adjuvant chemotherapy (ChT). 52.6% were treated with intravaginal brachytherapy (IVB) and 47.4% with IVB + external beam radiotherapy (EBRT). All pts were included in this retrospective cohort study and statistically evaluated (chi-square, LogRank test, Cox regression).Results: Five year local recurrence free survival (LRFS), distant metastases free survival (DMFS) and overall survival (OS) were 90%, 88.2% and 77.8% respectively. 22.2% died, 8.9% had a local recurrence and 8.9% developed distant metastases.Better LRFS was associated with lower FIGO stage (p=.002), smaller tumor size (p<.001), N0 (p<.001), L0 (p<.001), V0 (p=.003), R0 (p<.001) and after LNE (p<.016).DMFS was prolonged with age <66 (p=.005), lower FIGO stage (p=.006), smaller tumor size (p<.001), N0 (p=.001), lower grading (p=.039), endometrioid histology (p=.043), L0 (p<.001), V0 (p<.001) and after LNE (p=.006).OS was improved with age <66 years (p=.014), lower FIGO stage (p<.001), smaller tumor size (p<.001), N0 (p<.001), lower grading (p<.001), endometrioid histology (p<.001), L0 (p<.001), V0 (p<.001), R0 (p<.001) and after LNE (p=.004).In stage I there were no statistically significant survival differences for Grading in LRFS, DMFS or OS.In multivariate analysis for OS age (p=.019), grading (p=.014), histology (p=.001) and blood vessel infiltration (p<.001) remained as prognostic factors. For DMFS only blood vessel infiltration (p<.001) remained and for LRFS lymph vessel infiltration showed a tendency towards statistical significance (n.s.).Conclusions: RT ensures good local control rates in carcinomas of the uterus. However, carcinomas with non-endometrioid histology or advanced stages with high grading have a substantially worse prognosis and these pts are in need of a combined local and systemic therapy approach. For endometrioid carcinomas vessel infiltration might be the best predictive factor for a benefit from systemic therapy.

Foerster, R, Kluck, R, Rieken, S, Debus, J, Lindel, K, Prognosis and Survival of Women with Endometrial Carcinoma after Adjuvant Radiotherapy.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14042598.html