The role of radiation therapy in the treatment of Stage II endometrial cancer: A large database study

Andrzej P. Wojcieszynski, Craig R. Hullett, Erin E. Medlin, Neil K. Taunk, Jacob E. Shabason, Jeffrey V. Brower, Shuai Chen, Justin E. Bekelman, Lisa M. Barroilhet, Kristin A. Bradley

Research output: Contribution to journalArticle

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Abstract

Purpose: The optimum adjuvant treatment for Stage II endometrial cancer patients is unknown. External beam radiation therapy (EBRT) is often considered the standard of care; however, retrospective series suggest that brachytherapy (BT) alone may be sufficient for selected patients. As randomized data are lacking, we used a large database to explore this question. Methods and Materials: The National Cancer Data Base was queried for patients with pathologic International Federation of Gynecology and Obstetrics Stage II disease. Demographic, clinic-pathologic, and treatment details were compared between patients. Multivariable analysis was used to determine factors associated with receiving radiation therapy (RT). To account for imbalances between groups, a matched-pair analysis was completed. Results: Eight thousand one hundred forty patients were included. RT was associated with overall survival (OS), with EBRT (hazard ratio [HR] 0.64), BT (HR 0.47), and combination (HR 0.54) showing increased OS on univariate analysis. Facility, urban location, diagnosis year, hysterectomy type, and chemotherapy did not reach significance. On multivariate analysis, RT was associated with OS, with EBRT (HR 0.69), BT (HR 0.60), and combination (HR 0.54) showing benefit. Using propensity-score matching, RT continued to show improved OS regardless of type: BT (82% vs. 73% 5-year OS) and EBRT (77% vs. 71%). BT as compared to EBRT had equivalent survival (81% vs. 79%, not statistically significant). Conclusion: This study of over 8,000 patients demonstrates that adjuvant RT confers a survival benefit in Stage II endometrial cancer and supports the continued use of RT in these patients. BT alone may be reasonable in carefully selected patients.

Original languageEnglish (US)
Pages (from-to)645-652
Number of pages8
JournalBrachytherapy
Volume17
Issue number4
DOIs
StatePublished - Jul 1 2018

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Endometrial Neoplasms
Radiotherapy
Databases
Brachytherapy
Survival
Therapeutics
Matched-Pair Analysis
Propensity Score
Standard of Care
Hysterectomy
Gynecology
Obstetrics
Multivariate Analysis
Demography
Drug Therapy

Keywords

  • Brachytherapy
  • Database
  • Endometrial
  • Radiation therapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Wojcieszynski, A. P., Hullett, C. R., Medlin, E. E., Taunk, N. K., Shabason, J. E., Brower, J. V., ... Bradley, K. A. (2018). The role of radiation therapy in the treatment of Stage II endometrial cancer: A large database study. Brachytherapy, 17(4), 645-652. https://doi.org/10.1016/j.brachy.2018.02.001

The role of radiation therapy in the treatment of Stage II endometrial cancer : A large database study. / Wojcieszynski, Andrzej P.; Hullett, Craig R.; Medlin, Erin E.; Taunk, Neil K.; Shabason, Jacob E.; Brower, Jeffrey V.; Chen, Shuai; Bekelman, Justin E.; Barroilhet, Lisa M.; Bradley, Kristin A.

In: Brachytherapy, Vol. 17, No. 4, 01.07.2018, p. 645-652.

Research output: Contribution to journalArticle

Wojcieszynski, AP, Hullett, CR, Medlin, EE, Taunk, NK, Shabason, JE, Brower, JV, Chen, S, Bekelman, JE, Barroilhet, LM & Bradley, KA 2018, 'The role of radiation therapy in the treatment of Stage II endometrial cancer: A large database study', Brachytherapy, vol. 17, no. 4, pp. 645-652. https://doi.org/10.1016/j.brachy.2018.02.001
Wojcieszynski AP, Hullett CR, Medlin EE, Taunk NK, Shabason JE, Brower JV et al. The role of radiation therapy in the treatment of Stage II endometrial cancer: A large database study. Brachytherapy. 2018 Jul 1;17(4):645-652. https://doi.org/10.1016/j.brachy.2018.02.001
Wojcieszynski, Andrzej P. ; Hullett, Craig R. ; Medlin, Erin E. ; Taunk, Neil K. ; Shabason, Jacob E. ; Brower, Jeffrey V. ; Chen, Shuai ; Bekelman, Justin E. ; Barroilhet, Lisa M. ; Bradley, Kristin A. / The role of radiation therapy in the treatment of Stage II endometrial cancer : A large database study. In: Brachytherapy. 2018 ; Vol. 17, No. 4. pp. 645-652.
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abstract = "Purpose: The optimum adjuvant treatment for Stage II endometrial cancer patients is unknown. External beam radiation therapy (EBRT) is often considered the standard of care; however, retrospective series suggest that brachytherapy (BT) alone may be sufficient for selected patients. As randomized data are lacking, we used a large database to explore this question. Methods and Materials: The National Cancer Data Base was queried for patients with pathologic International Federation of Gynecology and Obstetrics Stage II disease. Demographic, clinic-pathologic, and treatment details were compared between patients. Multivariable analysis was used to determine factors associated with receiving radiation therapy (RT). To account for imbalances between groups, a matched-pair analysis was completed. Results: Eight thousand one hundred forty patients were included. RT was associated with overall survival (OS), with EBRT (hazard ratio [HR] 0.64), BT (HR 0.47), and combination (HR 0.54) showing increased OS on univariate analysis. Facility, urban location, diagnosis year, hysterectomy type, and chemotherapy did not reach significance. On multivariate analysis, RT was associated with OS, with EBRT (HR 0.69), BT (HR 0.60), and combination (HR 0.54) showing benefit. Using propensity-score matching, RT continued to show improved OS regardless of type: BT (82{\%} vs. 73{\%} 5-year OS) and EBRT (77{\%} vs. 71{\%}). BT as compared to EBRT had equivalent survival (81{\%} vs. 79{\%}, not statistically significant). Conclusion: This study of over 8,000 patients demonstrates that adjuvant RT confers a survival benefit in Stage II endometrial cancer and supports the continued use of RT in these patients. BT alone may be reasonable in carefully selected patients.",
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AU - Taunk, Neil K.

AU - Shabason, Jacob E.

AU - Brower, Jeffrey V.

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N2 - Purpose: The optimum adjuvant treatment for Stage II endometrial cancer patients is unknown. External beam radiation therapy (EBRT) is often considered the standard of care; however, retrospective series suggest that brachytherapy (BT) alone may be sufficient for selected patients. As randomized data are lacking, we used a large database to explore this question. Methods and Materials: The National Cancer Data Base was queried for patients with pathologic International Federation of Gynecology and Obstetrics Stage II disease. Demographic, clinic-pathologic, and treatment details were compared between patients. Multivariable analysis was used to determine factors associated with receiving radiation therapy (RT). To account for imbalances between groups, a matched-pair analysis was completed. Results: Eight thousand one hundred forty patients were included. RT was associated with overall survival (OS), with EBRT (hazard ratio [HR] 0.64), BT (HR 0.47), and combination (HR 0.54) showing increased OS on univariate analysis. Facility, urban location, diagnosis year, hysterectomy type, and chemotherapy did not reach significance. On multivariate analysis, RT was associated with OS, with EBRT (HR 0.69), BT (HR 0.60), and combination (HR 0.54) showing benefit. Using propensity-score matching, RT continued to show improved OS regardless of type: BT (82% vs. 73% 5-year OS) and EBRT (77% vs. 71%). BT as compared to EBRT had equivalent survival (81% vs. 79%, not statistically significant). Conclusion: This study of over 8,000 patients demonstrates that adjuvant RT confers a survival benefit in Stage II endometrial cancer and supports the continued use of RT in these patients. BT alone may be reasonable in carefully selected patients.

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