Chemotherapy reduces para-aortic node recurrences in endometrial cancer with positive pelvic and unknown para-aortic nodes

Int J Gynecol Cancer. 2015 Feb;25(2):263-8. doi: 10.1097/IGC.0000000000000337.

Abstract

Objective: The objective of this study was to evaluate how the administration of different adjuvant therapies influences the risk for developing recurrences in the para-aortic area in endometrial cancer (EC) with positive pelvic and unknown para-aortic nodes.

Methods: We retrospectively evaluated the data of 58 patients with EC affected by stage IIIC1 who had undergone pelvic but not para-aortic lymphadenectomy from January 1, 1990 to December 31, 2011. Survival outcomes within the first 5 years after surgery were assessed using the Kaplan-Meier model.

Results: Chemotherapy plus radiotherapy, chemotherapy only, and external radiotherapy only were administered in 12 (23%), 18 (34%), and 23 (43%) patients, respectively. Five (9%) patients, who were selected to forego adjuvant therapy due to poor performance status, were excluded from the analysis. Disease-free and overall survivals assessed at 5 years were 54%, and 61%, respectively. All para-aortic recurrences were observed among the patients with endometrioid EC, whereas no cases of para-aortic recurrences were found in patients with nonendometrioid histology (5/36 (14%) vs 0/17 (0%); P = 0.16); the latter were more likely to develop distant (hematogenous, peritoneal, and distant lymphatic) recurrences (P = 0.09). Type of adjuvant therapy was the only factor influencing para-aortic failure: chemotherapy (± radiotherapy) reduced the rate of para-aortic node recurrence in comparison with pelvic radiotherapy as a sole modality (P = 0.01). However, adjuvant therapy did not influence the 5-year survival outcomes (P > 0.05).

Conclusions: In the absence of local treatment (ie, para-aortic lymphadenectomy and radiotherapy), the administration of chemotherapy seems effective in reducing recurrences in the para-aortic area among patients with stage IIIC1 endometrioid EC.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Aorta
  • Carcinoma, Endometrioid / drug therapy*
  • Carcinoma, Endometrioid / epidemiology
  • Carcinoma, Endometrioid / pathology
  • Carcinoma, Endometrioid / radiotherapy
  • Endometrial Neoplasms / drug therapy*
  • Endometrial Neoplasms / epidemiology
  • Endometrial Neoplasms / pathology
  • Endometrial Neoplasms / radiotherapy
  • Female
  • Humans
  • Lymph Nodes / drug effects*
  • Lymph Nodes / pathology*
  • Lymphatic Metastasis
  • Middle Aged
  • Pelvis
  • Radiotherapy, Adjuvant
  • Recurrence
  • Retrospective Studies