Does prophylactic para-aortic lymphatic irradiation improve outcomes in women with stage IIIC1 endometrial carcinoma? A multi-institutional pooled analysis

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Pract Radiat Oncol


PURPOSE: To evaluate the impact of prophylactic PALN RT on clinical outcomes in patients with FIGO 2018 stage IIIC1 EC.

MATERIALS/METHODS: A multi-institutional retrospective study included patients with FIGO 2018 stage IIIC1 EC status post surgical staging, lymph node assessment followed by adjuvant chemotherapy and radiotherapy using various sequencing regimens. Overall survival (OS) and recurrence-free survival (RFS) rates were estimated by Kaplan-Meier method. Univariable and multivariable analysis were performed by Cox proportional hazard models for RFS/OS. In addition, propensity score matching were used to estimate the effect of the radiation field extent on survival outcomes.

RESULTS: A total of 378 patients were included with a median follow-up of 45.8 months. Pelvic RT was delivered to 286 patients while 92 patients received pelvic and PALN RT. The estimated OS and RFS rates at 5 years for the entire cohort were 80% and 69%, respectively. There was no difference in the 5-year OS (77% vs. 87%, p=0.47) and RFS rates (67% vs. 70%, p=0.78) between patients treated with pelvic RT and those with pelvic and prophylactic PALN RT, respectively. After propensity score matching, the estimated Hazard Ratios (HR) of prophylactic PALN RT vs. pelvic RT were 1.50 (95% CI = (0.71, 3.19), p-value = 0.28) for OS and 1.24 (95% CI = (0.64, 2.42), p-value = 0.51) for RFS suggesting that prophylactic PALN RT does not improve survival outcomes. Distant recurrence was the most common site of first recurrence, and the extent of RT field was not associated with the site of first recurrence (P=0.79).

CONCLUSIONS: Prophylactic PALN RT was not significantly associated with improved survival outcomes in stage IIIC1 EC. Distant metastases remain the most site of failure despite routine use of systemic chemotherapy, new therapeutic approaches are necessary to optimize the outcomes for women with stage IIIC1 EC.

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ePub ahead of print