Comparative Efficacy Analysis Between Adjuvant Vaginal Cuff Brachytherapy And Pelvic External Beam Radiation Treatment For Women With FIGO Stage I Uterine Endometrioid Carcinoma With Pathologic Negative Lymph Node Evaluation: A Propensity Score Matching Analysis

Document Type

Conference Proceeding

Publication Date

2-17-2025

Publication Title

Int J Gynecol Cancer

Keywords

adult, aged, Charlson Comorbidity Index, conference abstract, controlled study, drug therapy, endometrioid carcinoma, external beam radiotherapy, female, follow up, human, lymph node, major clinical study, overall survival, pelvis lymph node, propensity score, radiotherapy, retrospective study, surgery, uterus cancer, vaginal brachytherapy

Abstract

Introduction/Background Based on the PORTEC-2 study, there was no statistically significant difference in vaginal cuff recurrence between patients who received adjuvant vaginal cuff brachytherapy (VCB) and those who received pelvic external beam radiation treatment (EBRT). However, the majority of patients included in this study did not have a surgical lymph node evaluation (SLNE). Using propensity score matching (PSM), the aim of this study is to analyze the comparative efficacy of the two adjuvant radiation therapy (RT) modalities for women with FIGO stage I uterine endometrioid carcinoma (EC) who underwent SLNE. Methodology Our institutional uterine cancer database was queried for women with 2009 FIGO stage I EC who had surgical staging with pathologically negative pelvic lymph node evaluation who received adjuvant RT between 1/1990 and 12/2022. Demographics, surgical, and pathologic factors were analyzed comparing the two patient groups (VCB vs EBRT). 5-year recurrence-free (RFS), disease-specific (DSS), and overall survival (OS) were evaluated. Variables predicting RF, DSS, and OS were assessed using univariate and multivariate analyses for each treatment modality. Results 372 patients were identified with a median age of 67 years and median follow up time of 110 months. There were 248 (66.7%) and 124 (33.3%) patients in the VCB and EBRT groups, respectively. Using PSM (2:1), there was no statistically significant difference in 5-year RFS (89% vs. 84%, p=0.09), DSS (98% vs. 94%, p=0.09), and OS (88% vs. 82%, p=0.2) between VCB and EBRT patients, respectively. Independent predictors of worse 5-year RFS and DSS were higher grade and any lymphovascular space invasion (LVSI) while age >60, higher Charlson comorbidity index (CCI), higher grade, and any LVSI were independent predictors of worse 5-year OS. Similarly, there was no statistically significant difference in the pattern of first recurrence between the two groups. Conclusion Using propensity score matching, our data suggest no survival endpoint difference between adjuvant vaginal cuff brachytherapy and pelvic external beam radiation treatment for surgically staged patients with FIGO stage I endometrioid carcinoma whose pathologic pelvic lymph node evaluation was negative. Disclosures None

Volume

35

Issue

2

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