Survival Rate of Early Stage Endometrioid Adenocarcinoma of Endometrium Treated at Srinagarind Hospital

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DOI:http://dx.doi.org/10.7314/APJCP.2014.15.5.2217 Survival Rate of Early Stage Endometrioid Adenocarcinoma of Endometrium Treated at Srinagarind Hospital

Asian Pac J Cancer Prev, 15 (5), 2217-2220

Introduction

Adenocarcinoma of the endometrium is the third most common malignant neoplasm of the female genital tract.

In Thailand, 3,958 new cases of endometrial carcinoma were diagnosed between 2004 and 2006 (Khuhaprema HW DO  0RVW RI SDWLHQWV ZHUH FODVVLÀHG DV HDUO\

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83-85% (Algan et al., 1996; Creasman et al., 1997). The

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the loco-regional recurrence rate (Bliss et al., 1992;

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Division of Radiotherapy, Department of Radiology, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand *For correspondence:pmonti@kku.ac.th

Abstract

Purpose: To evaluate the survival outcome of early stage endometrioid adenocarcinoma of the endometrium with risk factors for locoregional recurrence treated with combined pelvic external beam radiotherapy (EBRT) and vaginal brachytherapy (VBT) after comprehensive surgery. Materials and Methods: Post-operative radiotherapy by pelvic EBRT and VBT for early stage endometrioid endometrial carcinoma resulted in excellent SHOYLFFRQWUROZLWKDFFHSWDEOHFRPSOLFDWLRQV7KLVVWXG\VKRZHGQRVLJQLÀFDQWUHODWLRQVKLSVEHWZHHQDJHVWDJH

histologic grade and LVSI and overall survival rate. Results: The 5-year overall survival rate (OS) of early stage HQGRPHWULRLGW\SHRIHQGRPHWULDOFDUFLQRPDZDV$FXWHWR[LFLW\RFFXUUHGLQRIWKHSDWLHQWVDOORI

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JUDGHDQGZHUHJUDGHConclusions: Post-operative radiotherapy by pelvic EBRT and VBT is DFFHSWDEOHIRUHDUO\VWDJHHQGRPHWULRLGHQGRPHWULDOFDUFLQRPDLQGHSHQGHQWRIDJHVWDJHKLVWRORJLFJUDGHDQG

LVSI.

Keywords: (QGRPHWULDODGHQRFDUFLQRPDVXUYLYDOUDGLRWKHUDS\EUDFK\WKHUDS\VXUYLYDO

5(6($5&+$57,&/(

Survival Rate of Early Stage Endometrioid Adenocarcinoma of Endometrium Treated at Srinagarind Hospital

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Prawat Padoongcharoen

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endometrial carcinoma with high-intermediate risk factors ZHUHHTXDOO\HIIHFWLYH1RXWHWDO

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endometrial carcinoma patients treated with external-beam UDGLRWKHUDS\DQGYDJLQDOEUDFK\WKHUDS\

Materials and Methods

Patients

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were 386 patients with endometrial carcinoma who were WUHDWHG E\ UDGLRWKHUDS\ LQ 6ULQDJDULQG KRVSLWDO 7KH

inclusion criteria were: 1) stage IA-IIB endometrioid W\SH RI HQGRPHWULDO FDUFLQRPD ZKR KDG XQGHUJRQH

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endometriod adenocarcinoma.

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incomplete or no surgical staging and were excluded from WKLVVWXG\

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Radiotherapy

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colpostat.

Radiotherapy technique

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which one was lower. The lateral borders were placed at WKHZLGHVWRSHQLQJRIERQ\SHOYLVSOXVFHQWLPHWHUV

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Statistics

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were collected from medical records. Treatment-related complications were documented according to Common 7HUPLQRORJ\ &ULWHULD IRU$GYHUVH (YHQWV &7&$( YHUVLRQ  1DWLRQDO &DQFHU ,QVWLWXWH  7KH

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the date of treatment completion to the date of death or GDWHRINQRZQOLYLQJVWDWXV.DSODQ0HLHUFXUYHVZHUH

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Results

Patients and tumor characteristics

The patient and tumor characteristics of the entire WUHDWPHQWJURXSDUHVXPPDUL]HGLQ7DEOH

Treatment

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Survival

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Table 2. Treatment Characteristics

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Table 1. Patients and Tumor Characteristics 3DWLHQWVDQGWXPRUFKDUDFWHULVWLFV 1R

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Age Median (range) 55.05 (26.79-80.88)

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80% 21 25.00

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2219

DOI:http://dx.doi.org/10.7314/APJCP.2014.15.5.2217 Survival Rate of Early Stage Endometrioid Adenocarcinoma of Endometrium Treated at Srinagarind Hospital

Table 3. Survival Data

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Unknown 72.41 52.34-85.13 0.071

Table 4. Treatment-Related Complications

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Acute complications

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Grade 3-4 3 3.57

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VRPHSDWLHQWVKDGPRUHWKDQFRPSOLFDWLRQ Figure 1. The Overall Survival Curve of the Entire Treatment Group

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Newly diagnosed without treatment Newly diagnosed with treatment Persistence or recurrence Remission None Chemotherapy Radiotherapy Concurrent chemoradiation

Figure 2. The Survival Curves by A) Age; B) Stage; C) Histologic Grade and D) Lymphovascular Space Invasion (LVSI)

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Treatment-related complications

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Discussion

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2010).

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Benjapibal, 2012).

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toxicities were found to be 8.8% with grade 1-2 and 1.8%

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9.5% of grade 1-2 with late complications and Kucera et

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patients with stage-1 endometrial carcinoma: multicentre UDQGRPLVHG WULDO 3257(& 6WXG\ *URXS 3RVW 2SHUDWLYH

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endometrial cancer: prognostic factors for local and distant PHWDVWDVLVDQGLPSOLFDWLRQRIWKHQHZ),*2VXUJLFDOVWDJLQJ

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Asian Pac J Cancer Prev, 9, 58-62.

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education, 6, 49-50.

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irradiation in pathologic stage I endometrial carcinoma:

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Gynecol Oncol, 38, 99-104.

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between surgical-pathological risk factors and outcome in clinical stage I and II carcinoma of the endometrium: a J\QHFRORJLFRQFRORJ\JURXSVWXG\Gynecol Oncol, 40, 55-6.

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follow-up. Int J Radiat Oncol Biol Phys, 309, 831-7.

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patients with endometrial cancer of high-intermediate risk 3257(& DQ RSHQODEHO QRQLQIHULRULW\ UDQGRPLVHG

trial. Lancet, 375, 816-23.

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external beam radiation for surgical stage I endometrial adenocarcinoma. Int J Radiat Oncol Biol Phys, 33, 851-4.

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outcome and relation of acute and late side effects in the DGMXYDQWUDGLRWKHUDS\RIHQGRPHWULDOFDUFLQRPDVWDJH,DQG

II. Radiother Oncol, 53, 37-44.

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prognostic factors in patients with endometrial carcinoma.

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there were 22.62% with grade 1-2 proctitis and 13.09%

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complications were manageable.

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Acknowledgements

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of the manuscript.

References

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external irradiation and prognostic parameters in stage I HQGRPHWULDOFDUFLQRPDFOLQLFDODQGKLVWRSDWKRORJLFDOVWXG\

of 540 patients. Obstet Gynecol, , 419-27.

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LQSDWLHQWVWUHDWHGZLWKSRVWRSHUDWLYHUDGLDWLRQWKHUDS\IRU

SDWKRORJLFVWDJH,,,HQGRPHWULDOFDQFHUInt J Radiat Oncol Biol Phys, 35, 925-33.

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LQFUHDVHGPRUELGLW\"Clin Oncol, 4, 373-6.

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clinical stage I adenocarcinoma of the endometrium. Gynecol Oncol, 57, 138-44.

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factors, diagnosis and treatment. Semin Oncol, 140-50.

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