Awada Ahmad, Recio Fernando O, Kuhn Theresa M, Ahmad Sarfraz, Zhu Jianbin, McKenzie Nathalie D, Kendrick James E, Holloway Robert W
AdventHealth Cancer Institute, Gynecologic Oncology Program, Orlando, FL 32804, USA.
Gynecol Oncol Rep. 2025 Jan 27;57:101684. doi: 10.1016/j.gore.2025.101684. eCollection 2025 Feb.
To compare clinical outcomes of patients with early-stage, high-intermediate risk (HIR) endometrial cancer (EC) and isolated tumor cells (ITC) lymph node metastases treated with chemotherapy/radiotherapy (CRT) vs. external beam radiotherapy (EBRT)/vaginal brachytherapy (VBT).
We retrospectively identified all patients with early-stage HIR endometrioid EC and ITC treated with CRT or EBRT from our institutional database (January-2015 to December-2023). All patients underwent sentinel lymph node (SLN) assessments per NCCN guidelines. Progression-free survival (PFS) and cancer specific survival (CSS) were analyzed using Kaplan-Meier method. We utilized a GOG-99 scoring system in the HIR-ITC cohort to assess risk factors for recurrence.
48 patients were identified, 32(67 %) treated with CRT, 15(31 %) with EBRT and 1(2 %) with VBT alone. Median follow-up was 63.2 and 28 months in CRT vs EBRT/VBT, respectively ( = 0.001). In CRT cohort, 4(12.5 %) recurred; two patients with isolated lung metastasis were salvaged and two with multiple sites of metastasis died with disease. No patient in EBRT/VBT cohort (n = 16) recurred. Estimated PFS were 84.4 % and 100 % for CRT and EBRT/VBT, respectively ( = 0.392), and CSS were 93.7 % vs. 100 %, respectively ( = 0.457). Using HIR scoring per GOG-99, 21(66 %) patients in CRT cohort had three or more HIR risk factors and 4(19 %) recurred despite adjuvant therapy.
In this retrospective study, there was no significant difference in survival for patients with HIR endometrial cancer and ITC SLNs treated with either EBRT/VBT or CRT. Patients with three or more HIR risk factors remain at risk for recurrence despite CRT. Further prospective studies should assess recurrence risk factors in HIR EC with ITC, likely incorporating standard histopathology and molecular profiles to tailor adjuvant CRT.
比较接受化疗/放疗（CRT）与外照射放疗（EBRT）/阴道近距离放疗（VBT）治疗的早期高中危（HIR）子宫内膜癌（EC）合并孤立肿瘤细胞（ITC）淋巴结转移患者的临床结局。
我们从机构数据库（2015年1月至2023年12月）中回顾性识别所有接受CRT或EBRT治疗的早期HIR子宫内膜样EC和ITC患者。所有患者均按照NCCN指南进行前哨淋巴结（SLN）评估。采用Kaplan-Meier法分析无进展生存期（PFS）和癌症特异性生存期（CSS）。我们在HIR-ITC队列中使用GOG-99评分系统评估复发的危险因素。
共识别出48例患者，32例（67%）接受CRT治疗，15例（31%）接受EBRT治疗，1例（2%）仅接受VBT治疗。CRT组和EBRT/VBT组的中位随访时间分别为63.2个月和28个月（P = 0.001）。在CRT队列中，4例（12.5%）复发；2例孤立肺转移患者经挽救治疗，2例多处转移患者死于疾病。EBRT/VBT队列中的16例患者均未复发。CRT组和EBRT/VBT组的估计PFS分别为84.4%和100%（P = 0.392），CSS分别为93.7%和100%（P = 0.457）。根据GOG-99的HIR评分，CRT队列中的21例（66%）患者有三个或更多HIR危险因素，4例（19%）患者尽管接受了辅助治疗仍复发。
在这项回顾性研究中，接受EBRT/VBT或CRT治疗的HIR子宫内膜癌和ITC SLN患者的生存率无显著差异。尽管接受了CRT治疗，但有三个或更多HIR危险因素的患者仍有复发风险。进一步的前瞻性研究应评估HIR EC合并ITC患者的复发危险因素，可能需要纳入标准组织病理学和分子特征以调整辅助CRT方案。
