Uterine (the womb) cancer is the
most common gynecologic cancer in the United States. Approximately 49,000 new uterine cancer cases
will occur annually. The treatment
usually consists of hysterectomy and lymph node removals. We then get more information after surgery
whether to add radiation or chemotherapy.
A recent study evaluated131 patients
with stage IB – IIA whose pathology showed negative nodes but there was
invasion of lymphatic and vascular space by tumor (LVSI). Median age was 67 years. After surgery, 45 patients were observed
(Obs), and 86 patients received adjuvant radiation. The study reported 30 total
relapses 30/131 (23%): 11/45 (24%) in the Obs group and 19/86 (22%) in the
adjuvant radiation group. Recurrence rates were similar between staged and
unstaged patients: 24% (20/84) and 21% (10/47), respectively. Among Obs
patients, 82% of relapses were local, whereas in patients treated with adjuvant
radiation, 84% were distant. Both cancer-related survival and overall survival
(OS) were not significantly impacted by adjuvant radiation, because of distant
failure rates. Adjuvant radiation significantly improved pelvic control (P =
0.007).
The conclusion of the study was overall
recurrence rates for stage IB-IIA patients with LVSI are high (23%).
Although adjuvant radiation therapy improved pelvic control, it did not impact
recurrence rates, cancer-related survival, likely secondary to distant
failures. Chemotherapy may have
important role in the future study. The
role of systemic therapy with or without radiotherapy for early-stage uterine cancer with
LVSI should be evaluated, particularly in patients with high-grade tumors or
involvement of the LVSI
Reference:
Simpkins F,
et al. Patterns
of recurrence in stage I endometrioid endometrial adenocarcinoma with
lymphovascular space invasion. Int J Gynecol
Cancer. 2013 ;23(1):98-104
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