High recurrent rates of patient with uterine cancer who has tumor in lymph vascular space

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