Main Session

Sep 29

QP 05 - GYN 2: Quick Pitch: Innovative Techniques and Patient-centered Approaches in the Treatment of Cervical and Endometrial Cancers

1027 - Recurrence Pattern in Women with 2023 FIGO Stage IIC Endometrial Carcinoma with Negative Nodal Evaluation and Adjuvant Therapies

05:20pm - 05:25pm PT

Room 22/23

Presenter(s)

Ahmed Ghanem, MD, PhD - Henry Ford Cancer Institute/Alexandria University, Detroit, MI

A. I. Ghanem^1,2, C. H. Lin³, M. Hijaz⁴, and M. A. Elshaikh¹; ¹Department of Radiation Oncology, Henry Ford Health, Detroit, MI, ²Clinical Oncology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt, ³Department of Public Health Sciences, Henry Ford Health, Detroit, MI, ⁴Department of Gynecologic Oncology, Henry Ford Health, Detroit, MI

Purpose/Objective(s):

There has been an ongoing debate regarding the optimal adjuvant treatment for women with 2023 FIGO stage IIC with aggressive histologies. We compared recurrence pattern and survival outcomes in this population after different adjuvant therapies (AT).

Materials/Methods:

We queried our uterine cancer database for patients with 2023 FIGO stage IIC who underwent surgical staging including negative pathological lymph node (LN) evaluation between 1995 and 2023. We included patients who received adjuvant radiation therapy (RT) alone (pelvic external beam RT, vaginal cuff brachytherapy or both), chemotherapy (CT) alone or a combination of RT+CT. Recurrence patterns and 5-year recurrence-free (RFS), distant metastases-free (DMFS), disease-specific (DSS) and overall survival (OS) among different AT groups were compared using Kaplan-Meier curves and log-rank tests. Multivariate cox analyses (MVA) were performed to identify predictors for survival endpoints.

Results:

We identified 371 patients with a median (IQR) follow up of 111 (96-127) months: median (IQR) age 66 (60-72) years and median (IQR) examined LN 11 (5-22). There were 222 patients (60%) with non-endometrioid histology, 153 (41%) with =50% myometrial invasion and 72 (19%) with cervical stromal invasion (CSI). Adjuvant RT alone was received in 156 patients (42%), CT alone in 57 (15%) and RT+CT in 158 (43%). RT alone was utilized more with endometrioid (76.3%) while RT+CT (86.7%) or CT alone (84.2%) were utilized more with non-endometrioid histologies (P<0.001). 86 (23%) patients were diagnosed with cancer recurrence, mostly with distant metastases (DM) as the first site of recurrence (70/86; 81.4%), of which only 6 (7%) were successfully salvaged. Pelvic (43/86; 50%) and vaginal cuff (23/86; 26.7%) recurrences were significantly higher in patients who received CT alone (26%) compared to RT alone (8.4%) and RT+CT (13.9%), whereas DM were more with RT alone (17.4%) and RT+CT (21.5%) compared to CT alone (15.7%); P=0.005 for all. Five-years RFS (82.9% vs 72.7% vs 76.8%; P=0.057), DMFS (82.1% vs 75.1% vs 81.9%; P=0.32), DSS (83.6% vs 75.3% vs 76.8%; P=0.1) and OS (70.1% vs 70.4% vs 70.5%; P=0.38) were not different for RT alone vs CT+RT vs CT alone, respectively. On MVA, carcinosarcoma was independently predictive for worse RFS and DSS; age, comorbidities and number of LNs examined for OS; and positive cytology, CSI and substantial lymphovascular space invasion were detrimental for all endpoints.

Conclusion:

Our data suggest that adjuvant RT is associated with a lower risk of locoregional recurrence in women with 2023 FIGO stage IIC endometrial cancer with negative LN evaluation. There were no significant differences in survival outcomes among the different AT groups. However, the high overall relapse rate, with distant recurrence as the predominant initial site despite AT, along with the limited success of salvage therapies, highlights the need for further optimization of adjuvant systemic therapies in this high-risk population.