Neoadjuvant radiotherapy with or without chemotherapy followed by extrafascial hysterectomy for locally advanced endometrial cancer clinically extending to the cervix or parametria

John A. Vargo, Michelle M. Boisen, John T. Comerci, Hayeon Kim, Christopher J. Houser, Paniti Sukumvanich, Alexander B. Olawaiye, Joseph L. Kelley, Robert P. Edwards, Marilyn Huang, Madeleine Courtney-Brooks, Sushil Beriwal

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Purpose For locally-advanced uterine cancer clinically extending to the cervix, two treatment paradigms exist: surgical staging radical hysterectomy with tailored adjuvant therapy or neoadjuvant therapy followed by a less extensive simple hysterectomy. Currently, insufficient data exists to guide consensus guidelines and practical application of preoperative radiotherapy. Materials and methods Retrospective IRB approved cohort study from 1999 to 2014 of 36 endometrial cancer patients with clinical involvement of cervix ± parametria treated with neoadjuvant external beam radiotherapy (45-50.4 Gy in 25-28 fractions) and image-based HDR brachytherapy (5-5.5 Gy times 3-4 fractions) ± chemotherapy followed by extrafascial hysterectomy performed at a median of 6 weeks after radiotherapy.

Results All patients had clinical cervical extension, 50% also had parametria extension, and 31% had nodal involvement. At the time of surgery 91% had no clinical cervical involvement, 58% had no pathologic cervical involvement, and all had margin negative resection. The pathologic complete response rate was 24%. Median follow-up from the time of surgery was 20 months (range: 0-153). The 3-year local control, regional control, distant control, disease free survival and overall survival rates were 96%, 89%, 84%, 73%, and 100%. The 3-year rate of grade 3 complications was 11%, with no grade 4 + toxicity.

Conclusions Neoadjuvant radiation therapy ± chemotherapy followed by extrafascial hysterectomy appears to be a viable option for patients with endometrial cancer clinically extending to the cervix and parametria. The HDR brachytherapy schema of 5-5.5 Gy times 3-4 fractions, for a cumulative EQD2 of 60-70 Gy, is well tolerated with high rates of clinical and pathological response.

Original languageEnglish (US)
Pages (from-to)190-195
Number of pages6
JournalGynecologic Oncology
Volume135
Issue number2
DOIs
StatePublished - Nov 1 2014
Externally publishedYes

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Peritoneum
Endometrial Neoplasms
Hysterectomy
Cervix Uteri
Radiotherapy
Drug Therapy
Neoadjuvant Therapy
Brachytherapy
Uterine Neoplasms
Research Ethics Committees
Disease-Free Survival
Cohort Studies
Survival Rate
Guidelines
Therapeutics

Keywords

  • Cervix
  • Endometrial cancer
  • Extrafascial hysterectomy
  • HDR brachytherapy
  • Preoperative
  • Stage II
  • Stage III

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

Cite this

Neoadjuvant radiotherapy with or without chemotherapy followed by extrafascial hysterectomy for locally advanced endometrial cancer clinically extending to the cervix or parametria. / Vargo, John A.; Boisen, Michelle M.; Comerci, John T.; Kim, Hayeon; Houser, Christopher J.; Sukumvanich, Paniti; Olawaiye, Alexander B.; Kelley, Joseph L.; Edwards, Robert P.; Huang, Marilyn; Courtney-Brooks, Madeleine; Beriwal, Sushil.

In: Gynecologic Oncology, Vol. 135, No. 2, 01.11.2014, p. 190-195.

Research output: Contribution to journalArticle

Vargo, JA, Boisen, MM, Comerci, JT, Kim, H, Houser, CJ, Sukumvanich, P, Olawaiye, AB, Kelley, JL, Edwards, RP, Huang, M, Courtney-Brooks, M & Beriwal, S 2014, 'Neoadjuvant radiotherapy with or without chemotherapy followed by extrafascial hysterectomy for locally advanced endometrial cancer clinically extending to the cervix or parametria', Gynecologic Oncology, vol. 135, no. 2, pp. 190-195. https://doi.org/10.1016/j.ygyno.2014.09.001
Vargo, John A. ; Boisen, Michelle M. ; Comerci, John T. ; Kim, Hayeon ; Houser, Christopher J. ; Sukumvanich, Paniti ; Olawaiye, Alexander B. ; Kelley, Joseph L. ; Edwards, Robert P. ; Huang, Marilyn ; Courtney-Brooks, Madeleine ; Beriwal, Sushil. / Neoadjuvant radiotherapy with or without chemotherapy followed by extrafascial hysterectomy for locally advanced endometrial cancer clinically extending to the cervix or parametria. In: Gynecologic Oncology. 2014 ; Vol. 135, No. 2. pp. 190-195.
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title = "Neoadjuvant radiotherapy with or without chemotherapy followed by extrafascial hysterectomy for locally advanced endometrial cancer clinically extending to the cervix or parametria",
abstract = "Purpose For locally-advanced uterine cancer clinically extending to the cervix, two treatment paradigms exist: surgical staging radical hysterectomy with tailored adjuvant therapy or neoadjuvant therapy followed by a less extensive simple hysterectomy. Currently, insufficient data exists to guide consensus guidelines and practical application of preoperative radiotherapy. Materials and methods Retrospective IRB approved cohort study from 1999 to 2014 of 36 endometrial cancer patients with clinical involvement of cervix ± parametria treated with neoadjuvant external beam radiotherapy (45-50.4 Gy in 25-28 fractions) and image-based HDR brachytherapy (5-5.5 Gy times 3-4 fractions) ± chemotherapy followed by extrafascial hysterectomy performed at a median of 6 weeks after radiotherapy.Results All patients had clinical cervical extension, 50{\%} also had parametria extension, and 31{\%} had nodal involvement. At the time of surgery 91{\%} had no clinical cervical involvement, 58{\%} had no pathologic cervical involvement, and all had margin negative resection. The pathologic complete response rate was 24{\%}. Median follow-up from the time of surgery was 20 months (range: 0-153). The 3-year local control, regional control, distant control, disease free survival and overall survival rates were 96{\%}, 89{\%}, 84{\%}, 73{\%}, and 100{\%}. The 3-year rate of grade 3 complications was 11{\%}, with no grade 4 + toxicity.Conclusions Neoadjuvant radiation therapy ± chemotherapy followed by extrafascial hysterectomy appears to be a viable option for patients with endometrial cancer clinically extending to the cervix and parametria. The HDR brachytherapy schema of 5-5.5 Gy times 3-4 fractions, for a cumulative EQD2 of 60-70 Gy, is well tolerated with high rates of clinical and pathological response.",
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T1 - Neoadjuvant radiotherapy with or without chemotherapy followed by extrafascial hysterectomy for locally advanced endometrial cancer clinically extending to the cervix or parametria

AU - Vargo, John A.

AU - Boisen, Michelle M.

AU - Comerci, John T.

AU - Kim, Hayeon

AU - Houser, Christopher J.

AU - Sukumvanich, Paniti

AU - Olawaiye, Alexander B.

AU - Kelley, Joseph L.

AU - Edwards, Robert P.

AU - Huang, Marilyn

AU - Courtney-Brooks, Madeleine

AU - Beriwal, Sushil

PY - 2014/11/1

Y1 - 2014/11/1

N2 - Purpose For locally-advanced uterine cancer clinically extending to the cervix, two treatment paradigms exist: surgical staging radical hysterectomy with tailored adjuvant therapy or neoadjuvant therapy followed by a less extensive simple hysterectomy. Currently, insufficient data exists to guide consensus guidelines and practical application of preoperative radiotherapy. Materials and methods Retrospective IRB approved cohort study from 1999 to 2014 of 36 endometrial cancer patients with clinical involvement of cervix ± parametria treated with neoadjuvant external beam radiotherapy (45-50.4 Gy in 25-28 fractions) and image-based HDR brachytherapy (5-5.5 Gy times 3-4 fractions) ± chemotherapy followed by extrafascial hysterectomy performed at a median of 6 weeks after radiotherapy.Results All patients had clinical cervical extension, 50% also had parametria extension, and 31% had nodal involvement. At the time of surgery 91% had no clinical cervical involvement, 58% had no pathologic cervical involvement, and all had margin negative resection. The pathologic complete response rate was 24%. Median follow-up from the time of surgery was 20 months (range: 0-153). The 3-year local control, regional control, distant control, disease free survival and overall survival rates were 96%, 89%, 84%, 73%, and 100%. The 3-year rate of grade 3 complications was 11%, with no grade 4 + toxicity.Conclusions Neoadjuvant radiation therapy ± chemotherapy followed by extrafascial hysterectomy appears to be a viable option for patients with endometrial cancer clinically extending to the cervix and parametria. The HDR brachytherapy schema of 5-5.5 Gy times 3-4 fractions, for a cumulative EQD2 of 60-70 Gy, is well tolerated with high rates of clinical and pathological response.

AB - Purpose For locally-advanced uterine cancer clinically extending to the cervix, two treatment paradigms exist: surgical staging radical hysterectomy with tailored adjuvant therapy or neoadjuvant therapy followed by a less extensive simple hysterectomy. Currently, insufficient data exists to guide consensus guidelines and practical application of preoperative radiotherapy. Materials and methods Retrospective IRB approved cohort study from 1999 to 2014 of 36 endometrial cancer patients with clinical involvement of cervix ± parametria treated with neoadjuvant external beam radiotherapy (45-50.4 Gy in 25-28 fractions) and image-based HDR brachytherapy (5-5.5 Gy times 3-4 fractions) ± chemotherapy followed by extrafascial hysterectomy performed at a median of 6 weeks after radiotherapy.Results All patients had clinical cervical extension, 50% also had parametria extension, and 31% had nodal involvement. At the time of surgery 91% had no clinical cervical involvement, 58% had no pathologic cervical involvement, and all had margin negative resection. The pathologic complete response rate was 24%. Median follow-up from the time of surgery was 20 months (range: 0-153). The 3-year local control, regional control, distant control, disease free survival and overall survival rates were 96%, 89%, 84%, 73%, and 100%. The 3-year rate of grade 3 complications was 11%, with no grade 4 + toxicity.Conclusions Neoadjuvant radiation therapy ± chemotherapy followed by extrafascial hysterectomy appears to be a viable option for patients with endometrial cancer clinically extending to the cervix and parametria. The HDR brachytherapy schema of 5-5.5 Gy times 3-4 fractions, for a cumulative EQD2 of 60-70 Gy, is well tolerated with high rates of clinical and pathological response.

KW - Cervix

KW - Endometrial cancer

KW - Extrafascial hysterectomy

KW - HDR brachytherapy

KW - Preoperative

KW - Stage II

KW - Stage III

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