Receipt of vaginal brachytherapy is associated with improved survival in women with stage I endometrioid adenocarcinoma of the uterus: A National Cancer Data Base study

Nicholas R. Rydzewski, Anna E. Strohl, Eric D. Donnelly, Margaux J. Kanis, John R. Lurain, Wilberto Nieves-Neira, Jonathan B. Strauss

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

BACKGROUND: Randomized controlled trials have consistently shown that the use of postoperative radiotherapy (RT) for stage I endometrial cancer leads to a reduction in the incidence of pelvic recurrences without a corresponding reduction in overall mortality. It was hypothesized that a reduction in mortality associated with the receipt of RT could be identified in a large data set with greater statistical power. METHODS: Women with surgically staged IA or IB endometrial adenocarcinoma who were treated with total hysterectomy between 2003 and 2011 were identified in the National Cancer Data Base. Chi-square tests and multivariate logistic regression were performed to analyze factors associated with the treatment type. A survival analysis was performed with log-rank testing, Cox proportional hazards regression, and Kaplan-Meier estimates. RESULTS: A total of 44,309 eligible women were identified (33,380 at stage IA and 10,929 at stage IB): 88.4% of the women with stage IA tumors and 51.6% of the women with stage IB tumors received no RT. Older age, comorbid disease, a higher histologic grade, and a larger tumor size were independently associated with an increase in mortality. The receipt of vaginal brachytherapy (VB) was independently associated with a reduction in mortality for both stage IA disease (hazard ratio [HR], 0.81; 95% confidence interval [CI], 0.67-0.97) and stage IB disease (HR, 0.62; 95% CI, 0.51-0.74). CONCLUSIONS: Analyses of this large database support the utility of postoperative VB for many women with stage I endometrial cancer. Unfortunately, RT appears to be underused in this population. Greater adherence to consensus guidelines may lead to improved outcomes. Cancer 2016;122:3724-31.

Original languageEnglish (US)
Pages (from-to)3724-3731
Number of pages8
JournalCancer
Volume122
Issue number23
DOIs
StatePublished - Dec 1 2016
Externally publishedYes

Fingerprint

Endometrioid Carcinoma
Brachytherapy
Uterus
Databases
Radiotherapy
Survival
Mortality
Neoplasms
Endometrial Neoplasms
Confidence Intervals
Kaplan-Meier Estimate
Chi-Square Distribution
Survival Analysis
Hysterectomy
Statistical Factor Analysis
Adenocarcinoma
Randomized Controlled Trials
Logistic Models
Guidelines
Recurrence

Keywords

  • brachytherapy
  • endometrial cancer
  • National Cancer Data Base (NCDB)
  • radiation oncology

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Rydzewski, N. R., Strohl, A. E., Donnelly, E. D., Kanis, M. J., Lurain, J. R., Nieves-Neira, W., & Strauss, J. B. (2016). Receipt of vaginal brachytherapy is associated with improved survival in women with stage I endometrioid adenocarcinoma of the uterus: A National Cancer Data Base study. Cancer, 122(23), 3724-3731. https://doi.org/10.1002/cncr.30228

Receipt of vaginal brachytherapy is associated with improved survival in women with stage I endometrioid adenocarcinoma of the uterus : A National Cancer Data Base study. / Rydzewski, Nicholas R.; Strohl, Anna E.; Donnelly, Eric D.; Kanis, Margaux J.; Lurain, John R.; Nieves-Neira, Wilberto; Strauss, Jonathan B.

In: Cancer, Vol. 122, No. 23, 01.12.2016, p. 3724-3731.

Research output: Contribution to journalArticle

Rydzewski, NR, Strohl, AE, Donnelly, ED, Kanis, MJ, Lurain, JR, Nieves-Neira, W & Strauss, JB 2016, 'Receipt of vaginal brachytherapy is associated with improved survival in women with stage I endometrioid adenocarcinoma of the uterus: A National Cancer Data Base study', Cancer, vol. 122, no. 23, pp. 3724-3731. https://doi.org/10.1002/cncr.30228
Rydzewski, Nicholas R. ; Strohl, Anna E. ; Donnelly, Eric D. ; Kanis, Margaux J. ; Lurain, John R. ; Nieves-Neira, Wilberto ; Strauss, Jonathan B. / Receipt of vaginal brachytherapy is associated with improved survival in women with stage I endometrioid adenocarcinoma of the uterus : A National Cancer Data Base study. In: Cancer. 2016 ; Vol. 122, No. 23. pp. 3724-3731.
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title = "Receipt of vaginal brachytherapy is associated with improved survival in women with stage I endometrioid adenocarcinoma of the uterus: A National Cancer Data Base study",
abstract = "BACKGROUND: Randomized controlled trials have consistently shown that the use of postoperative radiotherapy (RT) for stage I endometrial cancer leads to a reduction in the incidence of pelvic recurrences without a corresponding reduction in overall mortality. It was hypothesized that a reduction in mortality associated with the receipt of RT could be identified in a large data set with greater statistical power. METHODS: Women with surgically staged IA or IB endometrial adenocarcinoma who were treated with total hysterectomy between 2003 and 2011 were identified in the National Cancer Data Base. Chi-square tests and multivariate logistic regression were performed to analyze factors associated with the treatment type. A survival analysis was performed with log-rank testing, Cox proportional hazards regression, and Kaplan-Meier estimates. RESULTS: A total of 44,309 eligible women were identified (33,380 at stage IA and 10,929 at stage IB): 88.4{\%} of the women with stage IA tumors and 51.6{\%} of the women with stage IB tumors received no RT. Older age, comorbid disease, a higher histologic grade, and a larger tumor size were independently associated with an increase in mortality. The receipt of vaginal brachytherapy (VB) was independently associated with a reduction in mortality for both stage IA disease (hazard ratio [HR], 0.81; 95{\%} confidence interval [CI], 0.67-0.97) and stage IB disease (HR, 0.62; 95{\%} CI, 0.51-0.74). CONCLUSIONS: Analyses of this large database support the utility of postoperative VB for many women with stage I endometrial cancer. Unfortunately, RT appears to be underused in this population. Greater adherence to consensus guidelines may lead to improved outcomes. Cancer 2016;122:3724-31.",
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T1 - Receipt of vaginal brachytherapy is associated with improved survival in women with stage I endometrioid adenocarcinoma of the uterus

T2 - A National Cancer Data Base study

AU - Rydzewski, Nicholas R.

AU - Strohl, Anna E.

AU - Donnelly, Eric D.

AU - Kanis, Margaux J.

AU - Lurain, John R.

AU - Nieves-Neira, Wilberto

AU - Strauss, Jonathan B.

PY - 2016/12/1

Y1 - 2016/12/1

N2 - BACKGROUND: Randomized controlled trials have consistently shown that the use of postoperative radiotherapy (RT) for stage I endometrial cancer leads to a reduction in the incidence of pelvic recurrences without a corresponding reduction in overall mortality. It was hypothesized that a reduction in mortality associated with the receipt of RT could be identified in a large data set with greater statistical power. METHODS: Women with surgically staged IA or IB endometrial adenocarcinoma who were treated with total hysterectomy between 2003 and 2011 were identified in the National Cancer Data Base. Chi-square tests and multivariate logistic regression were performed to analyze factors associated with the treatment type. A survival analysis was performed with log-rank testing, Cox proportional hazards regression, and Kaplan-Meier estimates. RESULTS: A total of 44,309 eligible women were identified (33,380 at stage IA and 10,929 at stage IB): 88.4% of the women with stage IA tumors and 51.6% of the women with stage IB tumors received no RT. Older age, comorbid disease, a higher histologic grade, and a larger tumor size were independently associated with an increase in mortality. The receipt of vaginal brachytherapy (VB) was independently associated with a reduction in mortality for both stage IA disease (hazard ratio [HR], 0.81; 95% confidence interval [CI], 0.67-0.97) and stage IB disease (HR, 0.62; 95% CI, 0.51-0.74). CONCLUSIONS: Analyses of this large database support the utility of postoperative VB for many women with stage I endometrial cancer. Unfortunately, RT appears to be underused in this population. Greater adherence to consensus guidelines may lead to improved outcomes. Cancer 2016;122:3724-31.

AB - BACKGROUND: Randomized controlled trials have consistently shown that the use of postoperative radiotherapy (RT) for stage I endometrial cancer leads to a reduction in the incidence of pelvic recurrences without a corresponding reduction in overall mortality. It was hypothesized that a reduction in mortality associated with the receipt of RT could be identified in a large data set with greater statistical power. METHODS: Women with surgically staged IA or IB endometrial adenocarcinoma who were treated with total hysterectomy between 2003 and 2011 were identified in the National Cancer Data Base. Chi-square tests and multivariate logistic regression were performed to analyze factors associated with the treatment type. A survival analysis was performed with log-rank testing, Cox proportional hazards regression, and Kaplan-Meier estimates. RESULTS: A total of 44,309 eligible women were identified (33,380 at stage IA and 10,929 at stage IB): 88.4% of the women with stage IA tumors and 51.6% of the women with stage IB tumors received no RT. Older age, comorbid disease, a higher histologic grade, and a larger tumor size were independently associated with an increase in mortality. The receipt of vaginal brachytherapy (VB) was independently associated with a reduction in mortality for both stage IA disease (hazard ratio [HR], 0.81; 95% confidence interval [CI], 0.67-0.97) and stage IB disease (HR, 0.62; 95% CI, 0.51-0.74). CONCLUSIONS: Analyses of this large database support the utility of postoperative VB for many women with stage I endometrial cancer. Unfortunately, RT appears to be underused in this population. Greater adherence to consensus guidelines may lead to improved outcomes. Cancer 2016;122:3724-31.

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