Are endometrial cancer radiotherapy results age related?
- 8 Downloads
To analyze the impact of age on radiotherapy results based on cancer-specific survival (CSS), vaginal-cuff relapses (VCR) and complications analysis in 438 patients with endometrial carcinoma (EC) receiving postoperative radiotherapy (PRT) divided into three age groups for analysis.
Materials and methods
From 2003 to 2015, 438 patients with EC were treated with PRT and divided into three age groups: Group-1: 202 patients < 65 years; Group-2: 210 patients ≥ 65 and < 80 years; Group-3: 26 patients ≥ 80 years. Vaginal toxicity was assessed using the objective LENT-SOMA criteria and RTOG scores were recorded for the rectum, bladder, and small bowel. Statistics: Chi square and Student’s t tests, Kaplan–Meier survival study for analysis of CSS.
The mean follow-up was 5.6 years in Group-1, 5.6 years in Group-2 and 6.3 years in Group-3 (p = 0.38). No differences were found among the groups in distribution of stage, grade, myometrial invasion, Type 1 vs. 2 EC and VLSI (p = 0.97, p = 0.52, p = 0.35, p = 0.48, p = 0.76, respectively). There were no differences in rectal, bladder and vagina late toxicity (p = 0.46, p = 0.17, p = 0.75, respectively). A better CSS at 5 years was found in Group-1 (p = 0.006), and significant differences were found in late severe small bowel toxicity in Group-3 (p = 0.005). VCR was increased in Group-3 (p = 0.017).
Patients ≥ 65 years had a worse outcome in comparison to younger patients. Late vaginal, rectal and bladder toxicities were similar in the three groups, although an increase of severe late small bowel toxicity led to IMRT in patients ≥ 80 years. Further larger studies are needed including quality of life analysis in patients ≥ 80 years.
KeywordsRadiotherapy results Toxicity Age Endometrial carcinoma
This study was supported by a grant from the Spanish Association Against Cancer (AECC) Foundation (PS14152506ROVI).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The study has been approved by the appropriate ethics committee and it has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
Informed consent was obtained from all individual participants included in the study.
- 2.Gómez Portilla A, Martínez de Lecea C, Cendoya I, Olabarría I, Martín E, Magrach L, et al. Prevalence and treatment of oncologic disease in elderly-an impending challenge. Rev Esp Enfer Dig (Madrid). 2008;100(11):706–15.Google Scholar
- 15.Cortes S, Rovirosa A, Ascaso C, Sanchez J, Herreros A, Sola J, et al. Three short fractionation schedules for exclusive HDR-brachytherapy in endometrial carcinoma. Clin Transl Oncol. 2017;19(Extraordinary 1):100–1.Google Scholar
- 16.Cortes S, Rovirosa A, Ascaso C, Herreros A, Sanchez J, Huguet A, et al. Comparison of three short brachytherapy schedules after postoperative-external-beam-radiotherapy in endometrium. Clinical Transl Oncol. 2017;19(Extraordinary 1):24.Google Scholar
- 19.Small W Jr, Mell LK, Anderson P, Creutzberg C, De Los Santos J, Gaffney D, et al. Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy in postoperative treatment of endometrial and cervical cancer. Int J Radiat Oncol Biol Phys. 2008;71:428–34.CrossRefPubMedGoogle Scholar
- 20.Late effects consensus conference RTOG/EORTC. Radiother Oncol. 1995;35:5–7.Google Scholar
- 21.LENT SOMA scales for all anatomic sites. Int J Radiat Oncol Phys. 1995;31:1049–1191.Google Scholar
- 23.Wiltink LM, Nout RA, Fiocco M, Meershoek-Klein Kranenbarg E, Jürgenliemk-Schulz IM, Jobsen JJ, et al. No increased risk of second cancer after radiotherapy in patients treated for rectal or endometrial cancer in the randomized TME, PORTEC-1, and PORTEC-2 trials. J Clin Oncol. 2015;33(15):1640–6.CrossRefPubMedGoogle Scholar
- 24.Poupon C, Bendifallah S, Ouldamer L, Canlorbe G, Raimond E, Hudry N, et al. Management and survival of elderly and very elderly patients with endometrial cancer: an age-stratified study of 1228 women from the FRANCOGYN Group. Ann Surg Oncol. 2016. https://doi.org/10.1245/s10434-016-5735-9.PubMedGoogle Scholar
- 26.Cortes KS, Glickman A, Valdes S, Cordova O, Ascaso C, Torne A, et al. Charlson comorbidity index in very elderly patients receiving postoperative radiotherapy for endometrial cancer treatment. Radiother Oncol. 2018;127(Suppl):S424.Google Scholar