Current practices in the management of stage IB, grade 3 endometrial cancer in the United States

Abstract

Objectives

Endometrial cancer is the most common gynecologic malignancy in the United States (US). Most patients are diagnosed with early stage disease and those with stage IB, grade 3 disease have inferior outcomes. Due to the heterogeneity among these patients, existing data has failed to yield cohesive recommendations to guide management decisions. The present study sought to analyze current practices regarding the use of adjuvant radiation for these patients.

Methods

The Surveillance, Epidemiology, and End Results Program was used to find all cases of endometrial cancer diagnosed between 2009 and 2013 in patients aged 18 or older. Data regarding the age (<60 versus ≥60), race (white versus non-white), tumor size (less than or equal to 4 cm versus >4 cm), type of surgery performed (less than the total hysterectomy and bilateral salpingo-oophrectomy, TH/BSO, versus greater than or equal to TH/BSO), number of nodes examined (<10 versus ≥10), radiation sequence with surgery (none versus adjuvant radiation), and type of radiation (brachytherapy versus external beam radiation versus both) was extracted from the database. We compared type of treatment administered based on the presence of risk factors. We also analyzed survival outcomes based on these clinic-pathologic factors.

Results

There were no differences between patients receiving surgery alone versus adjuvant radiation based on any parameter. Among those who received radiation, we found no differences between the type of radiation administered, except with respect to tumor size. Patients with small tumors (<4 cm) were more likely to be offered VBT alone (p = 0.03). The overall survival (OS) estimate for the group as a whole was 89% at 59 months. The OS for VBT alone and EBRT alone was 89%, while for the combination, it was 91%. Large tumor size and sub-optimal surgery were associated with inferior survival.

Conclusion

The current study highlights the fact that there is tremendous variation in the management of patients with stage IB, grade 3 endometrial cancer. Forty percent of patients in the US are not offered adjuvant radiation, despite inferior outcomes among these patients when treated with surgery alone. Clearly defined, uniform guidelines are needed to standardize management decisions for this group of patients. Uniform practice is especially important to cut costs in medicine and standardize treatment across health networks.

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