Stage II Endometrial Cancer: Understanding Outcomes and Treatment
"A Deep Dive into the UPMC Hillman Cancer Center Experience and What It Means for Patients"
Endometrial cancer, the most common gynecologic malignancy in women, demands precise staging to determine the best course of treatment. Staging, a critical process, allows medical professionals to stratify risk and choose the most appropriate treatments. Surgical staging, which often involves procedures such as hysterectomies and the removal of the fallopian tubes and ovaries, is considered standard practice.
The International Federation of Gynecology and Obstetrics (FIGO) developed the most widely used system for surgical staging. The FIGO system was revised in 2009. This revision redefined Stage II endometrial cancer as cancer that has invaded the cervical stroma, with previous definitions including cases of cervical glandular involvement. This change is significant, and it necessitates a deeper evaluation of treatment approaches, as data specific to this refined Stage II classification is still emerging.
Following surgical staging, treatment of stage II endometrial cancer typically involves radiation therapy, including external beam radiation therapy (EBRT), vaginal brachytherapy (BT), or a combination of both, with numerous studies demonstrating that EBRT reduces the risk of pelvic recurrence. To evaluate recurrence patterns and survival impact, a retrospective analysis was performed on patients with modern Stage II endometrial cancer who underwent surgical staging and treatment at the UPMC Hillman Cancer Center.
Key Findings on Stage II Endometrial Cancer Treatment
A retrospective study was conducted on 110 patients diagnosed with surgically staged FIGO stage II endometrial cancer between 1990 and 2013. The study focused on patients with cervical stromal invasion. The primary objective was to evaluate recurrence patterns, overall survival, and the impact of adjuvant therapies.
- High Rates of Pelvic Control: The 5-year actuarial rate of locoregional control (LRC) was 94.9%, indicating effective management of cancer within the pelvic region.
- Distant Metastasis as Primary Recurrence: While locoregional control was high, the 5-year rate of distant metastasis (DM) was 85.1%, suggesting that when recurrence occurred, it was more likely to be in distant organs.
- Survival Rates: The 5-year disease-free survival (DFS) rate was 67.9%, and the overall survival (OS) rate was 75.0%.
- Impact of Lymph Node Dissection: The only factor significantly associated with LRC was pelvic lymph node dissection (PLND), underscoring the importance of assessing and managing lymph node involvement.
- Factors Influencing Distant Metastasis: Characteristics associated with DM included age, lymphovascular space invasion (LVSI), depth of myometrial invasion, and receipt of chemotherapy.
What This Means for Patients and Future Research
This study provides valuable insights for patients diagnosed with stage II endometrial cancer. It confirms that surgical staging followed by adjuvant therapy can lead to high rates of pelvic disease control. However, the study also underscores the importance of addressing the risk of distant metastasis.
For clinicians, these findings suggest careful consideration of adjuvant treatment strategies, particularly in patients with factors associated with distant metastasis, such as age, LVSI, and deep myometrial invasion. While the study demonstrates the effectiveness of EBRT combined with BT, further research is needed to determine the optimal radiation modality and the potential benefits of chemotherapy in specific patient subgroups.
Further research is needed through larger, prospective data sets to determine the optimal treatment for cancers with cervical stromal involvement. The role of lymphadenectomy also warrants further investigation to determine whether it truly impacts the rates of locoregional and distant failures.