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Clinical Outcomes of Surgically Unresectable Endometrial Cancers

Conway, Jessica L. MD*,†; Lukovic, Jelena MD, MSc*,†; Ferguson, Sarah E. MD‡,§; Zhang, Jiahui MSc; Xu, Wei PhD; Dhani, Neesha MD, PhD; Croke, Jennifer MD*,†; Fyles, Anthony MD*,†; Milosevic, Michael MD*,†; Rink, Alexandra PhD*,#; Rouzbahman, Marjan MD**; Han, Kathy MD, MSc, FRCPC*,†

American Journal of Clinical Oncology: October 2019 - Volume 42 - Issue 10 - p 777–782
doi: 10.1097/COC.0000000000000600
Original Articles: Gynecologic
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Objective: The objective of this study was to determine the outcomes of patients with unresectable endometrial cancer managed with definitive or neoadjuvant radiation (RT) and/or chemotherapy.

Materials and Methods: Patients with unresectable stages II to IVA endometrial cancer who were treated with curative intent between January 2000 and March 2018 were identified. Overall survival (OS) and disease-free survival (DFS) were analyzed using the Kaplan-Meier method and compared using the log-rank test. Multivariate logistic regression analysis was performed to identify factors associated with receipt of surgery. Multivariate Cox regression analysis was performed to identify factors associated with OS and DFS.

Results: Of the 59 patients identified, the median age was 63 years (range: 37 to 88 y) and histology was endometrioid in 59%. Median follow-up was 2.2 years (range: 0.3 to 9.8 y). Seventeen patients (29%) received neoadjuvant chemotherapy, 28 (47%) neoadjuvant radiation, and 14 (24%) definitive RT; 39 (66%) underwent surgery. Patients who received surgery had higher 3-year OS and DFS than those who did not (84% vs. 41%; P<0.001 and 56% vs. 11%; P<0.001, respectively). Factors associated with higher odds of surgical resection included younger age, endometrioid histology, and earlier stage. Younger age, endometrioid histology, and surgical resection were significantly associated with higher OS. Surgical resection was also associated with higher DFS.

Conclusions: Surgical resection following RT and/or chemotherapy for locally advanced, unresectable endometrial cancer is associated with higher DFS and OS and more likely to be achieved in endometrioid subtypes.

Departments of *Radiation Oncology

Obstetrics and Gynecology

Medical Oncology, University of Toronto

Departments of Biostatistics

**Pathology, Princess Margaret Cancer Centre

§Division of Gynecologic Oncology, University Health Network

Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network

#TECHNA Institute, Toronto, ON, Canada

Supported in part by the Princess Margaret Cancer Foundation—Department of Radiation Oncology Academic Enrichment Fund.

The authors declare no conflicts of interest.

Reprints: Kathy Han, MD, MSc, FRCPC, Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, ON, Canada M5G 2M9. E-mail: kathy.han@rmp.uhn.ca.

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