Brachytherapy is associated with improved survival in inoperable stage I endometrial adenocarcinoma: A population-based analysis
Menée à partir des données des registres américains des cancers portant sur 460 patientes atteintes d'un adénocarcinome de l'endomètre de stade I, inopérable et traité par radiothérapie, cette étude met en évidence une association entre l'utilisation de la curiethérapie et une amélioration de la survie des patientes
Purpose/Objective : To assess the use of brachytherapy (BT) with or without external beam radiation (EBRT) in inoperable stage I endometrial adenocarcinoma in the United States and to determine the effect of BT on overall survival (OS) and cause specific survival (CSS). Material/Methods : Data between 1998 and 2011 from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) database were analyzed. Coarsened exact matching (CEM) was used to adjust for differences in age and grade between patients who received BT and those who did not. Prognostic factors affecting OS and CSS were evaluated using Kaplan Meier product-limit method and Cox proportional hazards regression model. Results : A total of 460 patients with inoperable stage I endometrial adenocarcinoma treated with radiation therapy were identified. Radiation consisted of either EBRT (n=260) or BT with or without EBRT (n=200). The only factor associated with BT use was younger patient age (median age: 72 vs. 76, p=0.001). Patients who received BT had a higher 3-year OS (OS: 60% vs. 47%, p<0.001) and CSS (CSS: 82% vs. 74%, p=0.032) compared to those who did not. On multivariate analysis, BT use was independently associated with an improved OS (OS: hazard ratio [HR]=0.67, 95% confidence interval [CI]: 0.52 – 0.87) and CSS (CSS: HR=0.61, 95% CI: 0.39 – 0.93). When patients were matched on age, BT use remained significant on multivariate analysis for OS (OS: HR 0.65, 95% CI: 0.48 – 0.87) and CSS (CSS: HR 0.52, 95% CI: 0.31 – 0.84). When matched on age and grade, BT remained independently associated with improved OS and CSS (OS: HR=0.62, 95% CI: 0.46 - 0.83; CSS: HR=0.57 95% CI: 0.34 – 0.92). Conclusion : Brachytherapy is independently associated with an improved OS and CSS. It should be considered as part of the treatment regimen for stage I inoperable endometrial patients undergoing radiation.