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. 2019 Mar;152(3):439-444.
doi: 10.1016/j.ygyno.2018.11.005.

National Trends, Outcomes, and Costs of Radiation Therapy in the Management of Low- And High-Intermediate Risk Endometrial Cancer

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Free PMC article

National Trends, Outcomes, and Costs of Radiation Therapy in the Management of Low- And High-Intermediate Risk Endometrial Cancer

Rudy S Suidan et al. Gynecol Oncol. .
Free PMC article

Abstract

Objective: To assess treatment patterns, outcomes, and costs for women with low-(LIR) and high-intermediate risk endometrial cancer (HIR) who are treated with and without adjuvant radiotherapy.

Methods: All patients with stage I endometrioid endometrial cancer who underwent surgery from 2000 to 2011 were identified from the SEER-Medicare database. LIR was defined as G1-2 tumors with <50% myometrial invasion or G3 with no invasion. HIR was defined as G1-2 tumors with ≥50% or G3 with <50% invasion. Patients were categorized according to whether they received adjuvant radiotherapy (vaginal brachytherapy [VBT], external beam radiotherapy [EBRT], or both) or no radiotherapy. Outcomes were analyzed and compared (primary outcome was overall survival).

Results: 10,842 patients met inclusion criteria. In the LIR group (n = 7609), there was no difference in 10-year overall survival between patients who received radiotherapy and those who did not (67% vs 65%, adjusted HR 0.95, 95% CI 0.81-1.11). In the HIR group (n = 3233), patients who underwent radiotherapy had a significant increase in survival (60% vs 47%, aHR 0.75, 95% CI 0.67-0.85). Radiotherapy was associated with increased costs compared to surgery alone ($26,585 vs $16,712, p < .001). Costs for patients receiving VBT, EBRT, and concurrent VBT/EBRT were $24,044, $27,512, and $31,564, respectively (p < .001). Radiotherapy was associated with an increased risk of gastrointestinal (7 vs 4%), genitourinary (2 vs 1%), and hematologic (16 vs 12%) complications (p < .001).

Conclusions: Radiotherapy was associated with improved survival in women with HIR, but not in LIR. It also had increased costs and a higher morbidity risk. Consideration of observation without radiotherapy in LIR may be reasonable.

Keywords: Cost; Endometrial cancer; High-intermediate risk endometrial cancer; Low-intermediate risk endometrial cancer; Overall survival; Radiotherapy.

Conflict of interest statement

The other authors declare that there are no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Trend in radiotherapy modality use over time.
Fig. 2.
Fig. 2.
Low-intermediate risk endometrial cancer: Overall survival.
Fig. 3.
Fig. 3.
Low-intermediate risk endometrial cancer: Overall survival.

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