Study on Radiation and Stage 1 Endometrial Cancer

Over the years, there have been many threads on this board involving questions about radiation and early-stage endometrial cancer (EC). The need for adjuvant radiation for stage 1 EC has continued to be a much-debated topic among gyn-oncs and institutions in the ensuing years since I completed treatment for stage 1C, grade 2, EC in 1999.

While studies have rather consistently shown that pelvic radiation clearly reduces local recurrences, the real debate over the years has focused on whether there is in fact a survival benefit to radiation after surgery for stage 1 EC. Each of the studies conducted to date has had limitations that have made it difficult to definitively answer the question, although subgroup analysis of a recent study seemed to show a survival advantage for certain subgroups of stage 1 patients.

I am providing a link to the full text of a study published today in the Journal of the American Medical Association. This retrospective study used data from the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute. The study revealed a statistically significant association between improved overall and relative survival and adjuvant radiation therapy in certain categories of stage 1C patients.

The authors also stated that future work is needed to continue to delineate clinical and biological factors which can guide treatment decisions and account for disparities in outcome between varied subsets of patients.

Here's the link:

http://jama.ama-assn.org/cgi/content/full/295/4/389

Best regards,

MoeKay

Thanks MoeKay

It seems there are similar discussions going on re: early stage cervical cancer and radiation.

The rad/onc I spoke to told me that although radiation post-surgery decreases the chance of recurrence, it does not improve overall survival rates. Therefore he tries not to use radiation unless absolutely necessary.

I've had some trouble getting my head around this concept, but finally decided to trust the experts and try not to worry about it.

(It seems illogical to me - or perhaps I misheard him...)

At my last meeting with my gyn/onc told me that he was not as concerned with a local recurrence because of all the external and internal radiation that I had BUT was concerned about the possibility of a distant secondary cancer because of all the radiation that I had. Can't win for loosing! anna

Ack. Just when I think I'm not going to worry anymore....

For those who have not read the entire study, please do as Dr.Gaffney the author also concludes in the paragraph preceeding the one posted that "statistical analysis cannot replace clinical judgement when considering the individual patient, tumor characeristics, and the potential benefits of adjuvant RT. Hopefully, appropriate adjuvant RT will be used to decrease the death rate of this most common gynelogical cancer."

I think the above paragraph is important, and should prompt those who may still be questioning or who do not fully comprehend the clinical judgements made by their doctors, to further question him/her about concerns you still have about your disease and the individual treatment plan he/she formulated for you.

Thanks, Nightengale,

That paragraph also jumped out at me as another important one, but at the risk of making my post too lengthy, I did not include it. The paragraph you quoted was very relevant in my particular case, because some of the studies around the time I was treated in 1999 were starting to conclude that despite the fact that radiation substantially reduced the rate of local recurrence, there was no statistically-significant survival advantage to adjuvant radiation for stage 1 EC. I therefore extensively questioned my gyn-onc why it was necessary for me to have radiation if there was no real survival advantage. My gyn-onc said that he had seen women with cases similar to mine dying from their disease and he believed that the radiation would provide me with a distinct survival benefit.

At the risk of writing another lengthy post, I also want to quote what I consider to be another particularly important portion of the study dealing with the study's limitations:

"In addition, specific clinical and pathological data known to be of prognostic significance are not readily available, including information regarding lymphovascular invasion, precise depth of myometrial invasion, lower uterine segment involvement, or specifics of RT, such as radiation dose, field sizes, and compliance with therapy."

These clinical and pathological features of a woman's EC must also be figured into the mix in deciding the need for adjuvant radiation in any particular case of stage 1 EC. That's why clinical judgment plays such an important part in the overall treatment plan.

In my case, I did have extensive lymphovascular invasion, a lower uterine segment tumor and a very deeply invasive tumor.

MoeKay

Ladies: There was one other issue that seemed to be missing from this study. They did not take into account the exact pathological identification of the type of endometrial cancer that each woman had. My gyn/onc had quite a discussion with me about this before I even had surgery. My cancer was a relatively rare type, b ut as described by him, of similar aggressiveness as the most common type. He talked of several other types which had a very poor prognosis compared with the most common type. Those issues came up when we talked about follow-up treatment (for me none).

Since radiation and many other treatments have adverse health effects and some can lead to secondary cancers (most over 20 years out from treatment) this decision is difficult for anyone to make when the possibility of recurrence is low. The behavior of the cancer in the individual woman is far more important as a prognostic factor than is indicated in this study. I'm not really sure what the value is of this particular study.

Linda

Linda,

I too am not in a position to say what particular value this study may or may not have in any given case of stage 1 EC. I thought it appropriate to post, however, because the issue of adjuvant radiation in stage 1 EC remains a subject of much dispute among the gynecologic cancer experts, and the controversy has been going on for a number of years now. There are even different positions on the issue at MD Anderson Cancer Center, which recently held a uterine cancer symposium to discuss current issues. As a result of the symposium, MDA physician attendees published two opposing positions, one "pro" and one "con" radiation for stage 1 EC.

So I posted this study, which refers to and discusses a number of the prior radiation studies on EC, to provide women with a starting point for discussions with their treatment team. It will at bottom provide some information to let them know that there are differing opinions out there about this issue and that the issue is not as "cut and dried" as some threads in the past have seemed to suggest.

Warmest regards,

MoeKay

Moekay: Thanks for the posting. Yes, it's not cut and dried. There are many aspects to evaluating the proper treatment plan. An experienced oncologist and an informed patient makes for a good treatment plan.

Thanks.

Linda

MoeKay,
Thank you for taking the time to make such thoughtful posts

Do you happen to know when they held that conference at M.D. Anderson???

Thanks!
Beachball