Analyzing Treatment Patterns Among Patients With Stage IB Grade 3 Endometrioid Endometrial Carcinoma

David Barrington, MD, Gynecologic Oncology, The Ohio State University, Columbus, Ohio, discussed a study he worked on that sought to describe national treatment patterns over time, and examine associations between treatment modality and overall survival. 

This study was presented at the SGO 2022 Annual Meeting on Women’s Cancers. 

Transcript 
I'm David Barrington. I'm one of the third-year fellows at the Ohio State University, and I'll be briefly discussing a project that was presented at the 2022 SGO Annual Meeting on Women's Cancer, entitled, “Is Variety Really the Spice of Life? a National Cancer Database Analysis of Treatment Patterns for Stage 1B Grade 3 Endometrioid Endometrial carcinoma.” So, the rationale behind the study is we know that 1B grade 3 endometrial cancers are a uterine confined tumor with a high propensity for distal recurrence. And we still don't know the optimal adjuvant treatment for these patients after surgery. This is a fairly rare presentation of these tumors, and in most of our early-stage endometrial cancer trials have composed a pretty small percentage of the early stage endometrial cancer patients' studies. And most of our data is limited to some retrospective research and as expected for something that we're lacking clear data on, we see the NCCN guidelines really take a pretty broad approach to their recommendations.

So, there's a range of adjuvant treatments that are recommended by the NCCN ranging from vaginal brachytherapy to external beam therapy to consideration of chemotherapy as well, and so we sought to utilize a national cancer registry to examine the current national treatment patterns and see how these have changed over time, as well as to look at whether or not there was a specific modality that was associated with improved survival. And so, we found about 4,000 women included in the National Cancer Database that had a 1B grade 3 endometrioid endometrial carcinoma and found that there was a wide variation in treatment patterns. About a third of patients just received surgery alone and no adjuvant therapy, about 20% received vaginal brachytherapy alone, 24% received external beam radiation, some of those also received vaginal brachytherapy, and approximately 25% received some sort of adjuvant chemotherapy, some of those with external beam radiation and vaginal brachytherapy, some with just chemo alone.

We saw that over the course of the study period from 2010 to 2016, we've seen a decrease in the number of patients who are getting surgery alone. So, there's increase in adjuvant therapy use and specifically an increase in use of patients who are receiving some kind of chemotherapy with their adjuvant treatment. And we've also found on that use of adjuvant chemotherapy was associated with improved survival. Specifically, we noticed that this benefit seemed to be strongest for women over the age of 70, that also have lymphovascular space invasion, two other classic criteria or classic risk factors for endometrial cancer recurrence.

So, with the study looking at data from a National Cancer Database that's retrospective in nature, we think these results are hypothesis generating and think that tumors that have a high propensity for distant recurrence that are uterine confined, we really need more data specifically in this category of the tumor to guide optimal therapy. But I think from this data, there's some suggestion that in the future chemotherapy could play a potential role in the treatment for women with 1B grade 3 endometrioid endometrial carcinomas.

Thank you to the Journal Clinical Pathways for their interest in this study and for your attention.