Adjuvant radiotherapy for stage I endometrial cancer: an updated Cochrane systematic review and meta-analysis

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Adjuvant radiotherapy for stage I endometrial cancer : an updated Cochrane systematic review and meta-analysis. / Kong, Anthony; Johnson, Nick; Kitchener, Henry C; Lawrie, Theresa A.

In: Journal of the National Cancer Institute, Vol. 104, No. 21, 07.11.2012, p. 1625-34.

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@article{aa1b82ca1c624fd1ab12fbe116d318be,
title = "Adjuvant radiotherapy for stage I endometrial cancer: an updated Cochrane systematic review and meta-analysis",
abstract = "BACKGROUND: The role of adjuvant radiotherapy in stage I endometrial cancer has changed in recent years. This updated Cochrane systematic review aimed to reexamine the efficacy and toxicity of adjuvant radiotherapy vs no treatment in stage I endometrial cancer.METHODS: We searched various databases including The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and the Specialised Register of the Cochrane Gynaecological Cancer Review Group (CGCRG) for randomized controlled trials that met the predefined inclusion criteria. The primary outcome was overall survival (OS); secondary outcomes were endometrial cancer-specific survival, locoregional recurrence, distant recurrence, and toxicity. Hazard ratios (HRs) were estimated and pooled if possible; otherwise, dichotomous data were extracted. All statistical tests were two-sided.RESULTS: Of the eight included trials, seven trials (3628 women) compared external beam radiotherapy (EBRT) and no EBRT (or vaginal brachytherapy [VBT]), and one trial (645 women) compared VBT and no additional treatment. EBRT statistically significantly reduced locoregional recurrence compared with no EBRT (or VBT alone) (HR = 0.36, 95% confidence Interval [CI] = 0.25 to 0.52; P < .001), but this did not translate into an improvement in OS (HR = 0.99, 95% CI = 0.82 to 1.20; P = .95), endometrial cancer-specific survival (HR = 0.96, 95% CI = 0.72 to 1.28; P = .80), or distant recurrence rates (risk ratio = 1.04, 95% CI = 0.80 to 1.35; P = .77). EBRT was associated with an increased risk of severe acute toxicity, severe late toxicity, and reduced quality of life scores.CONCLUSIONS: EBRT reduces the risk of locoregional recurrence but has no statistically significant impact on cancer-related deaths or OS. However, EBRT is associated with clinically and statistically significant morbidity and a reduction in quality of life.",
keywords = "Brachytherapy, Disease-Free Survival, Endometrial Neoplasms, Female, Humans, Neoplasm Recurrence, Local, Neoplasm Staging, Odds Ratio, Quality of Life, Radiotherapy, Adjuvant, Randomized Controlled Trials as Topic, Research Design, Risk Assessment, Risk Factors, Survival Analysis, Treatment Outcome, Vagina",
author = "Anthony Kong and Nick Johnson and Kitchener, {Henry C} and Lawrie, {Theresa A}",
year = "2012",
month = nov,
day = "7",
doi = "10.1093/jnci/djs374",
language = "English",
volume = "104",
pages = "1625--34",
journal = "Journal of the National Cancer Institute",
issn = "0027-8874",
publisher = "Oxford University Press",
number = "21",

}

RIS

TY - JOUR

T1 - Adjuvant radiotherapy for stage I endometrial cancer

T2 - an updated Cochrane systematic review and meta-analysis

AU - Kong, Anthony

AU - Johnson, Nick

AU - Kitchener, Henry C

AU - Lawrie, Theresa A

PY - 2012/11/7

Y1 - 2012/11/7

N2 - BACKGROUND: The role of adjuvant radiotherapy in stage I endometrial cancer has changed in recent years. This updated Cochrane systematic review aimed to reexamine the efficacy and toxicity of adjuvant radiotherapy vs no treatment in stage I endometrial cancer.METHODS: We searched various databases including The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and the Specialised Register of the Cochrane Gynaecological Cancer Review Group (CGCRG) for randomized controlled trials that met the predefined inclusion criteria. The primary outcome was overall survival (OS); secondary outcomes were endometrial cancer-specific survival, locoregional recurrence, distant recurrence, and toxicity. Hazard ratios (HRs) were estimated and pooled if possible; otherwise, dichotomous data were extracted. All statistical tests were two-sided.RESULTS: Of the eight included trials, seven trials (3628 women) compared external beam radiotherapy (EBRT) and no EBRT (or vaginal brachytherapy [VBT]), and one trial (645 women) compared VBT and no additional treatment. EBRT statistically significantly reduced locoregional recurrence compared with no EBRT (or VBT alone) (HR = 0.36, 95% confidence Interval [CI] = 0.25 to 0.52; P < .001), but this did not translate into an improvement in OS (HR = 0.99, 95% CI = 0.82 to 1.20; P = .95), endometrial cancer-specific survival (HR = 0.96, 95% CI = 0.72 to 1.28; P = .80), or distant recurrence rates (risk ratio = 1.04, 95% CI = 0.80 to 1.35; P = .77). EBRT was associated with an increased risk of severe acute toxicity, severe late toxicity, and reduced quality of life scores.CONCLUSIONS: EBRT reduces the risk of locoregional recurrence but has no statistically significant impact on cancer-related deaths or OS. However, EBRT is associated with clinically and statistically significant morbidity and a reduction in quality of life.

AB - BACKGROUND: The role of adjuvant radiotherapy in stage I endometrial cancer has changed in recent years. This updated Cochrane systematic review aimed to reexamine the efficacy and toxicity of adjuvant radiotherapy vs no treatment in stage I endometrial cancer.METHODS: We searched various databases including The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and the Specialised Register of the Cochrane Gynaecological Cancer Review Group (CGCRG) for randomized controlled trials that met the predefined inclusion criteria. The primary outcome was overall survival (OS); secondary outcomes were endometrial cancer-specific survival, locoregional recurrence, distant recurrence, and toxicity. Hazard ratios (HRs) were estimated and pooled if possible; otherwise, dichotomous data were extracted. All statistical tests were two-sided.RESULTS: Of the eight included trials, seven trials (3628 women) compared external beam radiotherapy (EBRT) and no EBRT (or vaginal brachytherapy [VBT]), and one trial (645 women) compared VBT and no additional treatment. EBRT statistically significantly reduced locoregional recurrence compared with no EBRT (or VBT alone) (HR = 0.36, 95% confidence Interval [CI] = 0.25 to 0.52; P < .001), but this did not translate into an improvement in OS (HR = 0.99, 95% CI = 0.82 to 1.20; P = .95), endometrial cancer-specific survival (HR = 0.96, 95% CI = 0.72 to 1.28; P = .80), or distant recurrence rates (risk ratio = 1.04, 95% CI = 0.80 to 1.35; P = .77). EBRT was associated with an increased risk of severe acute toxicity, severe late toxicity, and reduced quality of life scores.CONCLUSIONS: EBRT reduces the risk of locoregional recurrence but has no statistically significant impact on cancer-related deaths or OS. However, EBRT is associated with clinically and statistically significant morbidity and a reduction in quality of life.

KW - Brachytherapy

KW - Disease-Free Survival

KW - Endometrial Neoplasms

KW - Female

KW - Humans

KW - Neoplasm Recurrence, Local

KW - Neoplasm Staging

KW - Odds Ratio

KW - Quality of Life

KW - Radiotherapy, Adjuvant

KW - Randomized Controlled Trials as Topic

KW - Research Design

KW - Risk Assessment

KW - Risk Factors

KW - Survival Analysis

KW - Treatment Outcome

KW - Vagina

U2 - 10.1093/jnci/djs374

DO - 10.1093/jnci/djs374

M3 - Article

C2 - 22962693

VL - 104

SP - 1625

EP - 1634

JO - Journal of the National Cancer Institute

JF - Journal of the National Cancer Institute

SN - 0027-8874

IS - 21

ER -