Effect of race and histology on patterns of failure in women with early stage endometrial cancer treated with high dose rate brachytherapy

• Black race is associated with earlier time to recurrence (TTR), recurrence free survival (RFS), and worse overall survival (OS).
• Black patients with type 2 histology treated with chemotherapy and vaginal HDR have >7-fold locoregional recurrence risk vs. white patients.
• Further study is needed to evaluate radiation and systemic chemotherapy for those at greatest risk for locoregional failure.

BackgroundClinical trials have helped refine management of early stage endometrial cancer (EC). For patients with intermediate risk features, adjuvant radiation is considered, primarily vaginal cuff brachytherapy. For higher risk patients, there may be a role for chemotherapy and radiation. The purpose of this study is to examine patterns of failure for early stage EC patients treated with postoperative high dose rate brachytherapy.MethodsIn this single institution retrospective cohort study, 208 women with early stage endometrial cancer who received definitive therapy between January 1, 2000 and January 1, 2013 were identified.ResultsMedian follow-up was 46.4 (range, 6.2–137.3) months. Thirteen (6.3%) patients developed with locoregional recurrent disease and 15 (7.2%) patients developed distant metastasis. Freedom from recurrence at 5 years was 88.6% for white patients and 60.5% for black patients (p = 0.0093). Five year recurrence free survival (RFS) for white vs. black patients was 82.9% vs. 48.9% (p = 0.0007). Five year overall survival (OS) was 86.8% for white patients and 59.5% for black patients (p = 0.0023). Black patients with unfavorable histology treated with chemotherapy and vaginal brachytherapy had a 15% locoregional recurrence rate, more than double the rate of local recurrence compared to AA patients with endometrioid histology and white patients with any histology (6% locoregional recurrence rate).ConclusionsBlack women with unfavorable histology early stage EC experience increased rates of recurrence and worse survival compared to white patients. Patterns of failure in this group also indicate a high locoregional failure rate for the black patients with unfavorable histology (type II).