Adjuvant vaginal brachytherapy decreases the risk of vaginal recurrence in patients with stage I non-invasive uterine papillary serous carcinoma. A multi-institutional study

• This is the largest report on patients with non-invasive stage I UPSC. The majority of recurrences were extra-pelvic.
• Adjuvant vaginal brachytherapy significantly reduced the risk of vaginal recurrence.
• Surgical staging was the only predictor of progression-free and overall survivals.

ObjectivesTo investigate the impact of adjuvant vaginal brachytherapy on vaginal recurrence in stage I non-invasive uterine papillary serous carcinoma (UPSC).MethodsThis is a retrospective multi-institutional study from 2000–2012. 103 patients who underwent surgical treatment with non-invasive stage IA UPSC were included.Results85% and 55% underwent staging lymphadenectomy and omentectomy respectively. 28.2% (29/103) developed recurrence. Vaginal, pelvic and extra-pelvic recurrences developed in 7.8% (8/103), 3.9% (4/103) and 16.5% (17/103) respectively. Among patients who were observed or received only chemotherapy, the rate of vaginal recurrence was 10.9% (7/64) compared to 2.6% (1/39) among those who received vaginal brachytherapy +/− chemotherapy (p = 0.035). The rate of vaginal recurrence was not different between those who were observed and those who received only chemotherapy (9.3% vs. 14.3%, p = 0.27). The 5-year progression free survival (PFS) and overall survival (OS) for the entire cohort were 88.3% and 90.6%. Patients who underwent surgical staging had longer PFS (p = 0.001) and OS (p = 0.0005) compared to those who did not. In multivariable analysis controlling for age, histology, chemotherapy, brachytherapy, and staging lymphadenectomy, only lymphadenectomy was an independent predictor of PFS (HR 0.28, 95% CI 0.11–0.71, p = 0.0037) and OS (HR 0.27, 95% CI 0.10–0.71, p = 0.0035). Neither chemotherapy nor brachytherapy were predictors of PFS or OS.ConclusionsThis is the largest study reported in stage I non-invasive UPSC. The majority of recurrences were extra-pelvic. Vaginal brachytherapy has a significant role in reducing the risk of vaginal recurrence and surgical staging was the only predictor of outcome. Therefore, both should be considered in these patients.