Management of elderly patients with early-stage medically inoperable endometrial cancer: Systematic review and National Cancer Database analysis

PURPOSE: To evaluate the effectiveness of radiation therapy among elderly patients who are deemed medically inoperable. METHODS AND MATERIALS: We searched PubMed to identify studies from the past 25 years that reported outcomes of medically inoperable endometrial cancer patients treated with radiation alone. The National Cancer Database (NCDB) was queried to identify patients 65 years and older with Stage I-II medically inoperable endometrial cancer. Univariable and multivariable models were performed to investigate the impact of prognostic factors on overall survival. RESULTS: Thirteen papers met inclusion criteria for the systematic review. Overall survival for Stage I tumors at 5 years was 30-95%. Reported pelvic control for the 888 total patients with Stage I tumors was 80-100% and 61-89% for Stage II. Late complications for all patients treated ranged from 0% to 21% across patients. The NCDB analysis demonstrated that any radiotherapy was associated with improved survival over no local therapy. Combination therapy (external beam radiation therapy + brachytherapy) was associated with the most favorable survival with a hazard ratio (HR) of 0.442 (p < 0.001 over no radiotherapy), although benefits were also seen with external beam radiation therapy alone (HR 0.694, p < 0.001) and with brachytherapy alone (HR 0.499, p < 0.001) compared to no radiotherapy. CONCLUSIONS: The available evidence suggests high rates of local control after radiation therapy for elderly women with Stage I-II medically inoperable endometrial cancer. Our analysis of the NCDB suggests that radiation therapy improves survival, and combination therapy provides the most favorable outcomes. Given a relatively favorable toxicity profile, definitive radiation therapy should be considered a preferred approach for patients with medically inoperable endometrial cancer. (C) 2017 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.