Trends in the utilization of adjuvant chemotherapy in early stage endometrial cancer: a SEER-Medicare study

Purpose of Investigation: To examine the utilization of adjuvant chemotherapy in treatment of patients with early stage endometrial cancer in the United States. Materials and Methods: The Surveillance, Epidemiology, and End Results (SEER)-Medicare database was used to identify women 65 years or older diagnosed with Stage I/II endometrial cancer from 1991 through 2007. Results: A total of 12,885 women met the eligibility criteria. Adjuvant chemotherapy was administered in 2.7% of the patients. In multivariable analysis of predictors of chemotherapy, age ≤ 80 years, residence in northeast region of the United States, diagnosis between years 2003-2007, high tumor grade, non-endometrioid histology, and higher stage disease showed a significant positive association (p < 0.05). The usage of chemotherapy increased from 1.5% between years 1991-1994 to 4.2% between years 2003-2007. Conclusion: This population-based study shows an increasing trend in the usage of adjuvant chemotherapy for treatment of women with early stage endometrial cancer.

Trends; Chemotherapy; Early-stage endometrial cancer.

[1] Siegel R.L., Miller K.D., Jemal A.: “Cancer statistics, 2015”. CA Cancer J. Clin., 2015, 65, 5.

[2] Cardenes H.R., Look K., Michael H.: “ Endometrium”. In: Halperin E.C., Perez C.A., Brady L.W. (eds). Perez and Brady’s principles and practice of radiation oncology. 5th ed. Philadelphia: Lippincott, Williams & Wilkins, 2008, 1610.

[3] Mariani A., Dowdy S.C., Keeney G.L., Long H.J., Lesnick T.G., Podratz K.C.: “High-risk endometrial cancer subgroups: candidates for target-based adjuvant therapy”. Gynecol. Oncol., 2004, 95, 120.

[4] Hogberg T., Signorelli M., de Oliveira C.F., Fossati R., Lissoni A.A., Sorbe B., et al.: “Sequential adjuvant chemotherapy and radiotherapy in endometrial cancer—results from two randomised studies”. Eur. J. Cancer, 2010, 46, 2422.

[5] Susumu N., Sagae S., Udagawa Y., Niwa K., Kuramoto H., Satoh S., et al.: “Randomized phase III trial of pelvic radiotherapy versus cisplatin-based combined chemotherapy in patients with intermediateand high-risk endometrial cancer: a Japanese Gynecologic Oncology Group study”. Gynecol. Oncol., 2008, 108, 226

[6] Suh D.H., Lee K.H., Kim K., Kang S., Kim J.W.: “Major clinical research advances in gynecologic cancer in 2014”. J. Gynecol. Oncol., 2015, 26, 156

[7] Maggi R., Lissoni A., Spina F., Melpignano M., Zola P., Favalli G., et al.: “Adjuvant chemotherapy vs radiotherapy in high-risk endometrial carcinoma: results of a randomised trial”. Br. J. Cancer, 2006, 95, 266.

[8] Wright J.D., Neugut A.I., Wilde E.T., Buono D.L., Malin J., Tsai W.Y., et al.: “Physician characteristics and variability of erythropoiesis-stimulating agent use among Medicare patients with cancer”. J. Clin. Oncol., 2011, 29, 3408.

[9] Klabunde C.N., Warren J.L., Legler J.M.: “Assessing comorbidity using claims data: an overview”. Med. Care, 2002, 40, 26.

[10] Klabunde C.N., Potosky A.L., Legler J.M., Warren J.L.: “Development of a comorbidity index using physician claims data”. J. Clin. Epidemiol., 2000, 53, 1258.

[11] Murphy K.T., Rotmensch J., Yamada S.D., Mundt A.J.: “Outcome and patterns of failure in pathologic stages I-IV clear-cell carcinoma of the endometrium: implications for adjuvant radiation therapy”. Int. J. Radiat. Oncol. Biol. Phys., 2003, 55, 1272.

[12] Mundt A.J., Murphy K.T., Rotmensch J., Waggoner S.E., Yamada S.D., Connell P.P.: “Surgery and postoperative radiation therapy in FIGO Stage IIIC endometrial carcinoma”. Int. J. Radiat. Oncol. Biol. Phys., 2001, 50, 1154

[13] Fader A.N., Drake R.D., O’Malley D.M., Gibbons H.E., Huh W.K., Havrilesky L.J., et al.: “Platinum/taxane-based chemotherapy with or without radiation therapy favorably impacts survival outcomes in stage I uterine papillary serous carcinoma”. Cancer, 2009, 115, 2119.

[14] Huh W.K., Powell M., Leath C.A. 3rd, Straughn J.M. Jr., Cohn D.E., Gold M.A., et al.: “Uterine papillary serous carcinoma: comparisons of outcomes in surgical Stage I patients with and without adjuvant therapy”. Gynecol. Oncol., 2003, 91, 470.

[15] Sutton G., Axelrod J.H., Bundy B.N., Roy T., Homesley H., Lee R.B., et al.: “Adjuvant whole abdominal irradiation in clinical stages I and II papillary serous or clear cell carcinoma of the endometrium: a phase II study of the Gynecologic Oncology Group”. Gynecol. Oncol., 2006, 100, 349.

[16] Sood B.M., Jones J., Gupta S., Khabele D., Guha C., Runowicz C., et al.: “Patterns of failure after the multimodality treatment of uterine papillary serous carcinoma”. Int. J. Radiat. Oncol. Biol. Phys., 2003, 57, 208.

[17] Dietrich C.S. 3rd, Modesitt S.C., DePriest P.D., Ueland F.R., Wilder J., Reedy M.B., et al.: “The efficacy of adjuvant platinum-based chemotherapy in Stage I uterine papillary serous carcinoma (UPSC)”. Gynecol. Oncol., 2005, 99, 557.

[18] Havrilesky L.J., Secord A.A., Bae-Jump V., Ayeni T., Calingaert B., Clarke-Pearson D.L., et al.: “Outcomes in surgical stage I uterine papillary serous carcinoma”. Gynecol. Oncol., 2007, 105, 677.

[19] http://www.nccn.org/professionals/physician_gls/pdf/uterine.pdf

[20] Pereira E.B., De B., Kolev V., Zakashansky K., Green S., Dottino P., et al.: “Survey of Current Practice Patterns in the Treatment of EarlyStage Endometrial Cancer”. Int. J. Gynecol. Cancer, 2016, 26, 341.

[21] Creasman W.T., Odicino F., Maisonneuve P., Beller U., Benedet J.L., Heintz A.P., et al.: “Carcinoma of the corpus uteri”. J. Epidemiol. Biostat., 2001, 6, 47.

[22] Irwin C., Levin W., Fyles A., Pintilie M., Manchul L., Kirkbride P.: “The role of adjuvant radiotherapy in carcinoma of the endometriumresults in 550 patients with pathologic stage I disease”. Gynecol. Oncol., 1998, 70, 247.

[23] Creutzberg C.L., van Putten W.L., Warlam-Rodenhuis C.C., van den Bergh A.C., de Winter K.A., Koper P.C., et al.: “Outcome of highrisk stage IC, grade 3, compared with stage I endometrial carcinoma patients: the Postoperative Radiation Therapy in Endometrial Carcinoma Trial”. J Clin Oncol., 2004, 22, 1234.

[24] Morrow C.P., Bundy B.N., Kurman R.J., Creasman W.T., Heller P., Homesley H.D., et al.: “Relationship between surgical-pathological risk factors and outcome in clinical stage I and II carcinoma of the endometrium: a Gynecologic Oncology Group study”. Gynecol. Oncol., 1991, 40, 55.

[25] Boruta D.M. 2nd, Gehrig P.A., Groben P.A., Bae-Jump V., Boggess J.F., Fowler W.C. Jr., et al.: “Uterine serous and grade 3 endometrioid carcinomas: is there a survival difference?” Cancer, 2004, 101, 2214.

[26] Alektiar K.M., McKee A., Lin O., Venkatraman E., Zelefsky M.J., McKee B., et al.: “Is there a difference in outcome between stage III endometrial cancer of papillary serous/clear cell and endometrioid FIGO Grade 3 cancer?” Int. J. Radiat. Oncol. Biol. Phys., 2002, 54, 79.

[27] Cirisano F.D. Jr., Robboy S.J., Dodge R.K., Bentley R.C., Krigman H.R., Synan I.S., et al.: “The outcome of stage I-II clinically and surgically staged papillary serous and clear cell endometrial cancers when compared with endometrioid carcinoma”. Gynecol. Oncol., 2000, 77, 55.

[28] Greenfield S., Blanco D.M., Elashoff R.M., Ganz P.A.: “Patterns of care related to age of breast cancer patients”. JAMA, 1987, 257, 2766.

[29] Samet J., Hunt W.C., Key C., Humble C.G., Goodwin J.S.: “Choice of cancer therapy varies with age of patient”. JAMA, 1986, 255, 3385.

[30] Giovanazzi-Bannon S., Rademaker A., Lai G., Benson A.B. 3rd: “Treatment tolerance of elderly cancer patients entered onto phase II clinical trials: an Illinois Cancer Center study”. J. Clin. Oncol., 1994, 12, 2447.

[31] Silliman R.A., Balducci L., Goodwin J.S., Holmes F.F., Leventhal E.A.: “Breast cancer care in old age: what we know, don’t know, and do”. J. Natl. Cancer Inst., 1993, 85, 190.

[32] Gridelli C., Maione P., Rossi A., Ferrara M.L., Castaldo V., Palazzolo G., et al.: “Treatment of advanced non-small-cell lung cancer in the elderly”. Lung Cancer, 2009, 66, 282.

[33] Lang K., Marciniak M.D., Faries D., Stokes M., Buesching D., Earle C., et al.: “Trends and predictors of first-line chemotherapy use among elderly patients with advanced non-small cell lung cancer in the United States”. Lung Cancer, 2009, 63, 264.

[34] Ramsey S.D., Howlader N., Etzioni R.D., Donato B.: “Chemotherapy use, outcomes, and costs for older persons with advanced nonsmall-cell lung cancer: evidence from surveillance, epidemiology and end results-Medicare”. J. Clin. Oncol., 2004, 22, 4971.

[35] Randall M.E., Filiaci V.L., Muss H., Spirtos N.M., Mannel R.S., Fowler J., et al.: “Randomized phase III trial of whole-abdominal irradiation versus doxorubicin and cisplatin chemotherapy in advanced endometrial carcinoma: a Gynecologic Oncology Group Study”. J. Clin. Oncol., 2006, 24, 36.

[36] Le T., Adolph A., Krepart G.V., Lotocki R., Heywood M.S.: “The benefits of comprehensive surgical staging in the management of early-stage epithelial ovarian carcinoma”. Gynecol. Oncol., 2002, 85, 351.