Hi Orchid65, 

Regarding your question on studies on improved survival for early stage endometrial cancer patients who received radiation therapy, here are links to two I came across.

https://www.ncbi.nlm.nih.gov/pubmed/27793358?log$=activity:

Adjuvant radiation therapy is associated with improved overall survival in high-intermediate risk stage I endometrial cancer: A national cancer data base analysis.

See also:

https://www.ncbi.nlm.nih.gov/pubmed/31474587

A proposal for a new classification of "unfavorable risk criteria" in patients with stage I endometrial cancer.

These are just the two I came across after doing a quick Pubmed search.  I also recall a few years after I was treated in 1999 reading a study discussing that the authors' results showed a trend toward a survival benefit for certain subgroups of Stage 1 patients, but that, for various reasons, the study was underpowered to establish the benefit with statistical significance, or words to that effect.  That's quite an old study now, and I wasn't able to locate it online. 

It looks like you have at least 3 of the risk factors that would put you into the high risk category for early stage cancer: lymphovascular invasion, grade 2-3 mutation, and stage 1B. That is a really helpful study to help you make a decision. Moekay is a really good researcher in this group and seems to have a knack for finding what someone with misgivings needs. She was a big help to me when I was trying to talk myself out of radiation in 2016 by helping me to understand the criteria I had showing that radiation was worth the risk in my particular circumstances. I know I said that some people in early stages save radiation for recurrence, but I think this study is really helpful for defining when it would be ok to do that and when it would be riskier to skip it.

Orchid65 said:

Trying to Understand 2nd Study

Hi MAbound,

I was reading and trying to understand the 2nd Study, A proposal for a new classification of "unfavorable risk criteria" in patients with stage I endometrial cancer.  In conclusion, the "study showed that adjuvant radiation was associated with an overall survival benefit in patients meeting GOG-99 criteria only; however, no survival benefit was seen in patients meeting PORTEC-1 criteria only".  How do I know who meets the Gynecologic Oncology Group (GOG)-99 criteria and who meets the Post_Operative Radiation Therapy in Endometrial Carcinoma (PORTEC)-1 criteria?  What do the numbers in parenthesis mean? (HR=0.73; 95%Cl 0.60 to 0.89; p=0.002).

Thanks for any clarification you can provide.

Hi, Orchid.  I haven't done this research in a while, and mine was serous, not endometrioid.  The GOG-99 was an older study, PORTEC-1 is an older study from a  different (mostly European, I think?) group.  It is possible to find these studies' protocols, inclusion criteria, and results on line.  The numbers in parentheses are statistical values.  How I wish I had had statistics relevant to clinical studies instead of all that stupid Calculus that I never, never needed.  Anyway, HR is hazard ratio, has to do with survival rates of the treated group as opposed to untreated group.   the CI is confidence interval, meaning that the value has a certain chance of falling within the proposed range.  And the p value has to do with how likely that something could have just happened by chance.  A p value of <0.05 is considered to be statistically significant, meaning that the odds of the results having happend just by chance, are less than 5%, or less than 1:20.  So a p value of 0.002 means the results are statistically signiificant.

I'm assuming they're only recommending vaginal brachytherapy.  I agree, because of the location, degree of invasion, grade, and LVSI, radiation is a good idea.

I had 3 brachytherapy for my 1a Serous with LVSI. I agonized over the decision and looking back it was a waste of energy. I agreed with my doctors‘s recommendations of chemo and brachytherapy but still wanted to make sure. I read the studies available in 2018, and had the brachytherapy sandwiched between my chemo. The actual procedure is embarrassing but very easy to tolerate. I had some diarrhea but it went away after a month, it was never bad. I have other issues with bladder and bowel that I think are possible damage from surgery. The cliche “new normal“ would apply. Mostly I have issues with not receiving the “signals“ of a full bladder until it is almost too late. Also the same with  bowel movement. The issue started immediately after surgery,  so I know it was not chemo or radiation. The docs say that some nerves were most likely damaged during surgery, but it has gotten better over time. All in all I am glad I did everything to survive this horrible disease. I do not regret any of my treatment and frankly knowing what I know now about recurrence that I did not know in the moment gives me more confidence I did the right thing for me. 

Denise

Orchid65 said:

Hi BluebirdOne,

Hi BluebirdOne,

Thanks for sharing your experience.  It's good to hear your bladder and bowel issues got better with time.  I thought the side effects might be permanent for life.  Did you have any recurrence of cancer?

Thanks for asking. Thankfully, NED. My problems gradually subsided, but I am not the same. But very minor issues, nothing I can’t handle. As I like to say, I am still here! 

Denise