2024
The Prognostic Impact of MLH1 Promoter Hypermethylation in Stage I-II Endometrial Cancer Treated with Adjuvant Radiotherapy
Sherwani Z, Damast S, Fields E, Shah S, Beriwal S, Horne Z, Parks E, Kidd E, Leung E, Khoja L, Taunk N, Chino J, Huang C, Russo A, Dyer M, Albuquerque K, Hathout L. The Prognostic Impact of MLH1 Promoter Hypermethylation in Stage I-II Endometrial Cancer Treated with Adjuvant Radiotherapy. International Journal Of Radiation Oncology • Biology • Physics 2024, 120: s32. DOI: 10.1016/j.ijrobp.2024.07.044.Peer-Reviewed Original ResearchRecurrence-free survivalExternal beam radiationMismatch repair statusOverall survivalAdjuvant radiotherapyVaginal brachytherapyAssociated with decreased RFSPromoter hypermethylationInferior recurrence-free survivalProportion of locoregional recurrenceTreated with adjuvant radiotherapyDepth of myometrial invasionLympho-vascular space invasionMulti-institutional cohort studyRetrospective multi-institutional cohort studyCervical stromal involvementSite of recurrenceKaplan Meier methodPost-surgical resectionCox proportional hazards modelsMulti-institutional studyDeficient mismatch repairProportional hazards modelImpact OSLocoregional recurrencePrognostic Effect of Mismatch Repair Status in Early-Stage Endometrial Cancer Treated With Adjuvant Radiation: A Multi-institutional Analysis
Hathout L, Sherwani Z, Alegun J, Ohri N, Fields E, Shah S, Beriwal S, Horne Z, Kidd E, Leung E, Song J, Taunk N, Chino J, Huang C, Russo A, Dyer M, Li J, Albuquerque K, Damast S. Prognostic Effect of Mismatch Repair Status in Early-Stage Endometrial Cancer Treated With Adjuvant Radiation: A Multi-institutional Analysis. International Journal Of Radiation Oncology • Biology • Physics 2024, 119: 1158-1165. PMID: 38253292, DOI: 10.1016/j.ijrobp.2024.01.203.Peer-Reviewed Original ResearchRecurrence-free survivalEndometrioid endometrial adenocarcinomaMismatch repair statusAdjuvant radiation therapyOverall survivalRadiation therapyVaginal brachytherapyMismatch repair deficiencyAssociated with worse recurrence-free survivalMulti-institutional retrospective cohort studyTreated with adjuvant radiation therapyAssociated with recurrence-free survivalMultivariate analysisExternal beam radiation therapyRecurrence-free survival ratesMismatch repair deficiency statusBeam radiation therapyGrades 1 to 2Kaplan-Meier methodOutcomes of patientsMulti-institutional analysisRetrospective cohort studyCox proportional hazards modelsProportional hazards modelAdjuvant radiation
2023
Prognostic Impact of Mismatch Repair Deficiency on Stage I-II Endometrioid Endometrial Cancer Treated with Adjuvant Radiation Therapy: A Multi-Institutional Analysis
Sherwani Z, Alegun J, Russo A, Damast S, Albuquerque K, Nwachukwu C, Dyer M, Fields E, Beriwal S, Horne Z, Vergalasova I, Ohri N, Taunk N, Chino J, Kidd E, Leung E, Song J, Hathout L. Prognostic Impact of Mismatch Repair Deficiency on Stage I-II Endometrioid Endometrial Cancer Treated with Adjuvant Radiation Therapy: A Multi-Institutional Analysis. International Journal Of Radiation Oncology • Biology • Physics 2023, 117: s8. DOI: 10.1016/j.ijrobp.2023.06.217.Peer-Reviewed Original ResearchEndometrioid endometrial cancerEarly-stage endometrioid endometrial cancerExternal beam radiation therapyAdjuvant radiation therapyLymphovascular space invasionOverall survivalGrade 3Radiation therapyStage IMultivariate analysisWorse RFSWorse OSEndometrial cancerUnivariate analysisMulti-institutional retrospective cohort studyFIGO 2009 stage IRecurrence-free survival ratesCox proportional hazards modelPost-surgical stagingRetrospective cohort studyKaplan-Meier methodDeep myometrial invasionFIGO grade 1Proportional hazards modelBeam radiation therapyThe Impact of Racial Disparities on Outcome in Patients With Stage IIIC Endometrial Carcinoma
Patrich T, Wang Y, Elshaikh M, Zhu S, Damast S, Li J, Fields E, Beriwal S, Keller A, Kidd E, Usoz M, Jolly S, Jaworski E, Leung E, Taunk N, Chino J, Russo A, Lea J, Lee L, Albuquerque K, Hathout L. The Impact of Racial Disparities on Outcome in Patients With Stage IIIC Endometrial Carcinoma. American Journal Of Clinical Oncology 2023, 46: 114-120. PMID: 36625449, DOI: 10.1097/coc.0000000000000975.Peer-Reviewed Original ResearchConceptsStage IIIC endometrial carcinomaRecurrence-free survivalNon-black patientsParaaortic lymph nodesGrade 3 tumorsBlack patientsOverall survivalEndometrial carcinomaWorse OSLymph nodesNonendometrioid histologyPositive paraaortic lymph nodesRetrospective multi-institutional studyKaplan-Meier methodMulti-institutional studySPSS version 27Adjuvant chemotherapyConcurrent chemoradiotherapyHazard ratioRFS ratesClinical outcomesRandomized trialsNonsignificant trendPatientsPrognostic covariates
2022
Racial Disparities in Patients with Stage IIIC Endometrial Cancer
Patrich T, Wang Y, Elshaikh M, Zhu S, Damast S, Li J, Fields E, Beriwal S, Keller A, Kidd E, Usoz M, Jolly S, Jaworski E, Leung E, Donovan E, Taunk N, Chino J, Russo A, Lea J, Lee L, Albuquerque K, Hathout L. Racial Disparities in Patients with Stage IIIC Endometrial Cancer. International Journal Of Radiation Oncology • Biology • Physics 2022, 114: e273-e274. DOI: 10.1016/j.ijrobp.2022.07.1283.Peer-Reviewed Original ResearchPositive paraaortic lymph nodesNon-black patientsRecurrence-free survivalExternal beam radiation therapyStage IIIC endometrial carcinomaNon-endometrioid histologyGrade 3 tumorsLymphovascular space invasionOverall survivalBlack patientsVaginal cuff brachytherapyEndometrial carcinomaCervical involvementWorse OSHazard ratioPropensity scoreStage IIIC endometrial cancerMulti-institutional cohort studyRetrospective multi-institutional cohort studyCox proportional hazards modelRacial disparitiesParaaortic lymph nodesKaplan-Meier methodProportional hazards modelBeam radiation therapyAn evaluation of prognostic factors, oncologic outcomes, and management for primary and recurrent squamous cell carcinoma of the vulva
Li JY, Arkfeld CK, Tymon-Rosario J, Webster E, Schwartz P, Damast S, Menderes G. An evaluation of prognostic factors, oncologic outcomes, and management for primary and recurrent squamous cell carcinoma of the vulva. Journal Of Gynecologic Oncology 2022, 33: 0. PMID: 34910394, PMCID: PMC8899873, DOI: 10.3802/jgo.2022.33.e13.Peer-Reviewed Original ResearchConceptsDisease-specific survivalSquamous cell carcinomaOverall survivalPositive marginsCell carcinomaNodal involvementPrognostic factorsStage IFive-year disease-specific survivalPrimary squamous cell carcinomaRecurrent squamous cell carcinomaFive-year RFSNode-positive patientsVulvar cancer patientsEscalation of treatmentConservative surgical approachKaplan-Meier estimatesLog-rank testCox proportional hazardsLocal RFSOverall RFSAdjuvant radiotherapyDistant recurrenceFree survivalMedian survival
2021
A phase 2 evaluation of pembrolizumab for recurrent Lynch‐like versus sporadic endometrial cancers with microsatellite instability
Bellone S, Roque DM, Siegel ER, Buza N, Hui P, Bonazzoli E, Guglielmi A, Zammataro L, Nagarkatti N, Zaidi S, Lee J, Silasi D, Huang GS, Andikyan V, Damast S, Clark M, Azodi M, Schwartz PE, Tymon‐Rosario J, Harold JA, Mauricio D, Zeybek B, Menderes G, Altwerger G, Ratner E, Alexandrov LB, Iwasaki A, Kong Y, Song E, Dong W, Elvin JA, Choi J, Santin AD. A phase 2 evaluation of pembrolizumab for recurrent Lynch‐like versus sporadic endometrial cancers with microsatellite instability. Cancer 2021, 128: 1206-1218. PMID: 34875107, PMCID: PMC9465822, DOI: 10.1002/cncr.34025.Peer-Reviewed Original ResearchConceptsObjective response rateImmune checkpoint inhibitorsProgression-free survivalEndometrial cancerWhole-exome sequencingSporadic endometrial cancerOverall survivalEnd pointPhase 2 pilot studyPrimary end pointSecondary end pointsTumor mutation burdenPhase 2 evaluationLarger confirmatory studiesAntigen processing/presentationProcessing/presentationCheckpoint inhibitorsSurgical resectionICI resistanceDMMR patientsPrognostic significanceDMMR tumorsMechanisms of resistanceLocal treatmentSporadic MSIDoes Prophylactic Paraortic Lymph Node Irradiation Improve Outcomes in Women With Stage IIIC1 Endometrial Carcinoma?
Yoon J, Fitzgerald H, Wang Y, Wang Q, Vergalasova I, Elshaikh MA, Dimitrova I, Damast S, Li JY, Fields EC, Beriwal S, Keller A, Kidd EA, Usoz M, Jolly S, Jaworski E, Leung EW, Donovan E, Taunk NK, Chino J, Natesan D, Russo AL, Lea JS, Albuquerque KV, Lee LJ, Hathout L. Does Prophylactic Paraortic Lymph Node Irradiation Improve Outcomes in Women With Stage IIIC1 Endometrial Carcinoma? Practical Radiation Oncology 2021, 12: e123-e134. PMID: 34822999, DOI: 10.1016/j.prro.2021.10.002.Peer-Reviewed Original ResearchConceptsStage IIIC1 endometrial cancerPelvic radiation therapyOverall survivalEndometrial cancerRadiation therapySurvival outcomesFirst recurrenceHazard ratioRFS ratesCommon siteRecurrence-free survival ratesMulti-institutional retrospective studyPropensity scoreCox proportional hazards modelImproved survival outcomesKaplan-Meier methodProportional hazards modelInternational FederationNew therapeutic approachesAdjuvant chemotherapyDistant recurrenceSystemic chemotherapyImprove OutcomesClinical outcomesDistant metastasisDeclining Use of Inguinofemoral Lymphadenectomy in the Treatment of Clinically Negative, Pathologic Node Positive Vulvar Cancer: A National Cancer Database Analysis
Mokhtech M, Gao S, Kassick M, Menderes G, Damast S. Declining Use of Inguinofemoral Lymphadenectomy in the Treatment of Clinically Negative, Pathologic Node Positive Vulvar Cancer: A National Cancer Database Analysis. International Journal Of Radiation Oncology • Biology • Physics 2021, 111: e636-e637. DOI: 10.1016/j.ijrobp.2021.07.1687.Peer-Reviewed Original ResearchSentinel lymph node biopsyNational Cancer DatabaseNode-positive vulvar cancerInguinofemoral lymphadenectomyVulvar cancerOverall survivalGroin diseaseUse of SLNBNational Cancer Database AnalysisProportional hazards regression modelingVulvar cancer patientsKaplan-Meier methodLymph node biopsyRate of patientsManagement of patientsLog-rank testInitial staging procedureLymph node dataSignificant differencesWilcoxon rank sum testMATERIAL/METHODSWarrants further studyRank sum testAdjuvant chemoradiationAdjuvant radiationPrognostic impact of mismatch repair deficiency in high- and low-intermediate-risk, early-stage endometrial cancer following vaginal brachytherapy
Li JY, Park HS, Huang GS, Young MR, Ratner E, Santin A, Damast S. Prognostic impact of mismatch repair deficiency in high- and low-intermediate-risk, early-stage endometrial cancer following vaginal brachytherapy. Gynecologic Oncology 2021, 163: 557-562. PMID: 34602287, DOI: 10.1016/j.ygyno.2021.09.018.Peer-Reviewed Original ResearchConceptsRecurrence-free survivalEndometrioid endometrial cancerVaginal brachytherapyPMMR patientsOverall survivalEEC patientsEndometrial cancerExact testThree-year recurrence-free survivalEarly-stage endometrial cancerCox proportional hazards regressionPoor recurrence-free survivalAdjuvant vaginal brachytherapyThree-year OSMultivariable Cox regressionLympho-vascular invasionSignificant prognostic variablesProportional hazards regressionLog-rank testKaplan-Meier estimatesDeficient mismatch repairMismatch repair statusFisher's exact testMismatch repair deficiencyDMMR statusA Multi-Institutional Analysis of Adjuvant Chemotherapy and Radiation Sequence in Women With Stage IIIC Endometrial Cancer
Hathout L, Wang Y, Wang Q, Vergalasova I, Elshaikh MA, Dimitrova I, Damast S, Li JY, Fields EC, Beriwal S, Keller A, Kidd EA, Usoz M, Jolly S, Jaworski E, Leung EW, Donovan E, Taunk NK, Chino J, Natesan D, Russo AL, Lea JS, Albuquerque KV, Lee LJ. A Multi-Institutional Analysis of Adjuvant Chemotherapy and Radiation Sequence in Women With Stage IIIC Endometrial Cancer. International Journal Of Radiation Oncology • Biology • Physics 2021, 110: 1423-1431. PMID: 33677053, DOI: 10.1016/j.ijrobp.2021.02.055.Peer-Reviewed Original ResearchConceptsStage IIIC endometrial carcinomaOverall survivalEndometrial carcinomaRadiation therapyAdjuvant chemotherapyAdjuvant therapyPALN recurrenceSystemic chemotherapyRFS ratesMulti-institutional retrospective cohort studyStage IIIC endometrial cancerRecurrence-free survival ratesLymph node recurrenceSequential radiation therapyAdjuvant radiation therapyRetrospective cohort studyGrade 3 tumorsAdjuvant treatment regimensKaplan-Meier methodVaginal cuff brachytherapyHigh rateSequence of treatmentChemotherapy concurrentNodal radiationNode recurrence
2020
Human epidermal growth factor 2 (HER2) in early stage uterine serous carcinoma: A multi-institutional cohort study
Erickson BK, Najjar O, Damast S, Blakaj A, Tymon-Rosario J, Shahi M, Santin A, Klein M, Dolan M, Cimino-Mathews A, Buza N, Ferriss JS, Stone RL, Khalifa M, Fader AN. Human epidermal growth factor 2 (HER2) in early stage uterine serous carcinoma: A multi-institutional cohort study. Gynecologic Oncology 2020, 159: 17-22. PMID: 32709539, PMCID: PMC7541557, DOI: 10.1016/j.ygyno.2020.07.016.Peer-Reviewed Original ResearchMeSH KeywordsAgedAntineoplastic Combined Chemotherapy ProtocolsBiomarkers, TumorChemoradiotherapy, AdjuvantCystadenocarcinoma, SerousFemaleFollow-Up StudiesHumansHysterectomyImmunohistochemistryMiddle AgedNeoplasm InvasivenessNeoplasm Recurrence, LocalNeoplasm StagingPrognosisProgression-Free SurvivalReceptor, ErbB-2Retrospective StudiesRisk AssessmentUnited StatesUterine NeoplasmsUterusConceptsHuman epidermal growth factor 2Uterine serous carcinomaHER2-positive tumorsEarly-stage diseaseOverall survivalSerous carcinomaCohort studyHER2 positivityPositive tumorsEarly stage uterine serous carcinomaLymph-vascular space invasionRecurrent uterine serous carcinomaMulti-institutional cohort studyHuman epidermal growth factor receptor 2Multi-center cohort studyEpidermal growth factor receptor 2Epidermal growth factor 2HER2-positive cohortGrowth factor receptor 2HER2-negative tumorsEquivocal IHC resultsFactor receptor 2Inferior PFSAdjuvant therapyGrowth factor 2Stage III uterine serous carcinoma: modern trends in multimodality treatment
Li JY, Young MR, Huang G, Litkouhi B, Santin A, Schwartz PE, Damast S. Stage III uterine serous carcinoma: modern trends in multimodality treatment. Journal Of Gynecologic Oncology 2020, 31: e53. PMID: 32266802, PMCID: PMC7286763, DOI: 10.3802/jgo.2020.31.e53.Peer-Reviewed Original ResearchConceptsUterine serous carcinomaExternal beam RTVaginal brachytherapyOverall survivalHuman epidermal growth factor receptorModern treatment eraSentinel node samplingRegional nodal recurrenceKaplan-Meier estimatesLog-rank testCox proportional hazardsExternal beam radiotherapyEpidermal growth factor receptorERA treatmentGrowth factor receptorUSC patientsFree survivalNodal recurrenceTreatment eraMultimodality treatmentPatient characteristicsPerioperative periodRegional nodalSerous carcinomaNode sampling
2019
Outcomes and relapse patterns of stage IB grade 2 or 3 endometrial cancer treated with adjuvant vaginal brachytherapy
Hochreiter A, Kelly JR, Young MR, Litkouhi B, Black JD, Stromberger C, Higgins S, Schwartz PE, Damast S. Outcomes and relapse patterns of stage IB grade 2 or 3 endometrial cancer treated with adjuvant vaginal brachytherapy. International Journal Of Gynecological Cancer 2019, 30: 48. PMID: 31722964, DOI: 10.1136/ijgc-2019-000675.Peer-Reviewed Original ResearchConceptsDisease-free survivalLower uterine segment involvementPelvic recurrence-free survivalStage IB grade 2Uterine segment involvementLymph node dissectionRecurrence-free survivalEndometrial cancerRisk factorsVaginal brachytherapyOverall survivalGrade 2Endometrioid histologyNode dissectionPelvic recurrenceSegment involvementLymph nodesMyometrial invasionMultivariable Cox proportional hazards regressionEarly-stage endometrial cancerUnderwent lymph node dissectionCox proportional hazards regressionReduced disease-free survivalAdjuvant vaginal brachytherapySole adjuvant therapy
2017
Adjuvant Therapy Use and Survival in Stage II Endometrial Cancer
Lester-Coll NH, Young MR, Park HS, Ratner ES, Litkouhi B, Damast S. Adjuvant Therapy Use and Survival in Stage II Endometrial Cancer. International Journal Of Gynecological Cancer 2017, 27: 1904-1911. PMID: 28763364, DOI: 10.1097/igc.0000000000001095.Peer-Reviewed Original ResearchConceptsReceipt of chemotherapyEndometrioid endometrial carcinomaNational Cancer Data BaseImproved overall survivalRole of chemotherapyOverall survivalAdjuvant chemotherapyAdjuvant treatmentStage II endometrial cancerCox proportional hazards regressionPropensity scoreAdjuvant therapy useGrade 3 diseaseStage II patientsProportional hazards regressionWorse overall survivalMultivariable logistic regressionKaplan-Meier estimatesLog-rank testAdjuvant radiotherapyExcellent prognosisLymphovascular invasionObservational cohortEEC patientsEndometrial cancer
2016
Treatment of early stage vaginal cancer with EBRT and MRI-based intracavitary brachytherapy: A retrospective case review
Damast S, Takiar V, McCarthy S, Higgins SA. Treatment of early stage vaginal cancer with EBRT and MRI-based intracavitary brachytherapy: A retrospective case review. Gynecologic Oncology Reports 2016, 17: 89-92. PMID: 27536721, PMCID: PMC4975702, DOI: 10.1016/j.gore.2016.08.002.Peer-Reviewed Original ResearchPrimary vaginal cancerIntracavitary brachytherapyPelvic radiotherapyVaginal cancerTumor thicknessLocal failure-free survivalLong-term clinical outcomesEarly stage vaginal cancerLate grade 3Non-bulky tumorsFailure-free survivalFIGO stage IDisease-specific survivalTerm clinical outcomesTime of diagnosisRetrospective case reviewSeries of patientsInitial tumor volumeTime of brachytherapyInitial tumor thicknessMedian followOverall survivalPartial responseRT doseComplete responseWho benefits from chemoradiation in stage III–IVA endometrial cancer? An analysis of the National Cancer Data Base
Lester-Coll NH, Park HS, Rutter CE, Corso CD, Young MR, Ratner ES, Litkouhi B, Decker RH, Yu JB, Damast S. Who benefits from chemoradiation in stage III–IVA endometrial cancer? An analysis of the National Cancer Data Base. Gynecologic Oncology 2016, 142: 54-61. PMID: 27151429, DOI: 10.1016/j.ygyno.2016.04.544.Peer-Reviewed Original ResearchConceptsAdvanced endometrial cancerImproved overall survivalNational Cancer Data BaseOverall survivalHistologic gradeEndometrial cancerCox proportional hazards regressionPropensity scoreMultivariable subgroup analysisSignificant OS benefitGrade 1 patientsProportional hazards regressionKaplan-Meier estimatesLog-rank testLack of benefitOS benefitAdjuvant therapyStage IIIAStage IVAFIGO stageAdjuvant CRTHazards regressionTumor sizeRegional radiotherapySubgroup analysis
2015
Factors Predictive of Improved Survival in Patients With Brain Metastases From Gynecologic Cancer
Gressel GM, Lundsberg LS, Altwerger G, Katchi T, Azodi M, Schwartz PE, Ratner ES, Damast S. Factors Predictive of Improved Survival in Patients With Brain Metastases From Gynecologic Cancer. International Journal Of Gynecological Cancer 2015, 25: 1711-1716. PMID: 26332394, PMCID: PMC4623851, DOI: 10.1097/igc.0000000000000554.Peer-Reviewed Original ResearchConceptsBrain metastatic diseaseEpithelial ovarian cancerBrain metastasesEndometrial cancerCervical cancerGynecologic cancerSurgical resectionTwo-year overall survival ratesLargest single-institution experienceSingle institution experienceOverall survival rateOverall survival dataMedian survival timeSignificant hazard ratioLong-term survivalHazard ratioMetastatic diseaseOverall survivalImproved survivalRetrospective reviewIntracranial metastasesPalliative carePoor prognosisCancer increasesFactors PredictiveHigh-dose-rate vaginal brachytherapy with chemotherapy for surgically staged localized uterine serous carcinoma
Damast S, Higgins SA, Ratner E, De Leon MC, Mani S, Silasi DA, Azodi M, Santin A, Rutherford T, Schwartz PE. High-dose-rate vaginal brachytherapy with chemotherapy for surgically staged localized uterine serous carcinoma. Journal Of Contemporary Brachytherapy 2015, 7: 35-40. PMID: 25829935, PMCID: PMC4371058, DOI: 10.5114/jcb.2015.48539.Peer-Reviewed Original ResearchRecurrence-free survivalUterine serous carcinomaComprehensive surgical stagingOverall survivalSurgical stagingSerous carcinomaPara-aortic lymph node dissectionFIGO 2009 stage ICarboplatin-paclitaxel chemotherapyInstitutional chart reviewIsolated vaginal recurrencesSimultaneous lung metastasisLymph node dissectionPelvic control rateKaplan-Meier methodRate vaginal brachytherapyCases of recurrenceMedian followNode dissectionPeritoneal cytologyVaginal brachytherapyVaginal recurrenceTotal hysterectomyChart reviewBrachytherapy dose
2014
Adjuvant Carboplatin, Paclitaxel, and Vaginal Cuff Brachytherapy for Stage III Endometrial Cancer: Analysis of Outcomes and Patterns of Recurrence Based on Pathologic Characteristics
Young MR, Higgins SA, Ratner E, Yu JB, Mani S, Silasi DA, Azodi M, Rutherford T, Schwartz PE, Damast S. Adjuvant Carboplatin, Paclitaxel, and Vaginal Cuff Brachytherapy for Stage III Endometrial Cancer: Analysis of Outcomes and Patterns of Recurrence Based on Pathologic Characteristics. International Journal Of Gynecological Cancer 2014, 25: 431. PMID: 25621409, PMCID: PMC5603450, DOI: 10.1097/igc.0000000000000376.Peer-Reviewed Original ResearchMeSH KeywordsAdenocarcinomaAgedAntineoplastic Combined Chemotherapy ProtocolsBrachytherapyCarboplatinChemoradiotherapy, AdjuvantDisease-Free SurvivalEndometrial NeoplasmsFemaleHumansHysterectomyLymph NodesLymphatic MetastasisMiddle AgedNeoplasm Recurrence, LocalNeoplasm StagingPaclitaxelRetrospective StudiesSurvival RateTreatment FailureConceptsDisease-free survivalVaginal cuff brachytherapyStage III endometrial adenocarcinomaStage III endometrial cancerNode-negative diseaseOverall survivalAdjuvant chemotherapyEndometrial cancerEndometrial adenocarcinomaType IComprehensive surgical stagingLow-risk histologyNode-positive diseaseOutcomes of patientsHigh-risk histologyNode-positive ratePatterns of recurrenceAnalysis of outcomesType II diseaseAdjuvant carboplatinVaginal failuresSurgical stagingAdjuvant therapyNode negativeNode positive