Endometrial cancer is the most common gynecologic cancer in the United States, and its incidence is rising. Although there have been significant recent advances in our understanding of endometrial cancer biology, many aspects of treatment remain mired in controversy, including the role of surgical lymph node assessment and the selection of patients for adjuvant radiation or chemotherapy. For the subset of women with microsatellite‐instable, metastatic disease, anti– programmed cell death protein 1 immunotherapy (pembrolizumab) is now approved by the US Food and Drug Administration, and numerous trials are attempting to build on this early success.

BACKGROUND: This study sought to determine if treatment time impacts pelvic failure (PF), distant failure (DF), or disease-specific mortality (DSM) in patients undergoing concurrent chemoradiotherapy (CCRT). METHODS: A retrospective review was performed of 113 consecutive eligible patients with stage IB2 to IIIB cervical cancer. All patients received whole-pelvis radiation with concurrent chemotherapy and consolidative intracavitary brachytherapy (BT) to the cervix, followed by an external beam parametrial boost when appropriate. The effect of treatment time on PF, DF, and DSM was examined with univariate and multivariate analyses. Characteristics of patients with and without treatment prolongation were compared to explore reasons for treatment prolongation. RESULTS: The median time to completion of BT was 60 days, and the median time to complete all RT was 68 days. The 3-year cumulative incidence of PF, DF, and DSM were 18%, 23%, and 26%, respectively. On multivariate analysis, time to completion of BT >56 days was associated with increased PF (hazard ratio, 3.8; 95% confidence interval, 1.2-16; P ¼ .02). The 3-year PF for >56 days versus 56 days was 26% versus 9% (P ¼ .04). Treatment time was not associated with DF or DSM. Treatment prolongation was found to be associated with delay in starting BT and higher incidence of acute grade 3/4 toxicities. CONCLUSIONS: In the setting of CCRT, treatment time >56 days is detrimental to pelvic control but is not associated with an increase in DF or DSM. To maximize pelvic control, we recommend completing BT in 8 weeks or less. Cancer 2013;119:325-31. V C 2012 American Cancer Society.KEYWORDS: cervical cancer, treatment time, radiation timing, prognostic factor, concurrent chemoradiation. INTRODUCTIONHistorically, locally advanced cervical carcinomas were treated with radical radiation therapy (RT) alone using a combination of external beam RT to the whole pelvis and a brachytherapy (BT) boost to the cervix. In 1999, the treatment paradigm shifted to concurrent chemoradiotherapy (CCRT) after the publication of 5 randomized trials that demonstrated a survival advantage with the addition of cisplatin-based chemotherapy to RT in the adjuvant and definitive setting.1-5 A number of patient and tumor characteristics have been found to be prognostic in the setting of RT alone or CCRT. For patients treated with RT alone, the detrimental effect of RT prolongation is well established. Total RT time beyond 7 to 9 weeks results in increased pelvic failures (PFs), decreased cause-specific survival, and decreased overall survival (OS).

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Statin use is independently associated with significant improvements in PFS for the overall group and PFS and OS in the hyperlipidemic group.

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