A multicenter evaluation of sequential multimodality therapy and clinical outcome for the treatment of advanced endometrial cancer

Secord, Angeles Alvarez; Havrilesky, Laura J.; O’Malley, David M.; Bae‐Jump, Victoria L.; Fleming, Nicole D.; Broadwater, Gloria; Cohn, David E.; Gehrig, Paola A.

doi:10.1016/j.ygyno.2009.06.005

Cited by 112 publications

(81 citation statements)

References 12 publications

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“…This series is one of the largest series of stage III endometrial cancer reported in the literature. Similar results have been recently reported by Secord et al [24] who analyzed 84 patients with stage III endometrial cancer treated with chemotherapy, radiotherapy or combined chemotherapy and radiotherapy. In this study, the authors found an advantage in OS and PFS rate in patients treated with the combined modality.…”

Section: Discussionsupporting

confidence: 90%

“…Few trials have evaluated the role of chemotherapy in addition to radiotherapy in endometrial cancer, and the studies were performed in a mixed population of high-risk patients including stage III; only few randomized trials have been performed and most data come from phase II or retrospective studies that suggest encouraging OS and PFS data for the combined modality [17,18,19,20,21,22,23,24,25,26]. The largest randomized phase III trial addressing this question is the NSGO-EC-9501/EORTC 55991 [20,26] study that randomized 372 patients with high-risk endometrial cancer (stage I–IIIC, grade 3, deep myometrial invasion, DNA nondiploidy, serous, clear-cell, or anaplastic histology) to receive either external beam irradiation with or without vaginal brachytherapy, or radiotherapy plus sequential platinum-based chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

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Use of Adjuvant Therapy in Patients with FIGO Stage III Endometrial Carcinoma: A Multicenter Retrospective Study

et al. 2011

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Objectives: Adjuvant treatment for stage III endometrial cancer is not yet defined. Previous experiences support the usefulness of combined chemotherapy and radiotherapy. The aim of this retrospective study was to describe the outcome in a cohort of patients with stage III endometrial cancer treated with chemotherapy and/or radiotherapy. Methods: A multicenter retrospective analysis of patients with stage III endometrial cancer from 1998 to 2009 was conducted. The impact on relapse-free survival of clinical and pathological variables and adjuvant treatment received was analyzed by univariate and multivariate analysis. Results: Eighty-two patients were considered. Median age was 62 years (range 38–82). Seventy-eight (95%) patients received an adjuvant treatment: chemotherapy (41; 50%), radiotherapy (18; 22%), or combined chemo-radiotherapy (19; 23%). Four patients were excluded from analysis because they were not treated with any adjuvant therapy. At univariate analysis, tumor grade (G3 vs. G1–G2; p = 0.003) was associated with risk of recurrence; similarly, patients treated with radiotherapy alone (p = 0.031, hazard ratio 0.19, 95% CI 0.04–0.86) or chemotherapy alone (p = 0.053, hazard ratio 0.54, 95% CI 0.29–1.01) had a significantly higher risk for relapse, compared to those treated with the multimodality approach. Relapse-free survival at 3 years was 86.5, 65.8 and 44.1%, with the multimodality approach, chemotherapy and radiotherapy, respectively. At multivariable analysis, age and grading were independently associated with recurrence-free survival. Hazard ratio for relapse-free survival was 0.14 (95% CI 0.02–1.04) and 0.20 (95% CI 0.04–1.11) for multimodality treatment compared to chemotherapy alone and radiotherapy alone, respectively. Conclusions: Age and grading are independent prognostic factors. A combined approach with radiotherapy and chemotherapy may induce an advantage in relapse-free survival compared to radiotherapy or chemotherapy alone. Prospective clinical trials are needed to verify this clinical hypothesis.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Use of Adjuvant Therapy in Patients with FIGO Stage III Endometrial Carcinoma: A Multicenter Retrospective Study

et al. 2011

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“…No Phase III studies comparing adjuvant chemotherapy plus radiation versus chemotherapy alone have been done. The feasibility of delivery multimodality treatment has been described in various retrospective studies [134,136,[140][141][142][143]. Both the appropriate timing of initiating chemotherapy treatment and the most appropriate agents to use remain controversial.…”

Section: Advanced-stage and Recurrent Diseasementioning

confidence: 99%

“…It is unclear whether systemic treatment should be delivered prior to, after radiation, or delivered as a "sandwich" technique with some chemotherapy delivered before and after radiation. In a multi-institutional trial of 109 women with advanced-stage EC, patients were treated with one of the following sequences: chemotherapy followed by radiation, radiation followed by chemotherapy or radiation "sandwiched" between chemotherapy [143]. Improved 3-year PFS and OS was seen in the patients treated with the "sandwich" technique (69% and 88%, respectively), when compared to those treated with radiation followed by chemotherapy (47% and 54%, respectively) and those receiving chemotherapy followed by radiation (52% and 57%, respectively) [143].…”

Section: Advanced-stage and Recurrent Diseasementioning

confidence: 99%

“…In a multi-institutional trial of 109 women with advanced-stage EC, patients were treated with one of the following sequences: chemotherapy followed by radiation, radiation followed by chemotherapy or radiation "sandwiched" between chemotherapy [143]. Improved 3-year PFS and OS was seen in the patients treated with the "sandwich" technique (69% and 88%, respectively), when compared to those treated with radiation followed by chemotherapy (47% and 54%, respectively) and those receiving chemotherapy followed by radiation (52% and 57%, respectively) [143]. The reported p values for comparison of PFS and OS between the women treated with the "sandwich" technique versus the other sequences were 0.011 and 0.025, respectively [143].…”

Section: Advanced-stage and Recurrent Diseasementioning

confidence: 99%

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