Adjuvant combined-modality therapy for stage IIIC endometrioid and non-endometrioid endometrial cancer

Chapman, Bhavana V.; Swanick, Cameron W.; Ning, Matthew S.; Allen, Pamela K.; Soliman, Pamela T.; Westin, Shannon N.; Pardeshi, Vishakha; Broaddus, Russell R.; Lu, Karen H.; Jhingran, Anuja; Eifel, Patricia J.; Klopp, Ann H.

doi:10.1016/j.ygyno.2019.05.002

Cited by 25 publications

(31 citation statements)

References 21 publications

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“…The adjuvant chemotherapy or radiotherapy achieved similar overall survival (OS) outcomes; however, their pattern of recurrences differed [10,11]. Combined chemotherapy and radiotherapy might achieve better survival outcomes compared with chemotherapy or radiotherapy alone in patients with node-positive endometrial cancer [11][12][13][14]. In the PORTEC-3 trial, 170 (25.8%) patients had FIGO stage IIIC endometrial cancer and patients with FIGO stage IIIC disease had high risks of recurrences.…”

Section: Introductionmentioning

confidence: 99%

Lymph Node Number Predicts the Efficacy of Adjuvant Chemoradiotherapy in Node-Positive Endometrial Cancer Patients

Lee

Tsai

2020

Diagnostics

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This study aimed to evaluate the value of lymph node (LN) number as a predictor for adjuvant treatment in node-positive endometrial cancer. Data of 441 patients diagnosed with International Federation of Gynaecology and Obstetrics (FIGO) stage IIIC endometrial cancer and who underwent adjuvant chemotherapy alone or chemoradiotherapy between 2009 and 2015 from the Taiwan Cancer Registry were reviewed. The patients were stratified based on the number of positive LN as follows: 1, 2–5, and ≥ 6. The overall survival (OS) was analysed using the Kaplan–Meier method and the Cox proportional hazards model. In multivariable analysis, chemoradiotherapy was independently associated with improved OS (hazard ratio [HR]: 0.62, 95% confidence interval [CI]: 0.43–0.90; p = 0.01) compared with chemotherapy alone. Patients with ≥ 6 positive LNs were associated with a worse OS (HR: 2.22, 95% CI: 1.25–3.95; p = 0.006) and those with 2–5 LNs were not associated with a worse OS (HR: 1.56, 95% CI: 0.94–2.59; p = 0.09) compared to patients with one LN. When stratified based on LN number, chemoradiotherapy was found to significantly improve the 5-year OS of patients with ≥ 6 positive LNs compared to chemotherapy alone (35.9% vs. 70.0%, p < 0.001). No significant differences between chemotherapy alone and chemoradiotherapy were observed in 5-year OS among patients with one LN (73.1% vs. 80.8%, p = 0.31) or 2–5 positive LNs (71.4% vs. 75.7%, p = 0.68). Lymph node number may be used to identify node-positive endometrial cancer patients who are likely to have improved OS with intensification of adjuvant therapy.

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Section: Introductionmentioning

confidence: 99%

Lymph Node Number Predicts the Efficacy of Adjuvant Chemoradiotherapy in Node-Positive Endometrial Cancer Patients

Lee

Tsai

2020

Diagnostics

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“…Practitioners are choosing combined chemotherapy and external beam radiation therapy in the majority of instances for stage III disease, emphasizing the desire for the improved local control benefit of the addition of radiation therapy. A recently published article evaluating the optimal adjuvant treatment regimen for node-positive EC patients revealed that in grade 3 endometrioid EC patients, disease specific survival (DSS) was significantly improved with CT + RT over CT alone, however there was no difference in DSS between the two groups in grade 1–2 endometrioid EC ( Chapman et al, 2019 ). This suggests that grade, rather than stage, may be the more important factor in adjuvant treatment decision.…”

Section: Discussionmentioning

confidence: 99%

“…The use of radiation decreases local recurrence rates without improving distant failures, however the use of chemotherapy alone decreases distant failure rates without improving local control ( Matei et al, 2019 , De Boer et al, 2018 ). The adequacy of intraoperative nodal evaluation in choice of adjuvant treatment appears to be important as well, as one study showed that there were no para-aortic failures in node positive patients who received extended-field RT, however recurrences in the para-aortic nodes were found in 14% of those patients who received pelvic-only RT or chemotherapy alone ( Chapman et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Current practice patterns in nodal evaluation and adjuvant treatment of advanced stage endometrioid endometrial cancer: An SGO survey

Parker

Miller

Lee

et al. 2020

Gynecologic Oncology Reports

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Highlights The majority of respondents evaluate lymph nodes via sentinel lymph node mapping for grade 1–2 endometrial cancer. Only 50% of respondents perform intraoperative sentinel lymph node mapping for grade 3 endometrial cancer. 90% of respondents give chemotherapy-based adjuvant treatment for advanced endometrial cancer. 75% of respondents combine radiation therapy with chemotherapy in stage III endometrial cancer.

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“…The older pooled analysis of the NSGO-EORTC and MANGO-ILIADE trials used sequential chemotherapy and radiotherapy (either sequence) and reported significantly longer recurrence-free survival compared with radiotherapy alone [318]. Multiple retrospective studies indicated a survival benefit in advanced-stage endometrial carcinoma patients treated with post-operative combined treatment including radiotherapy and chemotherapy, delivered by either the sandwich or sequential method, compared to radiotherapy alone or chemotherapy alone [325][326][327][328][329][330][331][332][333][334][335][336][337][338][339][340][341][342][343].…”

Section: High Riskmentioning

confidence: 99%

ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma

Concin

Matías‐Guiu

Vergote

et al. 2021

Radiotherapy and Oncology

125

158

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A European consensus conference on endometrial carcinoma was held in 2014 to produce multidisciplinary evidence-based guidelines on selected questions. Given the large body of literature on the management of endometrial carcinoma published since 2014, the European Society of Gynaecological Oncology (ESGO), the European SocieTy for Radiotherapy & Oncology (ESTRO) and the European Society of Pathology (ESP) jointly decided to update these evidence-based guidelines and to cover new topics in order to improve the quality of care for women with endometrial carcinoma across Europe and worldwide. ESGO/ESTRO/ESP nominated an international multidisciplinary development group consisting of practicing clinicians and researchers who have demonstrated leadership and expertise in the care and research of endometrial carcinoma (27 experts across Europe). To ensure that the guidelines are evidence-based, the literature published since 2014, identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the

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Adjuvant combined-modality therapy for stage IIIC endometrioid and non-endometrioid endometrial cancer

Cited by 25 publications

References 21 publications

Lymph Node Number Predicts the Efficacy of Adjuvant Chemoradiotherapy in Node-Positive Endometrial Cancer Patients

Lymph Node Number Predicts the Efficacy of Adjuvant Chemoradiotherapy in Node-Positive Endometrial Cancer Patients

Current practice patterns in nodal evaluation and adjuvant treatment of advanced stage endometrioid endometrial cancer: An SGO survey

ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma

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