Combined chemotherapy and radiation improves survival for node-positive endometrial cancer

Abstract

Objective To evaluate the clinical outcomes for women with node-positive endometrioid adenocarcinoma of the uterus Methods Records were reviewed for 66 patients with Stage IIIC endometrioid adenocarcinoma diagnosed between 1/1995 and 12/2009. Study inclusion required TAH, BSO and negative chest imaging. Papillary serous and clear cell histologies were excluded. Adjuvant treatment was external beam radiation (RT) alone in 18 patients (27%), combined chemotherapy and RT in 44 (67%), chemotherapy alone in 1 (2%), and no adjuvant therapy in 3 (5%). The median follow-up was 48 months. Results Of 66 patients, 56 (85%) had positive pelvic nodes only, 5 (8%) had positive para-aortic nodes only, and 5 (8%) had both. Of the 62 patients who received adjuvant RT, only 4 (6%) had an in-field recurrence, including 2 with residual disease after surgery. Disease-free (DFS) and overall (OS) survival rates at 5 years were 71% and 81%, respectively. By adjuvant treatment modality, 5-year DFS and OS rates were 63% and 67% for RT alone and 79% and 90% for combined modality therapy (p=0.15 and p<0.01). On multivariate analysis, combined modality therapy significantly improved DFS (HR 0.12, 95% CI 0.03–0.49, p<0.01) and OS (HR 0.20, 95% CI 0.05–0.75, p=0.02) compared to adjuvant RT alone. Conclusions Compared to RT alone, combined modality therapy decreased recurrence and improved survival in patients with node-positive endometrioid adenocarcinoma of the uterus. In addition, external beam RT resulted in excellent local and regional control. Future studies are needed to define the optimal chemotherapy regimen, sequencing, and radiation fields.

Adjuvant Carboplatin, Paclitaxel, and Vaginal Cuff Brachytherapy for Stage III Endometrial Cancer

“…For these patients, strategies that combine chemotherapy and external beam radiotherapy seem promising, particularly in stage IIIC patients, with 3-year to 5-year DFS rates ranging from 73% to 79% and OS from 73% to 90%. 6,7,12,16,21 For high-risk histologies, potential use of systemic targeted agents and small molecules 22,23 is being actively investigated at this institution and others.…”

A multicenter analysis of adjuvant therapy after surgery for stage IIIC endometrial adenocarcinoma: A Korean Radiation Oncology Group study (KROG 13-17)

“…They reported that both treatment modalities resulted in comparable outcomes, and RT delayed local relapse, while CT delayed metastasis. Lee and Viswanathan [17] published the results of 66 patients with stage IIIC endometrioid adenocarcinoma according to RT alone versus CTRT treatment modalities. The authors reported that, of the 62 patients who received adjuvant RT, only 4 (6%) had an in-field recurrence.…”

ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: Diagnosis, Treatment and Follow-up

“…Patients with up to 2 cm residual disease were included in this trial, suggesting that the dose delivered with whole abdominal irradiation is not effective for macroscopic disease and is toxic. In view of findings from the pooled NSGO/EORTC/Iliace trials140 as well as results from prospective and retrospective trials,141,154,155,157,158 the use of combined RT and chemotherapy is recommended as opposed to either alone. Results of the recently completed GOG258 for stage III-IV endometrial cancer are awaited to see if the combination of EBRT and chemotherapy, as also evaluated in PORTEC-3, does indeed improve PFS and OS compared with chemotherapy alone.…”