Randomized phase III trial of pelvic radiotherapy versus cisplatin-based combined chemotherapy in patients with intermediate- and high-risk endometrial cancer: A Japanese Gynecologic Oncology Group study

Susumu, Nobuyuki; Sagae, Satoru; Udagawa, Yasuhiro; Niwa, Koichiro; Kuramoto, Hiroyuki; Satoh, Shinji; Kudo, Ryuichi

doi:10.1016/j.ygyno.2007.09.029

Cited by 423 publications

(277 citation statements)

References 17 publications

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“…No separate analysis was performed in the subset of the 90 women with stage Ic (FIGO 1988) disease and in the subset of the 31 women with stage II disease. The Japanese GOG study, which included 385 women with intermediate-and high-risk endometrioid carcinoma with more than 50% myometrial invasion, failed to detect any difference in progression-free survival and overall survival between chemotherapy and EBRT in the group of patients with FIGO stage Ic (1988) G 1-2 disease under 70 years old [23]. Conversely, chemotherapy achieved a significantly better progression-free survival (83.8% versus.…”

Section: Discussionmentioning

confidence: 97%

“…Therefore VBT could be the adjuvant treatment of choice in this clinical setting. Four randomized trials compared adjuvant platinum based chemotherapy to radiotherapy in high-risk endometrial cancer [22,23,29,30]. The pooled data meta-analyses showed a significant improvement in terms of progression-free survival (HR = 0.80; 95%CI = 0.66-0.97) and overall survival (HR = 0.76, 95% CI = 0.62-0.92) for chemotherapy arm [24].…”

Section: Discussionmentioning

confidence: 99%

“…Although recurrent disease occurs in less than 20% of patients with clinically early endometrial cancer, most of these failures involve distant sites. Postoperative platinum-based chemotherapy reduces the risk of developing the first recurrence outside the pelvis [22][23][24], and the pooled analysis of two randomized clinical trials (NSGO-EC-9501/ EORTC-55991 and MANGO ILIADE-III) has shown that the addition of adjuvant chemotherapy to radiotherapy improves progression-free survival in operated endometrial cancer patients with no residual tumor and a high-risk profile [25]. However most studies comparing adjuvant chemotherapy versus adjuvant radiotherapy or sequential adjuvant chemotherapy and radiotherapy versus adjuvant radiotherapy included heterogenous groups of women, i.e.…”

Section: Introductionmentioning

confidence: 99%

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Adjuvant treatment and analysis of failures in patients with high-risk FIGO Stage Ib–II endometrial cancer: An Italian multicenter retrospective study (CTF study)

Gadducci

Cosio

Landoni

et al. 2014

Gynecologic Oncology

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• Adjuvant chemotherapy reduces the risk of distant recurrences in patients with high-risk, early-stage endometrial cancer with negative pelvic nodes.• The sequential administration of adjuvant chemotherapy and radiotherapy achieves excellent local and distant control of disease in this clinical settings. Objectives. The purpose of this retrospective study was to assess the clinical outcome of patients with highrisk, early-stage endometrioid endometrial cancer (stage Ib or II with myometrial invasion N 50%, grade 2-3). a b s t r a c t a r t i c l e i n f oMethods. We assessed 192 patients who underwent hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy, had histologically negative pelvic nodes, and had negative CT findings for aortic node involvement.Results. Tumor relapsed in 36 patients after a median time of 21.2 months. The recurrence was vaginal in 7 (19.4%), distant in 16 (44.4%), aortic in 8 (22.2%), and involved multiple sites in 5 (13.9%). There was a trend to a lower vaginal recurrence rate in the 143 patients who received adjuvant radiotherapy (+chemotherapy) compared with the 46 who did not (2.1% versus 8.7%). Distant or aortic recurrences were lower in the 37 patients who received adjuvant chemotherapy (+radiotherapy) than in the 152 who did not (2.7% versus 18.4%, p = 0.02). Of the 29 patients who received sequential adjuvant chemotherapy and radiotherapy, none developed local recurrence and only one had distant recurrence. There was a trend for a better 5-year progression-free survival and overall survival for the patients who received chemotherapy (+ radiotherapy) compared with those who did not (86.0% versus 71.3%, and 92.3% versus 75.6%, respectively).Conclusions. Our data appear to suggest that adjuvant chemotherapy reduces the risk of distant or aortic recurrences and that sequential adjuvant chemotherapy and radiotherapy achieve an excellent local and distant control of disease in these clinical settings.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Adjuvant treatment and analysis of failures in patients with high-risk FIGO Stage Ib–II endometrial cancer: An Italian multicenter retrospective study (CTF study)

Gadducci

Cosio

Landoni

et al. 2014

Gynecologic Oncology

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“…No PFS or OS difference was seen betweenthe two arms [19]. Afterrandomizing 475patients to chemotherapy or RT, the Japanese GOG concluded that chemotherapy had no PFS or OS benefit over RT [20]. In their ad hoc analysis, they found that chemotherapy significantly improved PFS and overall survival in a "high-to-intermediaterisk group" (stage IC in patients over 70 years or with grade 3 or stage II or IIIA with positive cytology) (PFS was 84% vs. 66%, p 5 .024; and OS was 90% vs. 74%, p 5 .006).…”

Section: Combined Adjuvant Chemotherapy and Radiationmentioning

confidence: 99%

Adjuvant Therapy in Early-Stage Endometrial Cancer: A Systematic Review of the Evidence, Guidelines, and Clinical Practice in the U.S.

et al. 2014

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Endometrial cancer is the most common gynecologic malignancy in the U.S., with an increasing incidence likely secondary to the obesity epidemic. Surgery is usually the primary treatment for early stage endometrial cancer, followed by adjuvant therapy in selected cases. This includes radiation therapy [RT] with or without chemotherapy, based on stratification of patients into categories dependent on their future recurrence risk. Several prospective trials (PORTEC-1, GOG#99, and PORTEC-2) have shown that the use of adjuvant RT in the intermediate risk (IR) and the high-intermediate risk (HIR) groups decreases locoregional recurrence (LRR) but has no effect on overall survival. The ad hoc analyses from these studies have shown that an even larger LRR risk reduction was seen within the HIR group compared with the IR group. Vaginal brachytherapy is as good as external beam radiotherapy in controlling vaginal relapse where the majority of recurrence occur, and with less toxicity. In the high-risk group, multimodality therapy (chemotherapy and RT) may play a significant role. Although adjuvant RT has been evaluated in many cost-effectiveness studies, highquality data in this area are still lacking.The uptake of the above prospective trial results in the U.S. has not been promising. Implications for Practice: Several phase III randomized controlled trials have shown that adjuvant radiation for highintermediate risk early-stage endometrial cancer confers a benefit by reducing local regional recurrence with minimal added toxicity, but at increased cost and without significant overall survival benefit. This article reviews key trials regarding adjuvant radiation in early stage endometrial cancer and summarizes current clinical practice patterns and available guidelines. These facets must be considered and reviewed with each patient individually to determine the relative benefit to each patient.

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“…Regular 28 Similarly Japanese GOG study on comparing chemotherapy with radiotherapy in patients with stages IC to IIIC endometrioid adenocarcinoma concluded that chemotherapy had no benefit progression-free or overall survival over RT. 29 Published phase III studies have shown the efficacy of chemotherapy with cisplatin and doxorubicin or carboplatin and paclitaxel in advanced uterine cancer. 30 The results of two additional GOG studies 249 and 258, examining the role of adjuvant chemoradiotherapy in the treatment of endometrial carcinoma are awaited by 2017.…”

Section: Stage I Low Riskmentioning

confidence: 99%

Controversies in the management of early endometrial carcinoma: an update

Rani¹,

Begum²,

Reddy³

2017

Int J Reprod Contracept Obstet Gynecol

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Endometrial carcinoma (EC) is the commonest genital tract malignancy in developing countries and is usually confined to the uterus at the time of diagnosis with excellent prognosis and high cure rates. But the management is associated with lot of controversies like in staging, best surgical approach, extent of lymphadenectomy, adjuvant therapy, fertility sparing surgery in young women etc. A thorough surgical staging is important to determine uterine and extrauterine spread and also understanding of the pathophysiology and management strategies to identify women who are at high risk and tailoring the adjuvant treatment if necessary without increasing the morbidity. This evidence based narrative review conducted by searching Medline (1994- 2015) and other online articles from Pubmed, Google scholar. Articles were selected based on their currency and relevance to the discussion they summarize the current literature to provide an approach to best practice management of early endometrial carcinoma.

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Randomized phase III trial of pelvic radiotherapy versus cisplatin-based combined chemotherapy in patients with intermediate- and high-risk endometrial cancer: A Japanese Gynecologic Oncology Group study

Cited by 423 publications

References 17 publications

Adjuvant treatment and analysis of failures in patients with high-risk FIGO Stage Ib–II endometrial cancer: An Italian multicenter retrospective study (CTF study)

Adjuvant treatment and analysis of failures in patients with high-risk FIGO Stage Ib–II endometrial cancer: An Italian multicenter retrospective study (CTF study)

Adjuvant Therapy in Early-Stage Endometrial Cancer: A Systematic Review of the Evidence, Guidelines, and Clinical Practice in the U.S.

Controversies in the management of early endometrial carcinoma: an update

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