The role of multi-modality adjuvant chemotherapy and radiation in women with advanced stage endometrial cancer

Secord, Angeles Alvarez; Havrilesky, Laura J.; Bae‐Jump, Victoria L.; Chin, Jeannette; Calingaert, Brian; Bland, Amy E.; Rutledge, Teresa; Berchuck, Andrew; Clarke‐Pearson, Daniel L.; Gehrig, Paola A.

doi:10.1016/j.ygyno.2007.06.014

Cited by 122 publications

(44 citation statements)

References 13 publications

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“…These results agree with those in several prospective and retrospective studies [46484950]. In a retrospective analysis of 356 patients with stage III and IV endometrial cancer, combined adjuvant chemotherapy and RT was associated with improved PFS and OS compared with either modality alone [51]. The recently completed GOG 258 trial for stage III–IV endometrial cancer may show whether the combination of external beam RT and chemotherapy has benefits reducing the recurrence or death compared with chemotherapy alone.…”

Section: Clinical Considerations and Recommendationssupporting

confidence: 87%

Practice guidelines for management of uterine corpus cancer in Korea: a Korean Society of Gynecologic Oncology Consensus Statement

Lee

Hong

et al. 2017

J Gynecol Oncol

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Clinical practice guidelines for gynecologic cancers have been developed by many organizations. Although these guidelines have much in common in terms of the practice of standard of care for uterine corpus cancer, practice guidelines that reflect the characteristics of patients and healthcare and insurance systems are needed for each country. The Korean Society of Gynecologic Oncology (KSGO) published the first edition of practice guidelines for gynecologic cancer treatment in late 2006; the second edition was released in July 2010 as an evidence-based recommendation. The Guidelines Revision Committee was established in 2015 and decided to produce the third edition of the guidelines as an advanced form based on evidence-based medicine, considering up-to-date clinical trials and abundant qualified Korean data. These guidelines cover screening, surgery, adjuvant treatment, and advanced and recurrent disease with respect to endometrial carcinoma and uterine sarcoma. The committee members and many gynecologic oncologists derived key questions from the discussion, and a number of relevant scientific literatures were reviewed in advance. Recommendations for each specific question were developed by the consensus conference, and they are summarized here, together with other details. The objective of these practice guidelines is to establish standard policies on issues in clinical areas related to the management of uterine corpus cancer based on the findings in published papers to date and the consensus of experts as a KSGO Consensus Statement.

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Section: Clinical Considerations and Recommendationssupporting

confidence: 87%

Practice guidelines for management of uterine corpus cancer in Korea: a Korean Society of Gynecologic Oncology Consensus Statement

Lee

Hong

et al. 2017

J Gynecol Oncol

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“…Recent publications exploring concurrent use of chemo-therapy and radiation in advanced endometrial cancer have shown promise with acceptable toxicity profiles[10,14,17,18]. Secord et al published a retrospective multicenter analysis of 45 stage III and IV endometrial cancer patients treated using the “sandwich” method.…”

Section: Resultsmentioning

confidence: 99%

A phase II trial of carboplatin and docetaxel followed by radiotherapy given in a “Sandwich” method for stage III, IV, and recurrent endometrial cancer

Geller

Ivy

Ghebre

et al. 2011

Gynecologic Oncology

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Objective. To determine feasibility and efficacy of administering docetaxel and carboplatin chemotherapy followed by pelvic radiotherapy and then consolidation chemotherapy in patients with advanced or recurrent endometrial cancer. Methods. Patients with surgically staged III–IV (excluding IIIA from positive cytology alone) endometrial cancer or biopsy confirmed recurrent disease were eligible. Treatment consisted of 3 cycles of docetaxel (75 mg/m2) and carboplatin (AUC 6) on a q21 day schedule followed by involved field irradiation (45 Gy)± brachytherapy and three additional cycles of docetaxel and carboplatin. Kaplan–Meier (KM) methods estimated overall survival (OS) and progression free survival (PFS). Results. Forty-two patients enrolled, 7 did not complete therapy. 95% (39/41) had primary disease. Median age=58 years (range: 21–81 years). 78% (32/41)=endometrioid histology. Stages=10 IIIA, 21 IIIC, 1 IVA, 7 IVB, (recurrent=1 IC, 1 IIA). There were 23 non-hematologic and 14 grade 3 and 16 grade 4 hematologic toxicities. Seven patients died following treatment with a median follow-up of 28 months (range: 7–70 months). KM estimates and 95% confidence intervals for OS at 1 year were 95% (82–99%), at 3 years 90% (75–96%), and at 5 years 71% (45–86%). Of the 39 with primary disease, 11 progressed or died within 5 years of study enrollment. KM estimates and 95% confidence intervals for PFS at 1 year were 87% (72–94%), at 3 years 71% (51–83%), and at 5 years 64% (42–80%). Conclusions. “Sandwiching” radiation between chemotherapy for advanced or recurrent endometrial cancer merits further development based on the reported PFS and OS.

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“…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%

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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The role of multi-modality adjuvant chemotherapy and radiation in women with advanced stage endometrial cancer

Cited by 122 publications

References 13 publications

Practice guidelines for management of uterine corpus cancer in Korea: a Korean Society of Gynecologic Oncology Consensus Statement

Practice guidelines for management of uterine corpus cancer in Korea: a Korean Society of Gynecologic Oncology Consensus Statement

A phase II trial of carboplatin and docetaxel followed by radiotherapy given in a “Sandwich” method for stage III, IV, and recurrent endometrial cancer

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

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