Value of combined adjuvant chemotherapy and radiation on survival for stage III uterine cancer: is less radiation equal to more?

Wang, Chiachien Jake; Christie, Alana; Folkert, Michael R.; Xie, Xian Jin; Albuquerque, Kevin

doi:10.3802/jgo.2018.29.e49

Cited by 10 publications

(7 citation statements)

References 29 publications

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“…While chemotherapy use became more common, many women were treated with chemotherapy in combination with radiation, with several studies suggesting a possible trend towards improved survival among these women. 17,18,19,20 In our cohort, use of chemotherapy, with or without brachytherapy, was slightly more common than use of combination therapy.…”

Section: Discussionmentioning

confidence: 63%

Chemotherapy, Radiation, or Combination Therapy for Stage III Uterine Cancer

Syeda

Chen

Hou

et al. 2019

Obstetrics &Amp; Gynecology

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Objective-To compare the outcomes of women with stage III uterine cancer treated with chemotherapy alone, external beam radiation alone, and combination chemotherapy and radiation. Methods-The National Cancer Database was used to identify women with stage III endometrioid, serous, and clear cell uterine cancer treated with either chemotherapy (with or without vaginal brachytherapy) alone, external beam radiation (with or without brachytherapy) or combination chemotherapy and external beam radiation (with or without vaginal brachytherapy) from 2004-2015. Survival was estimated using Cox proportional hazards models and adjusted survival curves after propensity score analysis using inverse probability of treatment weighting to balance the clinical and demographic characteristics between the cohorts. Results-Of the 20,873 patients identified, 9,456 (45.3%) received chemotherapy alone, 2,417 (11.6%) were treated with radiation alone, and 9,000 (43.1%) received chemotherapy in combination with external beam radiation. Use of combination therapy was 33.0% in 2004, and then rose to 50.5% in 2015. The mortality of the cohort was 33.1% and median survival was 115 months. Within the cohort, combination therapy was associated with a 23% reduction in mortality (HR=0.77; 95% CI, 0.73-0.80) compared to chemotherapy alone. Similar findings of decreased mortality were noted in subgroup analyses for both stage IIIA (HR=0.81; 95% CI, 0.68-0.98) and stage IIIC (HR=0.79; 95% CI, 0.75-0.84) tumors. Similarly, when compared to radiation alone, combination therapy was accompanied by a 19% decrease in mortality (HR=0.

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Section: Discussionmentioning

confidence: 63%

Chemotherapy, Radiation, or Combination Therapy for Stage III Uterine Cancer

Syeda

Chen

Hou

et al. 2019

Obstetrics &Amp; Gynecology

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“…Several published data suggest that patients with stage III endometrial cancer might benefit from a combination radiotherapy-chemotherapy approach. According to Wang et al [3], who analyzed 8738 patients from the United States' National Cancer Database with (surgically staged) stage III uterine cancer who had received adjuvant treatments, concluded that chemoradiotherapy was associated with superior survival outcomes compared to monotherapy. Studies by Kuku et al [4], Marchetti et al [5], and Lee et al [27] of 90, 82, and 66 patients with stage IIIC endometrioid adenocarcinoma, respectively, all concluded that sequential chemoradiotherapy improved patient survival.…”

Section: Discussionmentioning

confidence: 99%

“…Endometrial cancer is the most common malignancy of the female genital tract; moreover, its incidence rate continues to increase [1]. Approximately one-fifth of the patients are diagnosed at an already advanced stage; the 5-year overall survival (OS) rates of those with stage III disease who are able to undergo optimal resection are 70-80% when adjuvant therapy is administered and 30-40% when it is not [2,3]. The most suitable adjuvant treatment for stage III endometrial cancer remains undefined, including the appropriate adjuvant chemotherapy, radiotherapy, or combined chemoradiotherapy options [4][5][6][7]; notably, only a few prospective studies on this topic have been performed [8,9].…”

Section: Introductionmentioning

confidence: 99%

Impact of adjuvant radiotherapy on the survival of women with optimally resected stage III endometrial cancer in the era of modern radiotherapy: a retrospective study

Chen

Huang

et al. 2020

Radiat Oncol

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Background: The optimal adjuvant treatment for stage III endometrial cancer in the era of modern radiotherapy remains undefined. We investigated the benefit of adjuvant radiotherapy for women who underwent optimal resection for stage III endometrial cancer in the era of modern radiotherapy. Methods: We retrospectively reviewed patients with endometrial cancer who were treated between 2010 and 2018. Adjuvant treatment included radiotherapy by modern radiotherapy techniques (intensity-modulated or volumetric modulated arc radiotherapy), chemotherapy, or both. Recurrence-free survival (RFS) and overall survival (OS) were calculated using the Kaplan-Meier method and analyzed via multivariate Cox proportional hazards models. Results: One hundred sixty-one patients were initially included (52, 9, and 100 with stages IIIA, IIIB, and IIIC cancer, respectively); 154 patients (96%) received adjuvant therapy. Such adjuvant treatment was associated with improved RFS (p = 0.014) and OS (p = 0.044) over surgery alone. Adjuvant radiotherapy by modern radiotherapy techniques led to low incidence of acute (25%) and chronic (7%) grade ≥ 2 gastrointestinal toxicity. On univariate analysis, non-endometrioid histology and grade 3 status were associated with higher risks of tumor recurrence and death, whereas adjuvant radiotherapy alone or in combination chemotherapy reduced their risks. On multivariate analysis, non-endometrioid histology was associated with increased recurrence (hazard ratio [HR], 2.95; p = 0.009), whereas adjuvant radiotherapy alone or with chemotherapy was associated with lower recurrence (HR, 0.62; p = 0.042). Patients > 60 years of age (p = 0.038) as well as those with endometrioid histology (p = 0.045), lymphovascular space invasion (p = 0.031), and ≥ 2 positive lymph nodes (p = 0.044) benefited most from adjuvant radiotherapy. Conclusions: Modern adjuvant radiotherapy (intensity-modulated or volumetric modulated arc radiotherapy) alone or with chemotherapy should be considered for women with optimally resected stage III endometrial cancer.

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“…Three previously published randomized trials compared adjuvant chemotherapy with radiotherapy and found no difference in overall survival and progression-free survival ( 34 – 36 ). Since pelvic relapse has been reported frequently in patients who had undergone chemotherapy alone ( 37 , 38 ), the combination of radiotherapy and chemotherapy was proposed to maximize both local and distant control ( 39 , 40 ). The updated analysis of the Postoperative Radiation Therapy in Endometrial Carcinoma 3 has exhibited significantly improved overall survival and failure-free survival in stage III patients treated with chemoradiotherapy vs. radiotherapy alone ( 41 ).…”

Section: Discussionmentioning

confidence: 99%