J Gynecol Oncol.  2015 Oct;26(4):284-292. 10.3802/jgo.2015.26.4.284.

Adjuvant sequential chemo and radiotherapy improves the oncological outcome in high risk endometrial cancer

• Signorelli M
• Lissoni AA
• De Ponti E
• Grassi T
• Ponti S
• Fruscio R

• KMID: 2345919
• DOI: http://doi.org/10.3802/jgo.2015.26.4.284

Abstract

OBJECTIVE
Evaluation of the impact of sequential chemoradiotherapy in high risk endometrial cancer (EC).
METHODS
Two hundred fifty-four women with stage IB grade 3, II and III EC (2009 FIGO staging), were included in this retrospective study.
RESULTS
Stage I, II, and III was 24%, 28.7%, and 47.3%, respectively. Grade 3 tumor was 53.2% and 71.3% had deep myometrial invasion. One hundred sixty-five women (65%) underwent pelvic (+/- aortic) lymphadenectomy and 58 (22.8%) had nodal metastases. Ninety-eight women (38.6%) underwent radiotherapy, 59 (23.2%) chemotherapy, 42 (16.5%) sequential chemoradiotherapy, and 55 (21.7%) were only observed. After a median follow-up of 101 months, 78 women (30.7%) relapsed and 91 women (35.8%) died. Sequential chemoradiotherapy improved survival rates in women who did not undergo nodal evaluation (disease-free survival [DFS], p=0.040; overall survival [OS], p=0.024) or pelvic (+/- aortic) lymphadenectomy (DFS, p=0.008; OS, p=0.021). Sequential chemoradiotherapy improved both DFS (p=0.015) and OS (p=0.014) in stage III, while only a trend was found for DFS (p=0.210) and OS (p=0.102) in stage I-II EC. In the multivariate analysis, only age (< or =65 years) and sequential chemoradiotherapy were statistically related to the prognosis.
CONCLUSION
Sequential chemoradiotherapy improves survival rates in high risk EC compared with chemotherapy or radiotherapy alone, in particular in stage III.

Keyword

Endometrial Neoplasms; Lymph Node Excision; Multivariate Analysis; Retrospective Studies; Survival rate

MeSH Terms

Adult
Aged
Aged, 80 and over
Chemoradiotherapy/*methods
Chemotherapy, Adjuvant/methods
Endometrial Neoplasms/*therapy
Female
Humans
Laparoscopy/methods
Lymph Node Excision/methods
Lymphatic Metastasis
Middle Aged
Radiotherapy, Adjuvant/methods
Retrospective Studies
Risk Factors
Treatment Outcome
Young Adult

Figure

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  Fig. 1 Kaplan-Meier curves for (A) disease-free and (B) overall survival according to the adjuvant treatments. RT, radiotherapy.

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  Fig. 2 Kaplan-Meier curves for (A) disease-free survival and (B) overall according to the adjuvant treatments in stage I-II and in stage III endometrial cancer. RT, radiotherapy. RT, radiotherapy.

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