J Gynecol Oncol.  2019 May;30(3):e28. 10.3802/jgo.2019.30.e28.

A multi-institutional analysis of sequential versus ‘sandwich’ adjuvant chemotherapy and radiotherapy for stage IIIC endometrial carcinoma

• Onal C
• Sari SY
• Yildirim B
• Yavas G
• Gultekin M
• Guler OC
• Akyurek S
• Yildiz F

• KMID: 2440512
• DOI: http://doi.org/10.3802/jgo.2019.30.e28

Abstract

OBJECTIVE
To analyze the outcomes of sequential or sandwich chemotherapy (ChT) and radiotherapy (RT) in patients with node-positive endometrial cancer (EC).
METHODS
Data from 4 centers were collected retrospectively for 179 patients with stage IIIC EC treated with postoperative RT and ChT (paclitaxel and carboplatin). Patients were either treated with 6 cycles of ChT followed by RT (sequential arm; 96 patients) or with 3 cycles of ChT, RT, and an additional 3 cycles of ChT (sandwich arm; 83 patients). Prognostic factors affecting overall survival (OS) and progression-free survival (PFS) were analyzed.
RESULTS
The 5-year OS and PFS rates were 64% and 59%, respectively, with a median follow-up of 41 months (range, 5-167 months). The 5-year OS rates were significantly higher in the sandwich than sequential arms (74% vs. 56%; p=0.03) and the difference for 5-year PFS rates was nearly significant (65% vs. 54%; p=0.05). In univariate analysis, treatment strategy, age, International Federation of Gynecology and Obstetrics (FIGO) stage, pathology, rate of myometrial invasion, and grade were prognostic factors for OS and PFS. In multivariate analysis, non-endometrioid histology, advanced FIGO stage, and adjuvant sequential ChT and RT were negative predictors for OS, whereas only non-endometrioid histology was a prognostic factor for PFS.
CONCLUSION
Postoperative adjuvant ChT and RT for stage IIIC EC patients, either given sequentially or sandwiched, offers excellent clinical efficacy and acceptably low toxicity. Our data support the superiority of the sandwich regimen compared to the sequential strategy in stage IIIC EC patients for OS.

Keyword

Endometrial Cancer; Surgery; Radiotherapy; Chemotherapy; Lymphatic Metastasis

MeSH Terms

Arm
Chemotherapy, Adjuvant*
Disease-Free Survival
Drug Therapy
Endometrial Neoplasms*
Female
Follow-Up Studies
Gynecology
Humans
Lymphatic Metastasis
Multivariate Analysis
Obstetrics
Pathology
Radiotherapy*
Retrospective Studies
Treatment Outcome

Figure

• 

  Fig. 1. (A) The OS and (B) PFS of patients treated with postoperative sandwich ChT (solid line) and adjuvant sequential ChT and RT (dashed line) in the entire cohort. ChT, chemotherapy; OS, overall survival; PFS, progression-free survival; RT, radiotherapy.

• 

  Fig. 2. (A) The OS and (B) PFS of patients treated with postoperative sandwich ChT (solid line) and adjuvant sequential ChT and RT (dashed line) for patients with non-endometrioid histology. ChT, chemotherapy; OS, overall survival; PFS, progression-free survival; RT, radiotherapy.

• 

  Fig. 3. (A) The OS and (B) PFS of patients treated with postoperative sandwich ChT (solid line) and adjuvant sequential ChT and RT (dashed line) for patients with endometrioid histology. ChT, chemotherapy; OS, overall survival; PFS, progression-free survival; RT, radiotherapy.

Reference

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