Journal Browser Advanced Search Help
Journal Browser Advanced search HELP
J Gynecol Oncol. 2019 May;30(3):e28. English. Original Article. https://doi.org/10.3802/jgo.2019.30.e28
Onal C , Sari SY , Yildirim BA , Yavas G , Gultekin M , Guler OC , Akyurek S , Yildiz F .
Department of Radiation Oncology, Baskent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Treatment Center, Adana, Turkey. hcemonal@hotmail.com
Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Department of Radiation Oncology, Selcuk University Faculty of Medicine, Konya, Turkey.
Department of Radiation Oncology, Ankara University Faculty of Medicine, Ankara, Turkey.
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.

Copyright © 2019. Korean Association of Medical Journal Editors.