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A Multi-Institutional Analysis of Adjuvant Chemotherapy and Radiation Sequence in Women with Stage IIIC Endometrial Cancer. International journal of radiation oncology, biology, physics Hathout, L. n., Wang, Y. n., Wang, Q. n., Vergalasova, I. n., Elshaikh, M. A., Dimitrova, I. n., Damast, S. n., Li, J. Y., Fields, E. C., Beriwal, S. n., Keller, A. n., Kidd, E. A., Usoz, M. n., Jolly, S. n., Jaworski, E. n., Leung, E. W., Donovan, E. n., Taunk, N. K., Chino, J. n., Natesan, D. n., Russo, A. L., Lea, J. S., Albuquerque, K. V., Lee, L. J. 2021

Abstract

To evaluate the impact of sequence and type of adjuvant therapy for patients with stage IIIC endometrial carcinoma (EC) on outcomes.In a multi-institutional retrospective cohort study, patients with stage IIIC EC who had surgical staging and received both adjuvant chemotherapy and radiation treatment (RT) were included. Adjuvant treatment regimens were classified as: adjuvant chemotherapy followed by sequential RT (upfront chemo) which was predominant sequence, RT with concurrent chemotherapy followed by chemotherapy (concurrent), systemic chemotherapy before and after RT (sandwich), adjuvant RT followed by chemotherapy (upfront RT) or chemotherapy concurrent with vaginal cuff brachytherapy alone (chemo-brachy). Overall survival (OS) and recurrence-free survival (RFS) rates were estimated by Kaplan-Meier method.A total of 686 eligible patients were included with a median follow-up of 45.3 months. The estimated 5-year OS and RFS rates were 74% and 66%, respectively. The sequence and type of adjuvant therapy was not correlated with OS or RFS (adjusted p=0.68 and 0.84, respectively). On multivariate analysis, black race, non-endometrioid histology, grade 3 tumor, stage IIIC2, presence of adnexal and cervical involvement were associated with worse OS and RFS (all p<0.05). Regardless of the sequence of treatment, the most common site of first recurrence was distant metastasis (20.1%). Vaginal only, pelvic only and para-aortic lymph node (PALN) recurrences occurred in 11 (1.6%) ,15 (2.2 %) and 43 (6.3 %) patients, respectively. Brachytherapy alone was associated with a higher rate of PALN recurrence (15%) compared to External Beam Radiotherapy (EBRT) (5%) p<0.0001.The sequence and type of combined adjuvant therapy did not impact OS or RFS rates. Brachytherapy alone was associated with a higher rate of PALN recurrence emphasizing the role of nodal radiation for stage IIIC EC. The vast proportion of recurrences were distant despite systemic chemotherapy, highlighting the need for novel regimens.

View details for DOI 10.1016/j.ijrobp.2021.02.055

View details for PubMedID 33677053