Endometrial cancer: benefit of adding radiation to adjuvant chemo in stage III-IVA

  • Xiang M & al.
  • Gynecol Oncol
  • 27 Jun 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • Addition of pelvic external beam radiotherapy (EBRT) to adjuvant chemotherapy yields a modest survival benefit in patients with stage III-IVA endometrial cancer.
  • OS benefit was significant in patients with stage IIIC2 endometrioid and IIIB-C nonendometrioid disease.

Why this matters

  • These findings suggest heterogeneity in these patients and may help identify those most likely to benefit from combined modality treatment.

Study design

  • 13,270 patients with FIGO stages III-IVA endometrial carcinoma received total hysterectomy and adjuvant chemotherapy during 2004-2016.
  • Funding: None disclosed.

Key results

  • Median follow-up, 3.7 years.
  • 43% of patients received pelvic EBRT.
  • Patients with endometrioid disease: EBRT+chemotherapy showed OS advantage vs chemotherapy alone in univariate (77% vs 72%; P<.0001 and multivariate p=".003)" analysis. style="list-style-type:circle;">
  • OS significantly improved in stage IIIC2 disease (HR, 0.73; P=.01).
  • The benefit of EBRT persisted in patients with >15 lymph nodes removed (aHR, 0.65; P=.01) or ≥5 para-aortic nodes removed (aHR, 0.56; P=.002).
  • Patients with nonendometrioid cancer: EBRT improved OS in univariate (57% vs 48%; P<.0001 and multivariate p analysis. style="list-style-type:circle;">
  • OS advantage was observed in patients with stages IIIB (aHR, 0.52; P=.01) and IIIC disease (aHR, 0.79; P<.0001>
  • The benefit of EBRT persisted in patients with >15 lymph nodes removed.
  • Limitations

    • Observational study.