Stage IIIC endometrial cancer: chemotherapy first is better than concurrent CRT

  • Gynecol Oncol
  • 6 Aug 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • In patients with stage IIIC endometrial carcinoma, use of chemotherapy before external beam radiation therapy (EBRT) has increased, while the use of radiotherapy before chemotherapy decreased.
  • Chemotherapy before radiotherapy improves survival vs concurrent therapy.
  • Survival is similar with chemotherapy-radiotherapy vs radiotherapy-chemotherapy sequence.

Why this matters

  • Optimal sequence of chemoradiation is controversial in these patients; in PORTEC-3 trial, radiotherapy-chemotherapy sequence improved PFS but failed to show OS benefit. 
  • Prospective validation is needed.

Study design

  • 6981 patients with stage IIIC endometrial carcinoma treated with adjuvant chemoradiation.
  • Funding: None disclosed.

Key results

  • Median follow-up of the cohort was 43 months.
  • During 2004-2015, the use of chemotherapy before radiotherapy increased from 39.9% to 75.5%, while radiotherapy before chemotherapy decreased from 34.0% to 4.4% (P<.001>
  • Compared with chemotherapy-radiotherapy sequence, risk for mortality was:
    • higher with concurrent therapy (HR, 1.47; 95% CI, 1.31-1.66).
    • not significantly different with radiotherapy-chemotherapy sequence (HR, 1.01; 95% CI, 0.86-1.19).
  • Mortality was 25% higher (HR, 1.25; 95% CI, 1.13-1.39) in patients who received radiotherapy first (radiotherapy-chemotherapy sequence or concurrent treatment) vs chemotherapy-radiotherapy sequence.

Limitations

  • Retrospective study.