Changing trends in the management of early stage endometrial cancer over the past decade: Experience from a tertiary cancer center

Abstract

Objectives: Treatment of locally advanced endometrial cancer is not well established. The “sandwich” approach offers combination treatment with chemotherapy and radiation. The aim of this study was to evaluate overall survival (OS) and progression-free survival (PFS) between two “sandwich” protocols. Methods: Patients were retrospectively identified between 2006 and 2013 at a single institution. Clinical information was abstracted, including age, body mass index (BMI), surgical debulking method, “sandwich” protocol, disease status, and complications. OS and PFS were calculated using Kaplan–Meier method. Results: A total of 58 patients with high-grade and/or advanced-stage disease were identified who received “sandwich” therapy. The median agewas 61 years (range, 29– years).Median BMIwas 31.9 (range, 19.5– 56.1). All patients had no residual disease after surgical debulking, 19% by laparotomy and 81% by laparoscopy. Twenty-four patients received a “sandwich” protocol of 2 cycles of platinum/taxane chemotherapy followed by radiation and concurrent cisplatin, followed by 2 cycles of platinum/taxane chemotherapy. Thirty-four patients received a 3-cycle platinum/taxane “sandwich” around radiation therapy alone. Among patients treated with the 2-cycle protocol, 75% (18/24) remain with no evidence of disease (NED), 17% are alive with disease (AED), and 8% are dead of disease (DOD). Median time to recurrence was 12 months (range, 1–39 months). Among patients treated with the 3-cycle protocol, 82% (28/34) remain with NED, 6% are AED, and 12% are DOD. Median time to recurrence was 7 months (range, 4–44 months). PFS of the 2-cycle protocol was 12 months (range, 1–39months) compared to 7 months (range, 4–44months) in the 3-cycle protocol (P=0.12). The OS of the 2-cycle protocol was 22 months (range, 7–65 months) compared to 33 months (range, 11–100 months) in the 3-cycle protocol (P= 0.76). Complications included pulmonary embolism in seven patients (4/7 in 2-cycle, 3/7 in 3 cycles) and severe grade 3/4 neutropenia in five patients (4/5 in 2-cycle, 1/5 in 3-cycle). Conclusions: Optimizing care for locally advanced disease is challenging. In our study, no statistically significant difference was shown in PFS and OS between protocols. The concurrent use of cisplatin with radiation therapy needs to be further studied because it may provide the same efficacy in fewer chemotherapy cycles.