Cisplatin, doxorubicin and cyclophosphamide (PAC) followed by radiation therapy in high-risk endometrial carcinoma

Abstract

Gabriele A, Lissoni A, Cormio G, Zanetta G, Colombo A, Pasta F, Landoni F. Cisplatin, doxorubicin and cyclophosphamide (PAC) followed by radiation therapy in high-risk endometrial carcinoma. Int J Gynecol Cancer 1998; 8: 397–402. To assess the feasibility, toxicity, failure patterns and impact on survival of chemotherapy followed by radiation therapy for high-risk endometrial cancer, a review of clinical records and a computerized database of patients who received postoperative chemotherapy with cisplatin, doxorubicin and cyclophosphamide followed by external beam radiotherapy for high-risk endometrial carcinoma was performed. Nineteen stage III and two stage IV endometrial carcinoma patients received postoperative chemotherapy followed by radiotherapy. Overall, 73 courses of chemotherapy were administered, with a median of three cycles per patient. Irradiation was administered to the standard pelvic fields in node negative patients or in those with pelvic node involvement only. The volume of radiation was extended to the peri-aortic area in subjects with positive aortic lymph nodes. A median of 50.4 Gy external beam radiation was delivered to the pelvis. This therapeutic sequence was well tolerated, with only two patients requiring discontinuation of radiation therapy. With a median follow-up of 85 months, 12 patients (57.1%) have presented with recurrent tumor. Patients with deep myometrial invasion had a worse prognosis than subjects with initial infiltration of the myometrium (P= 0.047). Among patients who relapsed, no statistically significant difference in survival is reported for those with different types of recurrence. Postoperative chemotherapy with cisplatin, doxorubicin and cyclophosphamide followed by external beam radiation therapy is feasible and well tolerated. Although our results confirm previously reported data, postsurgical therapy still remains controversial. A randomized study comparing the standard radiotherapy with chemotherapy followed by radiation therapy regimen is needed.