Abstract
BackgroundPatients with International Federation of Gynaecology and Obstetrics (FIGO) stage III endometrial cancer (EC) have a substantial risk of adverse outcomes. After surgery, adjuvant therapy is recommended with external beam radiotherapy (EBRT), chemotherapy (CT) or both EBRT and CT. Recent trials suggest that EBRT + CT is superior to EBRT or CT alone but also results in more toxicity. We have compared the outcome of different adjuvant treatments in a population-based cohort to identify subgroups that benefit most from EBRT + CT. MethodsAll patients diagnosed with FIGO stage III EC and treated with surgery in 2005–2016 were identified from the Netherlands Cancer Registry. The primary outcome was overall survival (OS); associations with adjuvant treatment were analysed using Cox regression analysis. ResultsAmong 1241 eligible patients, EBRT + CT was associated with a better OS than CT (hazard ratio [HR] = 1.84, 95% confidence interval [CI] = 1.34–2.52) and EBRT alone (HR = 1.37, 95% CI = 1.05–1.79). In stage IIIC, there was a significant benefit of EBRT + CT compared with CT or EBRT alone. In stage IIIA–B, there was no difference between EBRT + CT or EBRT alone. In endometrioid EC (EEC) and carcinosarcomas, EBRT + CT was associated with a better OS than CT or EBRT alone. For uterine serous cancers, there was no survival benefit of EBRT + CT over CT. In all analysis by stage and histology, any adjuvant treatment was superior to no adjuvant therapy. ConclusionsIn this population-based study, adjuvant EBRT + CT was associated with improved OS compared with CT or EBRT alone in FIGO stage IIIC EC, EEC and carcinosarcoma. This suggests that application of EBRT + CT in stage III should be further stratified according to these subgroups.
Highlights
Endometrial cancer (EC) is the most common gynaecological malignancy in developed countries, affecting approximately 380,000 women annually worldwide [1]
In this population-based study, we have shown that the administration of adjuvant CT, external beam radiotherapy (EBRT) or EBRT þ CT is associated with improved overall survival (OS) compared with no adjuvant therapy in stage III endometrial cancer (EC), with the highest impact for EBRT þ CT
After stratification for stage, EBRT þ CT resulted in a better OS than EBRT or CT alone in Federation of Gynaecology and Obstetrics (FIGO) stage IIIC EC, but not in stage IIIA and IIIB disease
Summary
Endometrial cancer (EC) is the most common gynaecological malignancy in developed countries, affecting approximately 380,000 women annually worldwide [1]. The appropriate adjuvant treatment strategy for patients with stage III disease is still under debate, resulting in widespread variation in application of external beam radiotherapy (EBRT), chemotherapy (CT) and EBRT þ CT [6e11]. The GOG-258 study randomised 715 patients with stage III EC to EBRT þ CT or CT alone and observed a non-significant difference in progression-free survival of 59% for patients treated with EBRT þ CT versus 58% in patients treated with CT alone [13]. Data of this trial on OS are not yet presented.
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