Abstract
Background: Aim was to evaluate the additional benefit of adjuvant chemotherapy in patients of early stage endometrial carcinoma (EC) with adverse features. Materials and methods: Between June 2006 and July 2011, 56 patients with EC after surgery were randomized to receive either adjuvant radiotherapy (RT) [35 patients] or adjuvant sequential chemotherapy and radiotherapy (CRT) [21 patients]. Median age was 57.6 years (40-80). Predominant stages were FIGO IB (44.6%) and IIA (26.7%). Mean body mass index was 35.9 kg/m2 (23-72). Results: Median follow-up was 55 months (6-60). The Kaplan-Meier estimates for loco regional control (LRC), distant metastasis control (DMC) and overall survival (OS) for RT and CRT arms were; 85.7% vs. 74.2% (p 0.04), 85.7% vs. 85.7% (p 0.9) and 82.8% vs. 81% (p 0.8) respectively. Patients in CRT arm had earlier and higher pelvic recurrences {hazard ratios of 2.21 (1.45-7.85)}. Acute hematological grade3 toxicity was higher in CRT arm (9.5%) and no difference in acute or delayed non-hematological toxicities was seen between two arms. Conclusion: Adjuvant chemotherapy in patients with EC after surgery is associated with inferior LRC and no additional benefit in DMC and OS. If adjuvant chemotherapy is considered it shall be given after adjuvant radiotherapy.
Highlights
Endometrial carcinoma (EC) is the tenth most common and the second most common gynecologic malignancy in women in the Saudi Arabia [1]
The Kaplan-Meier estimates for loco regional control (LRC), distant metastasis control (DMC) and overall survival (OS) for RT and chemotherapy and radiotherapy (CRT) arms were; 85.7% vs. 74.2% (p 0.04), 85.7% vs. 85.7% (p 0.9) and 82.8% vs. 81% (p 0.8) respectively
Adjuvant chemotherapy in patients with endometrial carcinoma (EC) after surgery is associated with inferior LRC and no additional benefit in DMC and OS
Summary
Endometrial carcinoma (EC) is the tenth most common and the second most common gynecologic malignancy in women in the Saudi Arabia [1]. Randomized trials by Post-operative Radiation therapy in endometrial cancer (PORTEC) and Gynecological Oncology Group 99 (GOG-99) have shown significant reduction of the risk of pelvic and vaginal recurrence by adjuvant radiotherapy, a survival benefit is not yet proven [4,5]. Large randomized trial of Gynecologic Oncology Group (GOG 122) has shown the improvement in both progression free survival (PFS) and overall survival (OS) at 52 months with the use of adjuvant chemotherapy alone compared with adjuvant radiotherapy in stage III and IV patients (without evidence of hematogenous metastases) after surgery [6]. Two large randomized trials have shown that adjuvant chemotherapy alone was not better than adjuvant radiotherapy alone with no difference in PFS and OS rates in patients with early stage EC [7,8]. Aim was to evaluate the additional benefit of adjuvant chemotherapy in patients of early stage endometrial carcinoma (EC) with adverse features
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