Association of chemotherapy and radiotherapy sequence with overall survival in locoregionally advanced endometrial cancer

Chelain R. Goodman*, Saleh Hatoum, Brandon Luke L. Seagle, Eric D. Donnelly, Emma L. Barber, Shohreh Shahabi, Daniela E. Matei, Jonathan B. Strauss

*Corresponding author for this work

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: The optimal adjuvant management of women with FIGO Stage III-IVA endometrial cancer (EC) is unclear. While recent prospective data suggest that treatment with pelvic radiotherapy (RT) prior to chemotherapy (CT) is not associated with a survival benefit compared to CT alone, no prospective randomized trial has included a treatment arm in which CT is given before RT. Methods: An observational cohort study was performed on women with FIGO Stage III-IVA Type 1 (grade 1–2, endometrioid) EC who underwent hysterectomy and received multi-agent CT and/or RT from 2004 to 2014 at Commission on Cancer-accredited hospitals. Multivariable parametric accelerated failure time models were performed to estimate the association of sequence of adjuvant CT and RT with overall survival (OS) using propensity score-adjusted matched cohorts. Results: Of 5795 women identified, 1260 (21.7%) received RT only, 2465 (42.5%) received CT only, 593 (9.7%) received RT before CT, and 1506 (26.0%) received RT after CT. Women who received RT after CT experienced significantly longer 5-year OS than women who received RT before CT (5-year OS: 80.1% vs 73.3%; time-ratio (TR) = 1.37, 95% CI = 1.18–1.58, P < 0.001), CT only (68.9%; TR = 1.33, 95% CI = 1.19–1.48, P < 0.001), or RT only (64.5%, TR = 1.50, 95% CI = 1.32–1.70, P < 0.001). Conclusions: For women with advanced EC, treatment with multi-agent CT followed by RT is associated with longer OS compared with treatment with RT followed by CT or either treatment alone. These hypothesis-generating data support inclusion in future prospective trials of regimens in which multi-agent CT starts prior to RT.

Original languageEnglish (US)
Pages (from-to)41-48
Number of pages8
JournalGynecologic oncology
Volume153
Issue number1
DOIs
StatePublished - Apr 2019

Fingerprint

Endometrial Neoplasms
Radiotherapy
Drug Therapy
Survival
Therapeutics
Cancer Care Facilities
Propensity Score
Adjuvant Radiotherapy
Adjuvant Chemotherapy
Hysterectomy
Observational Studies
Cohort Studies

Keywords

  • Chemotherapy
  • Endometrial cancer
  • Radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Cite this

@article{73bac2ca86ab464088bd056bab4e3fa7,
title = "Association of chemotherapy and radiotherapy sequence with overall survival in locoregionally advanced endometrial cancer",
abstract = "Objective: The optimal adjuvant management of women with FIGO Stage III-IVA endometrial cancer (EC) is unclear. While recent prospective data suggest that treatment with pelvic radiotherapy (RT) prior to chemotherapy (CT) is not associated with a survival benefit compared to CT alone, no prospective randomized trial has included a treatment arm in which CT is given before RT. Methods: An observational cohort study was performed on women with FIGO Stage III-IVA Type 1 (grade 1–2, endometrioid) EC who underwent hysterectomy and received multi-agent CT and/or RT from 2004 to 2014 at Commission on Cancer-accredited hospitals. Multivariable parametric accelerated failure time models were performed to estimate the association of sequence of adjuvant CT and RT with overall survival (OS) using propensity score-adjusted matched cohorts. Results: Of 5795 women identified, 1260 (21.7{\%}) received RT only, 2465 (42.5{\%}) received CT only, 593 (9.7{\%}) received RT before CT, and 1506 (26.0{\%}) received RT after CT. Women who received RT after CT experienced significantly longer 5-year OS than women who received RT before CT (5-year OS: 80.1{\%} vs 73.3{\%}; time-ratio (TR) = 1.37, 95{\%} CI = 1.18–1.58, P < 0.001), CT only (68.9{\%}; TR = 1.33, 95{\%} CI = 1.19–1.48, P < 0.001), or RT only (64.5{\%}, TR = 1.50, 95{\%} CI = 1.32–1.70, P < 0.001). Conclusions: For women with advanced EC, treatment with multi-agent CT followed by RT is associated with longer OS compared with treatment with RT followed by CT or either treatment alone. These hypothesis-generating data support inclusion in future prospective trials of regimens in which multi-agent CT starts prior to RT.",
keywords = "Chemotherapy, Endometrial cancer, Radiotherapy",
author = "Goodman, {Chelain R.} and Saleh Hatoum and Seagle, {Brandon Luke L.} and Donnelly, {Eric D.} and Barber, {Emma L.} and Shohreh Shahabi and Matei, {Daniela E.} and Strauss, {Jonathan B.}",
year = "2019",
month = "4",
doi = "10.1016/j.ygyno.2019.01.007",
language = "English (US)",
volume = "153",
pages = "41--48",
journal = "Gynecologic Oncology",
issn = "0090-8258",
publisher = "Academic Press Inc.",
number = "1",

}

TY - JOUR

T1 - Association of chemotherapy and radiotherapy sequence with overall survival in locoregionally advanced endometrial cancer

AU - Goodman, Chelain R.

AU - Hatoum, Saleh

AU - Seagle, Brandon Luke L.

AU - Donnelly, Eric D.

AU - Barber, Emma L.

AU - Shahabi, Shohreh

AU - Matei, Daniela E.

AU - Strauss, Jonathan B.

PY - 2019/4

Y1 - 2019/4

N2 - Objective: The optimal adjuvant management of women with FIGO Stage III-IVA endometrial cancer (EC) is unclear. While recent prospective data suggest that treatment with pelvic radiotherapy (RT) prior to chemotherapy (CT) is not associated with a survival benefit compared to CT alone, no prospective randomized trial has included a treatment arm in which CT is given before RT. Methods: An observational cohort study was performed on women with FIGO Stage III-IVA Type 1 (grade 1–2, endometrioid) EC who underwent hysterectomy and received multi-agent CT and/or RT from 2004 to 2014 at Commission on Cancer-accredited hospitals. Multivariable parametric accelerated failure time models were performed to estimate the association of sequence of adjuvant CT and RT with overall survival (OS) using propensity score-adjusted matched cohorts. Results: Of 5795 women identified, 1260 (21.7%) received RT only, 2465 (42.5%) received CT only, 593 (9.7%) received RT before CT, and 1506 (26.0%) received RT after CT. Women who received RT after CT experienced significantly longer 5-year OS than women who received RT before CT (5-year OS: 80.1% vs 73.3%; time-ratio (TR) = 1.37, 95% CI = 1.18–1.58, P < 0.001), CT only (68.9%; TR = 1.33, 95% CI = 1.19–1.48, P < 0.001), or RT only (64.5%, TR = 1.50, 95% CI = 1.32–1.70, P < 0.001). Conclusions: For women with advanced EC, treatment with multi-agent CT followed by RT is associated with longer OS compared with treatment with RT followed by CT or either treatment alone. These hypothesis-generating data support inclusion in future prospective trials of regimens in which multi-agent CT starts prior to RT.

AB - Objective: The optimal adjuvant management of women with FIGO Stage III-IVA endometrial cancer (EC) is unclear. While recent prospective data suggest that treatment with pelvic radiotherapy (RT) prior to chemotherapy (CT) is not associated with a survival benefit compared to CT alone, no prospective randomized trial has included a treatment arm in which CT is given before RT. Methods: An observational cohort study was performed on women with FIGO Stage III-IVA Type 1 (grade 1–2, endometrioid) EC who underwent hysterectomy and received multi-agent CT and/or RT from 2004 to 2014 at Commission on Cancer-accredited hospitals. Multivariable parametric accelerated failure time models were performed to estimate the association of sequence of adjuvant CT and RT with overall survival (OS) using propensity score-adjusted matched cohorts. Results: Of 5795 women identified, 1260 (21.7%) received RT only, 2465 (42.5%) received CT only, 593 (9.7%) received RT before CT, and 1506 (26.0%) received RT after CT. Women who received RT after CT experienced significantly longer 5-year OS than women who received RT before CT (5-year OS: 80.1% vs 73.3%; time-ratio (TR) = 1.37, 95% CI = 1.18–1.58, P < 0.001), CT only (68.9%; TR = 1.33, 95% CI = 1.19–1.48, P < 0.001), or RT only (64.5%, TR = 1.50, 95% CI = 1.32–1.70, P < 0.001). Conclusions: For women with advanced EC, treatment with multi-agent CT followed by RT is associated with longer OS compared with treatment with RT followed by CT or either treatment alone. These hypothesis-generating data support inclusion in future prospective trials of regimens in which multi-agent CT starts prior to RT.

KW - Chemotherapy

KW - Endometrial cancer

KW - Radiotherapy

UR - http://www.scopus.com/inward/record.url?scp=85059944609&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85059944609&partnerID=8YFLogxK

U2 - 10.1016/j.ygyno.2019.01.007

DO - 10.1016/j.ygyno.2019.01.007

M3 - Article

C2 - 30660345

AN - SCOPUS:85059944609

VL - 153

SP - 41

EP - 48

JO - Gynecologic Oncology

JF - Gynecologic Oncology

SN - 0090-8258

IS - 1

ER -