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 journalArticlepeer-review

25 Scopus citations


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
Issue number1
StatePublished - Apr 2019


  • Chemotherapy
  • Endometrial cancer
  • Radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology


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