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

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

*Corresponding author for this work

Research output: Contribution to journalArticle

2 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 1 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 Donald} and Emma Barber and Shohreh Shahabi and Matei, {Daniela Elena} and Strauss, {Jonathan B}",
year = "2019",
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language = "English (US)",
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Association of chemotherapy and radiotherapy sequence with overall survival in locoregionally advanced endometrial cancer. / Goodman, Chelain R.; Hatoum, Saleh; Seagle, Brandon Luke L.; Donnelly, Eric Donald; Barber, Emma; Shahabi, Shohreh; Matei, Daniela Elena; Strauss, Jonathan B.

In: Gynecologic oncology, Vol. 153, No. 1, 01.04.2019, p. 41-48.

Research output: Contribution to journalArticle

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 Donald

AU - Barber, Emma

AU - Shahabi, Shohreh

AU - Matei, Daniela Elena

AU - Strauss, Jonathan B

PY - 2019/4/1

Y1 - 2019/4/1

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

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