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 language | English (US) |
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Pages (from-to) | 41-48 |
Number of pages | 8 |
Journal | Gynecologic oncology |
Volume | 153 |
Issue number | 1 |
DOIs | |
State | Published - Apr 2019 |
Funding
We acknowledge the NCDB for collecting the data used in these analyses. The NCDB and the participating hospitals are the source of the data. The NCDB has not verified and are not responsible for the statistical validity of the data analysis or conclusions. Dr. Matei reports personal fees from Astra Zeneca, Genentech/Roche, Tesaro, Astex, Clovis, and the European commission that are outside the submitted work. All other authors report no conflicts of interest. Conceptualization: Goodman, Seagle, Strauss. Formal Analysis and Methodology: Goodman, Strauss, Hatoum, Seagle. Writing – Original Draft: Goodman, Hatoum; Writing – Review and Editing: Goodman, Hatoum, Seagle, Barber, Matei, Strauss. Project Administration: Hatoum, Donnelly, Barber, Matei, Shahabi, Strauss. Supervision: Strauss, Shahabi.
Keywords
- Chemotherapy
- Endometrial cancer
- Radiotherapy
ASJC Scopus subject areas
- Obstetrics and Gynecology
- Oncology