[Preliminary study of sequential multi-modality adjuvant chemotherapy and radiation for advanced endometrial cancer]

Objective: To evaluate the clinical outcomes and feasibility of multi-modality adjuvant chemotherapy and radiation, which was conducted as postoperative chemotherapy, radiation, and consolidation chemotherapy (CRC) mode for the treatment of advanced endometrial cancer. Methods: A retrospective analysis of 124 patients with International Federation of Gynecology and Obstetrics (FIGO) stages Ⅲ and Ⅳ endometrial cancer from Jan. 2004 to Oct. 2012 was conducted in Peking University People's Hospital and Beijing Obstetrics and Gynecology Hospital. Inclusion criteria were comprehensive staging procedure including hysterectomy, bilateral salpingo-oophorectomy, and (or) selective pelvic aortic lymphadenectomy, and treatment with adjuvant chemotherapy and (or) radiation. The average age of these patients was (55.9±8.4) years old (range from 23 to 79 years old). According to different postoperative adjuvant treatment modes, the patients were divided into CRC group, chemotherapy-radiotherapy (CR) group and single chemotherapy (C) group. The survival and side effects of the three groups were compared. Results: (1) One hundred and twenty-four patients with advanced stage endometrial cancer were identified and received postoperative adjuvant therapies.Sixty-one (49.2%, 61/124) cases of them received postoperative CRC fashion, 19 (15.3%, 19/124) received postoperative CR and 44 (35.5%, 44/124) cases received C. The age, stage, grade and type of surgery of the three groups were not significantly different (all P>0.05); while, the pathology, chemotherapy cycles and chemotherapy regimens differed significantly (all P<0.05). (2) The progression-free survivals (PFS) of the patients with CRC, CR, and C group were (121±7), (68±15), and (100±11) months, respectively. The 3-year PFS rates were 87.9%, 43.7%, and 61.4%, respectively. The 5-year PFS rates were 82.2%, 36.4%, and 61.4%, respectively. The above indicators were significantly higher in the CRC group than in the CR group (all P<0.01), and there was no difference between the CRC group and the C group (P=0.037). The overall survival (OS) of patients with CRC, CR, and C group were (128±6), (80±12), and (99±10) months, respectively. The 3-year OS rates were 87.8%, 72.4%, and 67.1%, the 5-year OS rate were 84.2%, 54.3%, and 64.1%, respectively. The above indicators were significantly higher in the CRC group than those in the CR group and C group (all P<0.01). (3) There was no difference in the frequency of adverse effects either chemotherapy, such as severe bone suppression or radiotherapy; hepatotoxicity,blood transfusion, dose modifications; or cycle delays between the CRC, CR and C group (all P>0.05). (4) In the univariate analysis shown that, stage, the fashion of postoperative adjuvant therapy and type of surgery were risk factors for tumor progression in patients with advanced endometrial cancer (P<0.05). After adjusted for FIGO stage and type of surgery, the tumor progression hazard ratio (HR) was 3.931 (95%CI: 1.734-8.914, P=0.001) for the CR group and 2.188 (95%CI: 1.010-4.741, P=0.047) for the C group, compared to the CRC group. Conclusion: Sequential CRC delivered in a "sandwich" fashion for the treatment in advanced endometrial cancer could significantly improve the 3-year and 5-year OS rates and have a similar adverse effect profile compared with other sequencing modalities.