Adjuvant Chemotherapy plus Radiation for Locally Advanced Endometrial Cancer

Area of Science:

• Gynecologic Oncology
• Radiation Oncology
• Medical Oncology

Background:

• Stage III or IVA endometrial cancer presents a substantial risk for both local and systemic recurrence.
• Current treatment paradigms aim to mitigate these risks through multimodal approaches.

Purpose of the Study:

• To evaluate if a 6-month regimen of platinum-based chemotherapy combined with radiation therapy (chemoradiotherapy) improves relapse-free survival compared to chemotherapy alone in patients with stage III or IVA endometrial carcinoma.
• To assess secondary endpoints including overall survival, toxicity, and quality of life.

Main Methods:

• A randomized phase 3 trial involving eligible patients with stage III or IVA endometrial carcinoma.
• Patients were assigned to receive either 6 months of chemoradiotherapy or six cycles of combination chemotherapy alone.
• Relapse-free survival served as the primary endpoint, with a median follow-up of 47 months.

Main Results:

• At 60 months, relapse-free survival was similar between the chemoradiotherapy group (59%) and the chemotherapy-only group (58%).
• Chemoradiotherapy significantly reduced the 5-year incidence of vaginal recurrence (2% vs. 7%) and pelvic/paraaortic lymph node recurrence (11% vs. 20%).
• However, distant recurrence was more frequent in the chemoradiotherapy group (27% vs. 21%), and severe adverse events were comparable between groups (58% vs. 63%).

Conclusions:

• Combined chemoradiotherapy did not demonstrate superior relapse-free survival compared to chemotherapy alone for stage III or IVA endometrial carcinoma.
• While chemoradiotherapy effectively controlled local disease, it did not improve overall survival and was associated with an increased risk of distant recurrence.