The Role of Adjuvant Chemotherapy in Endometrial Cancer Following Preoperative Neoadjuvant Chemoradiation Therapy

In patients with surgically unresectable disease who undergo neoadjuvant chemoradiation (CRT) or neoadjuvant radiation therapy (RT) before surgical staging, little is known about whether adjuvant chemotherapy confers a survival benefit. We aim to explore the survival impact of adjuvant chemotherapy in patients with locally advanced endometrial cancer who undergo neoadjuvant CRT or RT.

A retrospective, single-institution review of all patients from April 2008 to October 2021 who underwent neoadjuvant RT or CRT before surgical resection of endometrial cancer was performed. Kaplan-Meier method with log-rank test was used to determine differences in overall survival (OS) and disease-free survival (DFS) between the group that received adjuvant chemotherapy and the group that did not. Subgroup analysis was performed to assess whether specific subgroups benefited from adjuvant chemotherapy.

Eighty-nine patients, 48 (54%) of whom received adjuvant chemotherapy, were identified. There was no statistically significant difference in OS ( P =0.062) between those who received adjuvant chemotherapy and those who did not. Adjuvant chemotherapy had a significant association with worse DFS ( P =0.037). On subgroup analysis, there were no statistically significant differences in OS or DFS in any subgroups when examining the impact of adjuvant chemotherapy.

After receiving neoadjuvant CRT or RT for advanced and high-grade endometrial cancers, adjuvant chemotherapy was not predictive of improved OS, but was predictive of worse DFS. A larger cohort and longer follow-up are needed to ascertain whether certain high-risk subgroups of patients benefit from adjuvant chemotherapy.