Long-Term quality of life after (chemo)radiotherapy for high-risk endometrial cancer in PORTEC-3
Post, C. De Boer, S. M. Powell, M. E. Mileshkin, L. Katsaros, D. Bessette, P. Haie-Meder, C. Ottevanger, P. B. Ledermann, J. A. Khaw, P.
Post, C.
De Boer, S. M.
Powell, M. E.
Mileshkin, L.
Katsaros, D.
Bessette, P.
Haie-Meder, C.
Ottevanger, P. B.
Ledermann, J. A.
Khaw, P.
Citations
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Abstract
Purpose or Objective
The survival results of the PORTEC-3 trial showed a
significant improvement in both overall and failure-free
survival with chemoradiotherapy versus radiotherapy
alone. The present analysis was performed to establish
long-term adverse events and health related quality of life
(HRQOL).
Material and Methods
The PORTEC-3 trial is an international randomized phase 3
trial. Women with high-risk endometrial cancer (stage I
grade 3 with deep myometrial invasion or lymph-vascular
space invasion; stage II/III endometrioid cancer; or stage
I-III serous or clear cell cancer) were randomly assigned to
receive pelvic radiotherapy alone (RT) or
chemoradiotherapy (CTRT, concurrent 2 cycles of cisplatin
followed by 4 cycles of carboplatin/paclitaxel). Adverse
events (AE) were graded using CTCAE v3.0. HRQOL was
measured using the EORTC QLQ-C30 and CX24 and OV28
symptom scales at baseline, after radiotherapy, and at 6,
12, 18, 24, 36 and 60 months. Symptoms rated as “quite a
bit” or “very much” were considered as severe. Toxicity
and HRQOL were analyzed according to treatment
received. HRQOL scores were compared to an agematched
European norm-population. Clinical trial
information: NCT00411138.
Results
Between 2006 and 2013, 660 women were randomized, of
whom 579 (88%) responded for HRQOL assessment at
baseline, 355 at 3 years and 237 at 5 years. Median follow
up was 74.6 months. At 5 years, AE grade ≥2 were scored
for 80 (39%) patients who had received CTRT vs 50 (26%)
who had received RT (p=0.007). Grade 3 AE did not differ
significantly between the two groups (8% vs 5%, p=0.24) at
5 years and only one grade 4 AE was reported
(ileus/obstruction after CTRT). Sensory neuropathy AE
persisted at long-term after CTRT in 7% (vs 0% after RT,
p<0.001 at 3 and 5 years). At 3 and 5 years, more women
who had CTRT reported severe tingling or numbness at
HRQOL (27% vs 8%, p<0.001 at 3 years; 24% vs 9%, p=0.002
at 5 years). At 3 years, more women reported severe weakness of arms/legs (21% vs 5%, p<0.001) and lower
physical (79.4 vs 86.6, p<0.001, Fig 1) and role functioning
(78.3 vs 88.0, p<0.001) scores. Additionally, a trend
towards more reported severe muscle or joint pain was
seen (28% vs 16%, p=0.037). At 5 years, no significant
differences in these HRQOL symptoms or functioning scales
were seen, with scores within range of the norm
population scores; however, trends towards a lower global
health/QOL score (74.4 vs 79.3, p=0.045), a higher fatigue score (24.1 vs 18.7, p=0.036) and more severe hearing
problems (12% vs 4%, p=0.044) were observed after CTRT.
Conclusion
Chemoradiotherapy causes significantly higher rates of
grade >2 AE, worse physical functioning and higher
symptom scores as compared with RT, but with clear
recovery within 2 years and stable scores from then
onwards. The most important long-term AE and QOL
impairment after CTRT was sensory neuropathy. These
long-term data are essential for patient information and
shared decision-making regarding adjuvant chemotherapy
for high-risk endometrial cancer.
Authors
Post, C.
De Boer, S. M.
Powell, M. E.
Mileshkin, L.
Katsaros, D.
Bessette, P.
Haie-Meder, C.
Ottevanger, P. B.
Ledermann, J. A.
Khaw, P.
D'Amico, R.
Fyles, A.
Baron, M.
Kitchener, Henry C
Nijman, H. W.
Lutgens, L. C.
Brooks, S.
Jurgenliemk-Schulz, I. M.
Feeney, A.
Nout, R. A.
Verhoeven-Adema, K. W.
Smit, V. T.
Putter, H
Creutzberg, C. L.
De Boer, S. M.
Powell, M. E.
Mileshkin, L.
Katsaros, D.
Bessette, P.
Haie-Meder, C.
Ottevanger, P. B.
Ledermann, J. A.
Khaw, P.
D'Amico, R.
Fyles, A.
Baron, M.
Kitchener, Henry C
Nijman, H. W.
Lutgens, L. C.
Brooks, S.
Jurgenliemk-Schulz, I. M.
Feeney, A.
Nout, R. A.
Verhoeven-Adema, K. W.
Smit, V. T.
Putter, H
Creutzberg, C. L.
Description
Date
2020
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Post C, De Boer SM, Powell ME, Mileshkin L, Katsaros D, Bessette P, et al. OC-0369: Long-Term Quality of Life after (chemo)radiotherapy for high-risk Endometrial Cancer in PORTEC-3. Radiotherapy and Oncology . 2020 Nov;152:S199–200.