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    Long-Term quality of life after (chemo)radiotherapy for high-risk endometrial cancer in PORTEC-3

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    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.
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    Affiliation
    Leiden University Medical Center, Radiation Oncology, Leiden,
    Issue Date
    2020
    
    Metadata
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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.
    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.
    Journal
    Radiotherapy and Oncology
    URI
    http://hdl.handle.net/10541/624397
    Type
    Meetings and Proceedings
    Language
    en
    Collections
    All Paterson Institute for Cancer Research

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