Sequential chemotherapy-radiotherapy as adjuvant treatment of high-risk endometrial carcinoma: a retrospective review of the Manchester experience

Abstract

Objective: The optimum sequencing of adjuvant treatment in patients with high-risk endometrial cancer remains contentious. Here, we report the outcomes of women treated in Manchester, United Kingdom, where sequential chemotherapy-radiotherapy is the standard adjuvant treatment approach for these patients. Methods: A retrospective analysis was carried out on 106 consecutive patients referred for adjuvant treatment of high-risk endometrial cancer in 2014 and 2015. High-risk endometrial cancer was defined as: International Federation of Gynaecology and Obstetrics (2009) stage I grade 3 endometrioid carcinoma with deep myometrial invasion and/or lymphovascular space invasion, stage II–III endometrioid carcinoma, or any other histological subtype with stage I–III disease. Adjuvant treatment included carboplatin (AUC5) and paclitaxel (175 mg/m2) every 21 days for 4/6 cycles, followed by external beam pelvic radiotherapy (40 Gy in 20 fractions#) or vaginal brachytherapy (28 Gy in 2 fractions#) or both. Primary outcome measures were recurrence free survival (RFS), overall survival (OS) and treatment-related toxicity. Results: Seventy-nine percent of patients were treated with sequential chemotherapy-radiotherapy. After a median follow-up of 64.4 months, 5-year RFS was 70% (95% CI 60.8–80.6%) and 5-year OS was 71.4% (95% CI 62.3–81.7%). Single modality adjuvant therapy was given for patient choice or contra-indications to treatment. Patients tolerated sequential treatment well; 96% of patients completed all treatment and 20% of patients had ≥grade 3 adverse events. Conclusions: Sequential chemotherapy-radiotherapy as adjuvant treatment for high-risk endometrial cancer was tolerable and was associated with survival outcomes consistent with recent international phase III clinical trials.