Chemoradiotherapy may be an appropriate treatment option after surgery for patients with stage 3 endometrial cancer, especially those are a higher risk of recurrence.
Adjuvant chemoradiotherapy demonstrated improved survival and decreased recurrence rates compared to adjuvant chemotherapy in patients with state 3 endometrial cancer, according to recent study results published in the journal BMC Cancer.
The National Comprehensive Cancer Network recommends adjuvant therapies (any treatment given after the main treatment, with the goal of making it more likely to be successful) after radical surgery, which may include, chemotherapy, radiotherapy or a combination of both. Although adjuvant chemotherapy can significantly improve survival, it does not decrease the rate of distant recurrence. Similarly, radiotherapy on its own can reduce the rates of local recurrence, but not distant recurrence, limiting long-term survival benefit, the authors noted.
“Combining the two therapies into adjuvant chemoradiotherapy may make up for the shortcomings of each therapy on its own,” the study authors wrote. “However, whether (adjuvant chemoradiotherapy) is associated with better prognosis than (adjuvant chemotherapy) is unclear.”
Therefore, researchers sought to compare the recurrence rate and survival in patients with stage 3 endometrial cancer who were treated with either adjuvant chemoradiotherapy or adjuvant chemotherapy after radical surgery.
Data were pulled from 15 studies and included 18,375 patients. Adjuvant chemoradiotherapy demonstrated a significantly lower risk of local (7.2%) and total recurrence (34.9%) compared to adjuvant chemotherapy (27.6% and 16.5%, respectively).
Additionally, adjuvant chemoradiotherapy was associated with significantly better overall survival (time from diagnosis or treatment start when patients are alive), progression-free survival (time during and after treatment when the patient lives without disease progression) and disease-free survival (the measure of time after treatment during which no sign of cancer is found).
These data confirm previous results which also demonstrated that chemoradiotherapy was associated with a better overall survival and relapse-free survival compared to chemotherapy alone in patients with stage 3 endometrial cancer.
The study also found evidence that survival with adjuvant chemoradiotherapy was better than adjuvant chemotherapy specifically in patients with stage 3C endometrial cancer. This suggests that adjuvant chemoradiotherapy is effective in preventing cancer recurrence and improving overall survival in the presence or pelvic lymph node involvement (substage 3C1) or paraaortic lymph node metastasis (substage 2C2), the study authors explained.
“(Adjuvant chemoradiotherapy) may provide greater benefit that (adjuvant chemotherapy) to patients in stage 3c because such patients are at a higher risk of local or distant recurrence,” the study authors wrote. “In contrast, (adjuvant chemoradiotherapy) may not offer greater benefit than (adjuvant chemotherapy) to patients in stage 3A because such patients do not have distant metastasis or lymph node involvement.”
Furthermore, there was evidence that adjuvant chemoradiotherapy resulted in better survival in subgroup of patients with endometrioid or non-endometroid carcinoma.
“This is an important finding because non-endometroid carcinomas include severe types such as carcinosarcoma, serous carcinoma and clear cell adenocarcinoma, which was associated with great risk of recurrence and worse survival,” the study authors wrote.
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