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Association of chemotherapy and radiotherapy sequence with overall survival in locoregionally advanced endometrial cancer
Chelain R. Goodman a, , Saleh Hatoum a, Brandon-Luke L. Seagle b, Eric D. Donnelly a, Emma L. Barber b, Shohreh Shahabi b, Daniela E. Matei b, Jonathan B. Strauss a
a Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
b Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
• No randomized trial of advanced endometrial cancer has evaluated treatment with chemotherapy (CT) before radiotherapy (RT).
• Women who received RT after CT had longer survival than those who received RT before CT or either treatment alone.
• Treatment with multi-agent CT before RT should be considered for inclusion as a treatment arm in future prospective trials.
Objective. The optimal adjuvant management of women with FIGO Stage III-IVA endometrial cancer (EC) is unclear. While recent prospective data suggest that treatment with pelvic radiotherapy (RT) prior to chemother-apy (CT) is not associated with a survival benefit compared to CT alone, no prospective randomized trial has in-cluded a treatment arm in which CT is given before RT.
Methods. An observational cohort study was performed on women with FIGO Stage III-IVA Type 1 (grade 1–2, endometrioid) EC who underwent hysterectomy and received multi-agent CT and/or RT from 2004 to 2014 at Commission on Cancer-accredited hospitals. Multivariable parametric accelerated failure time models were per-formed to estimate the association of sequence of adjuvant CT and RT with overall survival (OS) using propensity score-adjusted matched cohorts.
The optimal adjuvant management of stage III-IVA endometrial can-cer (EC) remains a source of debate. Results from recent trials PORTEC-3 and the Gynecology Oncology Group (GOG) 258 suggest minimal
Corresponding author at: Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, 251 E Huron St, Room LC-178, Chicago, IL 60611, United States of America.
E-mail address: [email protected] (C.R. Goodman).
improvement in overall survival (OS) with combined chemoradiother-apy (CRT) compared to chemotherapy (CT) or pelvic radiotherapy (RT) alone [1,2]. These data do, however, demonstrate the potential complementary roles of both adjuvant therapies: CT in the reduction of distant recurrence and RT in minimizing locoregional recurrence (LRR). A subset analysis of PORTEC-3 demonstrated that Stage III pa-tients treated with CRT experienced longer 5-year (y) progression-free survival (PFS) . No prospective trial has included a treatment arm in which CT is given before RT or sequenced in a “sandwich” fash-ion. This begs the question: should chemotherapy be the first adjuvant