Chemotherapy plus radiotherapy vs . radiotherapy alone in high-risk endometrioid endometrial carcinoma

Abstract

OBJECTIVE: Adding chemo-therapy to radiotherapy in patients with high-risk endometrioid endometrial cancer (EEC) remains controversial, particularly in stages I-II. We aimed to investigate the effect of treat-ment modalities on survival in high-risk EEC patients. PATIENTS AND METHODS: Patients with high-risk EEC were evaluated retrospectively between 2010 and 2019. Patients who did not re-ceive adjuvant treatment were excluded. We in-cluded seventy patients and formed two groups: patients who received radiotherapy (RT) alone and those who received chemotherapy and ra-diotherapy (CT and RT). RESULTS: The median follow-up time was 60.3 months (8.0-143.5). 38.5% of the patients had relapsed. Recurrence-free survival (RFS) rates were 97. 1%, 68.3% , and 60.8% at 12-, 36-, and 60-month, respectively. Overall survival rates were 97.1%, 80.6%, and 72.6% at 12-, 36-, and 60-month, respectively. Hematological adverse events and neuropathy were more common in the CT and RT group than in the RT group. Multi-variate Cox regression analysis for RFS revealed that the FIGO stage and treatment modalities were statistically independent factors (p=0.031 and p=0.040, respectively). Stage stratified log-rank test revealed that adding chemotherapy im-proved RFS in patients with stage III (p=0.020) but not in stage I-II disease (p=0.725). The num-ber of chemotherapy cycles administered (<= 4 vs. > 4) did not affect survival in all patients and stage III disease (p=0.497, and p=0.436, respec-tively). CONCLUSIONS: Adding chemotherapy to radiotherapy may be considered in high-risk stage III EEC. Further studies are needed to determine the optimal duration of chemother-apy.