Chemotherapy (CT) with radiotherapy versus CT alone for FIGO Stage IIIc endometrial cancer

To determine optimal treatment for women with Stage IIIc endometrial carcinoma, extended-field radiotherapy (RT) plus chemotherapy (CT) was compared versus CT alone as adjuvant therapy. Twenty-nine patient's with FIGO Stage IIIc endometrial cancer who underwent adjuvant treatment with 4.4 courses of CT (CAP or TC/DC) or 4.5 Courses of CT (CAP or TC/DC) plus external pelvic RT (50 Gy) with paraaortic boost after surgery between 1992 and 2004 were retrospectively assessed. Fifteen patients underwent CT alone and 14 received combined treatment with CT/RT. Following treatment, the recurrence rate was 46.6% and 28.5% in the two treatment arms. respectively. There was a significant (p < 0.05) difference in the pelvic recurrence rate (33.3% and 7.1%, respectively). Combined treatment with RT/CT was associated with a better survival rate than CT alone (78% versus 62%, respectively). In Stage IIIc endometrial cancer, combined treatment with RT and CT reduces pelvic recurrence and improves progression-free survival and overall Survival compared with CT alone.

Stage IIIc endometrial cancer; Endometrioid carcinoma; Chemotherapy; Radiotherapy; Overall survival

[1] The Report of the Japan Society of Gynecologic Oncology. ActaObstet. Gynaecol. Jpn. , 2002, 54, 1527.

[2] Prat J.: Prognostic parameters of endometrial carcinoma. Hum. Pathol. , 2004, 35, 649.

[3] Creasman W.T., Odicino F., Maisonneuve P.: FIGO annual report on the result of treatment in gynecologic cancer: carcinoma of corpus uteri. J. Epidemiol. Biostat. , 1998, 3, 35.

[4] The Report of the Japan Society of Gynecologic Oncology. ActaObstet. Gynaecol. Jpn. , 2001, 53, 1154.

[5] Bruzzone M., Miglietta L., Franzone P., Gadducci A., Boccardo F.:Combined treatment with chemotherapy and radiotherapy in high-risk FIGO Stage 3-4 endometrial cancer patients. Gynecol.Oncol. , 2004, 93, 345.

[6] Randall M., Brunetto G., Muss H., Mannel R., Spirtos N., JeffreyF. et al.: Whole abdominal radiotherapy versus combination doxorubicin-cisplatin chemotherapy in advanced endometrial carcinoma: a randomized phase III trial of the Gynecologic Oncology Group

[abstract 3]. ASCO 2003. J. Natl. Cancer Inst. Monogr. ,1995, 19, 13.

[7] Randall M.E., Filiaci V.L., Muss H., Spirtos N.M., Mannel R.S., Fowler J. et al.: Randomized phase III trial of whole-abdominal irradiation versus doxorubicin and cisplatin chemotherapy in advanced endometrial carcinoma: a Gynecologic Oncology Groupstudy. J. Clin. Oncol. , 2006, 24, 36.

[8] Michener C.M., Peterson G., Kulp B., Webster K.D., MarkmanM. : Carboplatin plus paclitaxel in the treatment of advanced or recurrent endometrial carcinoma. J. Cancer Res. Clin. Oncol. ,2005, 16, 581.

[9] Akram T., Maseelall P., Fanning J.: Carboplatin and paclitaxel for the treatment of advanced or recurrent endometrial cancer. Am. J.Obstet. Gynecol. , 2005, 192, 1365.

[10] Scudder S.A., Liu P.Y., Wilczynski S.P., Smith H.O., Jiang C., Hullum A.V. III et al.: Paclitaxel and carboplatin with amifostine in advanced, recurrent or refractory endometrial adenocarcinoma: a phase II study of the Southwest Oncology Group. Gynecol.Oncol. , 2005, 96, 610.

[11] Mundt A.J., Murphy K.T., Rotmensch J., Waggoner S.E., Yamada S.D., Connell P.P.: Surgery and postoperative radiation therapy in FIGO Stage IIIc endometrial carcinoma. Int. J. Radiat. Oncol. Biol. Phys. , 2001, 50, 1154.

[12] Sutton G., Axelrod J.H., Bundy B.N., Roy T., Homesley H.D., Malfetano J.H. et al.: Whole abdominal radiotherapy in the adjuvant treatment of patients with Stage III and IV endometrial cancer: a Gynecologic Oncology Group study. Gynecol. Oncol. ,2005, 97, 755.

[13] Smith R.S., Kapp D.S., Chen Q., Teng N.N.H.: Treatment of high-risk uterine cancer with whole abdominopelvic radiation therapy. Int. J. Radiat. Oncol. Biol. Phys. , 2000, 48, 767.

[14] Frigerio L., Mangili G., Aletti G., Carnelli M., Garavaglia E.,Beatrice S. et al.: Concomitant radiotherapy and paclitaxel for high-risk endometrial cancer: first feasibility study. Gynecol.Oncol. , 2001, 81, 53.

[15] Duska L.R., Berkowitz R., Matulonis U., Muto M., Goodman A., Mcintyre J.F. et al.: A pilot trial of TAC chemotherapy with filgastrim support followed by radiotherapy in patients with highrisk endometrial cancer. Gynecol. Oncol. , 2005, 96, 198.

[16] Maggi R., Lissoni A., Spina F., Melpignano M., Zola P., Favalli G. et al.: Adjuvant chemotherapy vs radiotherapy in high-risk endometrial carcinoma: results of a randomised trial. Br. J. Cancer, 2006, 95, 266.

[17] Chambers J.K., Kapp D.S., Peschel R.E., Lawrence R., MerinoM. , Kohorn E.I. et al.: Prognostic factors and sites of failure in FIGO I grade 3 endometrial carcinoma. Gynecol. Oncol. , 1987, 27, 180.

[18] Burke T.W., Gershenson D.M., Morris M., Stringer C.A., Levenback C., Tortolero-Luna G. et al.: Postoperative adjuvant cisplatin, doxorubicin, and cyclophosphamide (PAC) chemotherapy in women with high-risk endometrial carcinoma. Gynecol.Oncol. , 1994, 55, 47.

[19] Morrow C.P., Bundy B.N., Homesley H.D., Creasman W.T., Hornback N.B., Kurman R. et al.: Doxorubicin as an adjuvant following surgery and radiation therapy in patients with high risk endometrial carcinoma Stage I and occult Stage II. A Gynecologic Oncology Group study. Gynecol. Oncol. , 1990, 36, 166.

[20] Onda T., Yoshikawa H., Mizutani K., Mishima M., Yokota H.,Nagano H. et al.: Treatment of node-positive endometrial cancer with complete node dissection, chemotherapy and radiation therapy. Br. J. Cancer, 1997, 75, 1836.

[21] Hoskins P.J., Swenerton K.D., Pike J.A., Wong F., Lim P., Acquino-Parsons C. et al.: Paclitaxel and carboplatin, alone or with irradiation, in advanced or recurrent endometrial cancer: aphase II study. J. Clin. Oncol., 2001, 19, 4048.

[22] Morrow C.P., Bundy B.N., Kurman R.J., Creasman W.T., Heller P., Homesley H.D. et al.: Relationship between surgical-pathological risk factors and outcome in clinical Stage I and II carcinoma of the endometrium: a Gynecologic Oncology Group study. Gynecol. Oncol., 1991, 40, 55.

[23] Hicks M.L., Piver M.S., Puretz J.L., Hempling R.E., Baker T.R., Mcauley M. et al.: Survival in patients with paraaortic lymph node metastases from endometrial adenocarcinoma clinically confined to the uterus. Int. J. Radiat. Oncol. Biol. Phys., 1993, 26,607.

[24] Schorge J.O., Molpus K.L., Goodman A., Nikrui N., Fuller A.F. Jr.: The effect of postsurgical therapy on Stage III endometrial carcinoma. Gynecol. Oncol., 1996, 63, 34.