Sequential Chemoradiation versus Radiation for the Adjuvant Treatment of Stage III Endometrioid Adenocarcinoma of the Uterus

Purpose of Investigation: The optimal adjuvant therapy for women with Stage III endometrial cancer following surgical staging is controversial. Post-operative sequential chemotherapy followed by external beam radiotherapy is the standard treatment for Stage III uterine cancer at our institution since 2006. We aim to analyse the survival outcomes in this group of patients comparing with the historical group of patients who received radiation only. Materials and Methods: This is a retrospective single-institution analysis of patients with surgical Stage III endometrioid adenocarcinoma of the uterus treated at KK Women’s and Children’s Hospital from 2000 to 2010. Results: Ninety-six patients with surgical Stage III endometrioid endometrial cancer who received postoperative adjuvant therapies were identified; 43% (n = 41) received chemotherapy followed by radiotherapy, 57% (n = 55) received radiotherapy only. The 2 groups were well balanced with regard to age, ECOG performance status, tumour size, myometrial invasion, lymphovascular invasion, peritoneal cytology status and debulking status. At a median follow up of 62.5 months (range: 4 -164), the 5-year overall survival (OS), cancer-specific survival (CSS) and disease-free survival (DFS) were not significantly different. Following adjustment for age, disease stage, tumour grade, residual disease, tumour size and nodal status, the adjusted hazard ratios for DFS, CSS and OS for those treated with chemoradiation were not significantly better than those treated with radiation only. Conclusion: In this single institution retrospective analysis of Asian patients with surgical Stage III endometrioid endometrial cancer, there was a trend towards sequential chemotherapy followed by radiation having better OS and CSS over radiation alone but this did not reach statistical significance.

Endometrial cancer; Chemotherapy; Radiotherapy.

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