IntroductionAdjuvant treatment options for advanced-stage endometrialcancer include chemotherapy (CT) and radiation therapy (RT), but the optimaltreatment strategy is currently under debate. The aim of this study is to investigatethe utilization of adjuvant RT and CT in patients with stage III endometrialcancer and their impact on overall survival (OS) and disease-free survival(DFS). Materials and MethodsA retrospective review was performed of 40 patients withStage III endometrial cancer who received adjuvant treatment at UniversityClinic of Radiotherapy and Oncology (UCRO) in Skopje between 2012 and 2015.Postoperative treatment was administered based on performance status andmedical comorbidities. Chemotherapy regimens comprised of Carboplatin (AUC 5)and Paclitaxel (175 mg/m2), a 3-week interval for 6 cycles (chemotherapy alone)and 4 cycles (sequential arm).
RT was delivered using 3-D CRT with a total doseof 50 Gy in 25 fractions prescribed in PTV, for 5 weeks with/without anadditional 7 Gy prescribed at a depth of 0.5 cm from the vaginal surface. Theprimary endpoints were overall survival (OS) and disease-free survival (DFS). Combined radiotherapy and chemotherapywere compared with radiotherapy alone and chemotherapy alone. Results The distribution of surgical stages is as follows: IIIAaccounted for 60% (n=24), stage IIIB accounted for 9.8% (n=4) and stage IIICaccounted for 30% (n=12).The median age was 65 years and median follow-up was 35.
5months.There were 40 patients who received adjuvant treatment, 10%(n=4) received CT alone, 27.5% (n=11) received RT alone, and 62.5% (n=25)received sequential combined CT followed by 3D CRT with/without vaginal vaultbrachytherapy. Relapse occurred in 55% (n=22) of the patients. High grade andlymphovascular space invasion (LVSI) are risk factors for recurrence and poorprognosis.
Overall survival (OS) and Disease free survival (DFS) at 3 years forpatients receiving combined CT and RT, adjuvant RT alone and adjuvant CT alonewere 68.8%, 41.26%, and 37.57% OS and 58.03%, 33.08%, and 24.
96% for DFS,respectively. DFS and OS were significantly longer in patients treated withcombined RT and CT than in those treated with CT alone (DFS: p= 0.0005; hazardratio HR, 5.677; OS: p= 0.0143; HR, 4.
289) or RT alone (DFS: p = 0.0137; HR,2.482; OS: p = 0.0151; HR, 3.
036). ConclusionCombined modality treatment with chemotherapy andradiotherapy can improve both overall and disease-free survival in patientswith Stage III endometrial cancer compared with single modality alone.