TITLE:
Retrospective Analysis of Adjuvant Therapy in Intermediate and High Risk Endometrial Cancer Patients
AUTHORS:
Hanan E. Shafik, Salem H. Alshemmary, Mohamed Ashour
KEYWORDS:
Endometrial Cancer, Adjuvant, High Risk, Intermediate Risk
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.7 No.7,
July
25,
2016
ABSTRACT: Introduction: Endometrial cancer is the most common gynecologic
malignancy in developed countries. The most significant prognostic factors are
tumor stage, histological grade and type, depth of myometrial invasion,
lympho-vascular space or nodal involvement. The optimal adjuvant therapy in
high and intermediate risk endometrial cancer is still controversial. Aim of
the work: Evaluating the impact of adjuvant chemotherapy in addition to
radiotherapy on prognosis of high and intermediate risk endometrial cancer. Patients
and methods: Forty six patients with high and intermediate risk endometrial
cancer presenting to Kuwait Cancer Control Center (KCCC) underwent total
abdominal hysterectomy, bilateral salpingo-ophorectomy, and 18 patients
underwent lymphadenectomy (39.1%). All patients received adjuvant chemotherapy
followed by adjuvant radiotherapy. According to GOG risk stratification, 28
patients (60.9%) were high risk, 6 (13%) high intermediate and 12 (26.1%) low
intermediate. At the end of follow up period, 34.71% of patients relapsed,
21.71% locally and 13% systemic. Median PFS was 38.06 months(ms) (95% CI 36.94
- 39.18 ms). There was a statistically significant effect of lympho-vascular
space invasion (LVSI), grade and near statistically significant effect of
patients age on PFS (p = 0.01, 0.05, 0.06 respectively). Median OS for all
patients was not reached; estimated survival at 3 years was 87.5%. There was no
statistically significant effect of age, pathological subtype, grade, LVSI on survival
(p = 0.35, 0.95, 0.53 and 0.09 respectively). On stratifying patients into high
and intermediate risk based on GOG risk stratification, there was a statistically
significant difference on PFS and near statistically significant difference on
OS between those groups (p = 0.02 and 0.09 respectively). Conclusion: The most
effective adjuvant treatment regimen for patients with intermediate and high
risk endometrial cancer is still an area of controversy. Sequential
chemotherapy and radiotherapy is both efficacious and well tolerated.
Large-scale randomized controlled trials are necessary in the future.