Sequencing of Adjuvant Chemoradiation for Advanced Stage Endometrial Cancer: Outcomes and Toxicity Profiles.
Journal
American journal of clinical oncology
ISSN: 1537-453X
Titre abrégé: Am J Clin Oncol
Pays: United States
ID NLM: 8207754
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
pubmed:
10
8
2020
medline:
2
1
2021
entrez:
10
8
2020
Statut:
ppublish
Résumé
Radiation is frequently added to chemotherapy for adjuvant treatment of advanced stage endometrial cancer. Multiple adjuvant therapy sequencing options exist, and little data is available to compare these. We compared outcomes and toxicities after "sandwich" chemoradiation (chemotherapy, then radiation, then chemotherapy) and nonsandwich sequences (chemotherapy then radiation, radiation then chemotherapy, or concurrent chemoradiation). We recorded baseline characteristics, adjuvant treatment details, clinical outcomes, and toxicities for stage III to IVA patients who underwent surgical staging followed by both adjuvant chemotherapy and radiation therapy at our institution. Effects of adjuvant treatment order (sandwich or nonsandwich) on these outcomes were analyzed. Toxicities were graded according to CTCAE v4.0. We identified 107 patients with a median follow-up of 3.2 years. Five-year local, regional, and distant recurrence were 7%, 15%, and 33%; disease-free and overall survival were 61% and 68%, respectively. Outcomes did not differ by sequence group. The overall rate of acute toxicity did not differ by sequence group. The overall rate of chronic toxicity was significantly lower for sandwich patients (P<0.001), as were overall rates of chronic genitourinary (P=0.048) and gynecologic (P<0.001) toxicities. There were no grade 4 or 5 acute or chronic toxicities. Advanced stage endometrial cancer is an aggressive disease and adjuvant chemotherapy and radiation therapy are indicated. Clinical outcomes were similar amongst the different sequences; however, sandwich therapy led to less chronic toxicity, offering an opportunity for improved quality of life in survivorship.
Identifiants
pubmed: 32769405
doi: 10.1097/COC.0000000000000742
pii: 00000421-202011000-00001
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
755-761Références
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin. 2017;67:7–30.
Randall ME, Filiaci VL, Muss H, et al. Randomized phase iii trial of whole-abdominal irradiation versus doxorubicin and cisplatin chemotherapy in advanced endometrial carcinoma: a gynecologic oncology group study. J Clin Oncol. 2006;24:36–44.
De Boer SM, Powell ME, Mileshkin L, et al. Adjuvant chemoradiotherapy versus radiotherapy alone for women with high-risk endometrial cancer (portec-3): final results of an international, open-label, multicentre, randomised, phase 3 trial. Lancet Oncol. 2018;19:295–309.
Matei D, Filiaci V, Randall ME, et al. Adjuvant chemotherapy plus radiation for locally advanced endometrial cancer. N Engl J Med. 2019;380:2317–2326.
Nadeem R, Abu-Rustum M, Sarah Bean M, et al. Uterine neoplasms, version 1.2020, NCCN clinical practice guidelines in oncology; 2020.
Parker JE, Miller DS, Lee J, et al. Society of Gynecologic Oncology Survey. current practice patterns in the treatment of advanced stage endometrial cancer. Gynecol Oncol. 2020;156:e33.
Secord AA, Havrilesky LJ, O’Malley DM, et al. A multicenter evaluation of sequential multimodality therapy and clinical outcome for the treatment of advanced endometrial cancer. Gynecol Oncol. 2009;114:442–447.
Goodman CR, Hatoum S, Seagle BL, et al. Association of chemotherapy and radiotherapy sequence with overall survival in locoregionally advanced endometrial cancer. Gynecol Oncol. 2019;153:41–48.
Zhang G, Suo HY, Shen XY, et al. Preliminary study of sequential multi-modality adjuvant chemotherapy and radiation for advanced endometrial cancer. Zhonghua Fu Chan Ke Za Zhi. 2019;54:103–109.
Lu SM, Chang-Halpenny C, Hwang-Graziano J. Sequential versus “sandwich” sequencing of adjuvant chemoradiation for the treatment of stage III uterine endometrioid adenocarcinoma. Gynecol Oncol. 2015;137:28–33.
Boothe D, Orton A, Kim J, et al. Does early chemotherapy improve survival in advanced endometrial cancer? Am J Clin Oncol. 2019;42:813–817.
Cancer therapy evaluation program common terminology for adverse events, version 3.0, DCTD, NCI, NIH, DHHS. Book Cancer therapy evaluation program common terminology for adverse events, version 3.0, DCTD, NCI, NIH, DHHS, August 9, 2006. Available at: http://ctep.cancer.gov. Accessed July 1, 2019.
Chiara S, Conte P, Franzone P, et al. High-risk early-stage ovarian cancer. Randomized clinical trial comparing cisplatin plus cyclophosphamide versus whole abdominal radiotherapy. Am J Clin Oncol. 1994;17:72–76.
Misra S, Lal P, Kumar Ep S, et al. Comparative assessment of late toxicity in patients of carcinoma cervix treated by radiotherapy versus chemo-radiotherapy—minimum 5 years follow up. Cancer Treat Res Commun. 2018;14:30–36.
Huscher A, Bignardi M, Magri E, et al. Determinants of small bowel toxicity in postoperative pelvic irradiation for gynaecological malignancies. Anticancer Res. 2009;29:4821–4826.
Wedlake LJ, Thomas K, Lalji A, et al. Predicting late effects of pelvic radiotherapy: is there a better approach? Int J Radiat Oncol Biol Phys. 2010;78:1163–1170.
Nicholas S, Chen L, Choflet A, et al. Pelvic radiation and normal tissue toxicity. Semin Radiat Oncol. 2017;27:358–369.
Einstein MH, Frimer M, Kuo DY, et al. Phase ii trial of adjuvant pelvic radiation “sandwiched” between combination paclitaxel and carboplatin in women with uterine papillary serous carcinoma. Gynecol Oncol. 2012;124:21–25.
Viswanathan AN, Lee LJ, Eswara JR, et al. Complications of pelvic radiation in patients treated for gynecologic malignancies. Cancer. 2014;120:3870–3883.
Modh A, Ghanem AI, Burmeister C, et al. What is the optimal adjuvant treatment sequence for node-positive endometrial cancer? Results of a national cancer database analysis. Int J Gynecol Cancer. 2018;28:248–253.
Brown AP, Gaffney DK, Dodson MK, et al. Survival analysis of endometrial cancer patients with positive lymph nodes. Int J Gynecol Cancer. 2013;23:861–868.
Secord AA, Geller MA, Broadwater G, et al. A multicenter evaluation of adjuvant therapy in women with optimally resected stage IIIC endometrial cancer. Gynecol Oncol. 2013;128:65–70.
Lum MM, Belnap TW, Frandsen J, et al. Survival analysis of cancer patients with FIGO stage IIIA endometrial cancer. Am J Clin Oncol. 2015;38:283–288.
Ren Y, Huang X, Shan B, et al. Adjuvant concurrent chemoradiation followed by chemotherapy for high-risk endometrial cancer. Gynecol Oncol. 2016;140:58–63.