Adjuvant Carboplatin and Paclitaxel Chemotherapy Followed by Radiotherapy in High-Risk Endometrial Cancer: A Retrospective Analysis

Abstract

PurposeThe best adjuvant treatment in high-risk endometrial cancer remains unclear. Although adjuvant chemotherapy seems to improve overall survival (OS) in locally advanced disease, the role of adding radiotherapy is not certain. We evaluated the outcomes of patients with high-risk endometrial cancer treated with adjuvant chemotherapy followed by radiotherapy.Patients and MethodsWe performed a retrospective analysis of patients with high-risk endometrial cancer (endometrioid histology stages III to IVA or carcinosarcoma, clear cell, or serous histology stages I to IVA) treated with adjuvant carboplatin and paclitaxel, followed by radiotherapy, from 2010 to 2017 at a Brazilian cancer center. The Kaplan-Meier method was used for survival analysis, and prognostic factors were analyzed using the Cox proportional hazards model.ResultsOne hundred forty-six consecutive patients were evaluated. The OS rates were 86.2% at 3 years and 75.4% at 5 years. OS was significantly affected by pelvic lymphadenectomy (P = .001) and positive peritoneal cytology (P < .001). Three- and 5-year disease-free survival (DFS) rates were 78.3% and 69.5%, respectively. The initial site of recurrence was limited to the pelvis in 4.1% of patients, within the abdomen in 1.3%, and extra-abdominal in 11.6%. Patients with grade 1 or 2 endometrioid carcinoma had better prognosis than patients with endometrioid carcinoma grade 3 or nonendometrioid histology (3-year DFS, 93.67% v 68.5%, respectively; P = .0017).ConclusionAdjuvant carboplatin and paclitaxel, followed by radiotherapy, is effective in high-risk endometrial cancer and associated with low rates of pelvic recurrence, which might be explained by the addition of radiotherapy. The high-risk group is heterogeneous, and the benefit of adjuvant treatment in patients with grade 1 or 2 endometrioid carcinoma is less clear.

Clear Cell Carcinoma of the Endometrium: Evaluation of Prognostic Parameters in 27 Cases

“…External beam radiation (EBRT) or vaginal brachytherapy (VBT) can reduce vaginal stump recurrence, and EBRT is recommended for patients who are not eligible for chemotherapy ( 40 ). Some institutional studies have shown that both adjuvant chemotherapy and radiotherapy are found to be beneficial in CCC and UPSC patients ( 41 , 42 ), while other studies found that the patients treated with chemotherapy had no added benefit ( 43 , 44 ). There are no universally accepted guidelines for patient’s management ( 39 ).…”

Endometrial Adenocarcinoma with Discordant Microsatellite Stability Status Treated with First-Line Pembrolizumab: A Case Report and Narrative Review

“…Traditionally, metastatic endometrial carcinoma is treated with first-line chemotherapy consisting of carboplatin and paclitaxel [ 30 ]. Given our patient’s significant comorbidities, including paroxysmal atrial fibrillation and congestive heart failure with a reduced ejection fraction of 20%, as well as a poor ECOG performance status of 2, the decision was made to treat her with pembrolizumab as a first line.…”

Advanced gynecologic malignancy identified after acute stroke case report

“…Combination chemotherapy with carboplatin and paclitaxel has demonstrated good effects in the literature and is considered the first-line regimen (Bogani et al 2023). Though the literature is limited, there are some studies supporting the additional use of radiotherapy in high-risk endometrial cancer subtypes (Crane 2022;Cunha et al 2018). Immunotherapy also remains a good option, especially in individuals who don't respond to chemotherapy.…”