The role of multi-modality adjuvant chemotherapy and radiation in women with advanced stage endometrial cancer

Despite the publication of numerous studies, including some multicentered randomized controlled trials, there continues to be vigorous debate regarding the optimal management of early stage endometrial cancer, including the extent of surgery and the role of adjuvant chemotherapy and radiation. Resolving these questions has become increasingly important in view of the increase of endometrial cancer, related to the aging population and the alarming incidence of obesity. Furthermore, there are more surgical challenges encountered when operating on elderly patients or on patients with increased BMI and the associated comorbidities, such as diabetes, hypertension, heart disease, and pulmonary dysfunction. This paper will focus on the advantages of minimally invasive surgery, the value of lymphadenectomy including sentinel lymph node mapping, and some of the current controversies surrounding adjuvant chemotherapy and radiation.

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THE ROLE OF ADJUVANT CHEMOTHERAPY IN ENDOMETRIAL CANCER – THE EXPERIENCE OF A CENTER

10.26226/morressier.597eedbfd462b80296ca1399 ◽

2017 ◽

Author(s):

Filipa Ferreira Pereira

Keyword(s):

Endometrial Cancer ◽

Adjuvant Chemotherapy

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Role of brachytherapy in stage III endometrial cancer treated with adjuvant chemotherapy: Identifying factors predictive of a survival benefit

Brachytherapy ◽

10.1016/j.brachy.2021.02.007 ◽

2021 ◽

Author(s):

Michael Xiang ◽

Diana P. English ◽

Elizabeth A. Kidd

Keyword(s):

Endometrial Cancer ◽

Adjuvant Chemotherapy ◽

Survival Benefit ◽

Stage Iii

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Adjuvant Chemotherapy for Endometrial Cancer: Unproven

International Journal of Gynecological Cancer ◽

10.1111/igc.0b013e3181f60af6 ◽

2010 ◽

Vol 20 (Suppl 2) ◽

pp. S60-S63 ◽

Cited By ~ 3

Author(s):

Carien L. Creutzberg

Keyword(s):

Endometrial Cancer ◽

High Risk ◽

Adjuvant Chemotherapy ◽

Elderly Women ◽

Progression Free Survival ◽

Distant Metastases ◽

Survival Difference ◽

Increased Risk ◽

Radiotherapy Alone

High-risk endometrial cancer (EC), only 15% of all EC cases, mainly affects elderly women, often with significant comorbid diseases. Because patients with high-risk EC are at increased risk of distant metastases and EC death, the use of adjuvant chemotherapy has been investigated in several trials. Trials comparing radiotherapy and chemotherapy have not shown survival difference. A first trial comparing combinations of chemotherapy and radiotherapy with radiotherapy alone suggested a progression-free survival benefit. Toxicity and quality-of-life data are lacking. The role of adjuvant chemotherapy for endometrial carcinoma remains unproven. High-risk EC remains the challenge for further research.

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Angiogenesis and its modulation in the pathophysiology and treatment of endometrial carcinoma

Oncology Reviews ◽

10.4081/oncol.2011.43 ◽

2011 ◽

Vol 5 (1) ◽

pp. 43 ◽

Cited By ~ 1

Author(s):

Craig A. Mayr ◽

Dennis Yi-Shin Kuo ◽

Gary L. Goldberg ◽

June Yijuan Hou

Keyword(s):

Endometrial Cancer ◽

Critical Role ◽

Good Prognosis ◽

Advanced Stage ◽

Gynecologic Malignancy ◽

Tumor Mass ◽

Stage Disease ◽

Current Therapies ◽

Pathologic Physiology

Endometrial cancer is the most common gynecologic malignancy in women. When detected early, this disease has a relatively good prognosis. However, advanced stage disease is associated with a poor outcome. Current therapies for advanced endometrial cancer include surgery, chemotherapy, radiotherapy, and hormonal therapy. Responses to these modalities are variable, but rarely exceed 20%. Angiogenesis plays a critical role in both the normal and the pathologic physiology of the human endometrium. Like a wide array of other tumors, the formation of new blood vessels to feed an enlarging tumor mass occurs in endometrial cancer. This review focuses on the role of angiogenesis and its inhibition in the pathophysiology and treatment of endometrial cancer.

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Adjuvant chemotherapy in early-stage endometrioid endometrial cancer with >50% myometrial invasion and negative lymph nodes

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-002094 ◽

2021 ◽

Vol 31 (4) ◽

pp. 537-544

Author(s):

Francesco Multinu ◽

Simone Garzon ◽

Amy L Weaver ◽

Michaela E. McGree ◽

Enrico Sartori ◽

...

Keyword(s):

Endometrial Cancer ◽

High Risk ◽

Adjuvant Chemotherapy ◽

Early Stage ◽

Myometrial Invasion ◽

Recurrence Free Survival ◽

Free Survival ◽

Endometrioid Endometrial Cancer ◽

Negative Lymph Nodes

ObjectiveThe role of adjuvant chemotherapy as an addition or alternative to radiotherapy for early-stage high-risk endometrioid endometrial cancer is controversial. This study aimed to investigate the role of adjuvant chemotherapy in early-stage high-risk endometrioid endometrial cancer.MethodsWe identified patients with stage I or II endometrioid grade 2 or 3 endometrial cancer with myometrial invasion >50% and negative lymph nodes after pelvic with or without para-aortic lymphadenectomy at four institutions (USA and Italy). Associations between chemotherapy and cause-specific and recurrence-free survival were assessed with Cox proportional hazards models. Hematogenous, peritoneal, and lymphatic recurrences were defined as 'non-vaginal'.ResultsWe identified 329 patients of mean (SD) age 66.4 (9.8) years. The median follow-up among those alive was 84 (IQR 44–133) months. The 5-year cause-specific survival was 86.1% (95% CI 82.0% to 90.4%) and the 5-year recurrence-free survival was 82.2% (95% CI 77.9% to 86.8%). Stage II (vs stage IB) was associated with poorer cause-specific and recurrence-free survival. A total of 58 (90.6%) of 64 patients who had chemotherapy had 4–6 cycles of platinum-based regimen. In adjusted analysis, we did not observe a statistically significant improvement in cause-specific survival (HR 0.34; 95% CI 0.11 to 1.03; p=0.06) or non-vaginal recurrence-free survival (HR 0.36; 95% CI 0.12 to 1.08; p=0.07) with adjuvant chemotherapy. Sixteen of 18 lymphatic recurrences (88.9%; 3/5 pelvic, all 13 para-aortic) were observed in the 265 patients who did not receive adjuvant chemotherapy. Among stage II patients, no deaths (100% 5-year recurrence-free survival) were observed in the eight patients who received adjuvant chemotherapy compared with 66% 5-year recurrence-free survival in the 34 patients who did not.ConclusionAlthough we observed that adjuvant chemotherapy was associated with improved oncologic outcomes in early-stage high-risk endometrioid endometrial cancer, the associations did not meet conventional levels of statistical significance. Further research is warranted in this relatively uncommon subgroup of patients.

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