Chemotherapy for Early-stage High-risk Endometrial Cancer

Endometrial cancer generally has a good prognosis because most cases are diagnosed in stage I. It is possible to identify subgroups of patients with early-stage endometrial cancer with a poor prognosis. Despite a traditional generous use of adjuvant radiotherapy, these patients have five-year overall survival of approximately 80%. In this group there is a need for an effective systemic adjuvant therapy. Mainly based on superior response rates, doxorubicin + cisplatin was for many years the standard chemotherapy in endometrial cancer. Gynecologic Oncology Group (GOG)-177 was the first phase III study on chemotherapy in endometrial cancer that showed a survival advantage. Paclitaxel + doxorubicine + cisplatin was better than doxorubicine + cisplatin, but the toxicity of the three-drug regimen has precluded general acceptance. Paclitaxel + carboplatin has produced high response rates and is widely used, despite the lack of evidence based on randomised studies. GOG-122 compared doxorubicine + cisplatin with whole abdominal radiotherapy in advanced optimally operated endometrial cancer and showed that chemotherapy with doxorubicine + cisplatin resulted in superior survival. Two recent studies have compared adjuvant chemotherapy (cyclophosphamide + doxorubicine + cisplatin) with adjuvant radiotherapy in early-stage endometrial cancer. Both studies failed to show a difference between the treatments. Another study (NSGO-EC-9501/EORTC-55991) compared adjuvant radiotherapy plus chemotherapy with adjuvant radiotherapy, and showed better survival with the sequential combination.