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  • br d Department of Gynecological Oncology

    2022-05-10


    d Department of Gynecological Oncology, McGill University Health Centre, Cedars Cancer Centre, Canada
    • Adding chemotherapy didn't improve the survival compared to radiation therapy alone.
    • Grade 3 disease was an independent predictor for worse outcomes.
    • Patients with grade 3 disease appear to benefit from chemotherapy.
    Article history:
    Keywords:
    Endometrial cancer
    Stage 3
    Radiotherapy
    Chemotherapy
    Adjuvant therapy 
    Objective. To review outcomes of patients with stage III endometrial cancer confined to the pelvis treated with adjuvant pelvic radiotherapy (RT) or sequential chemoradiotherapy (CRT). Methods. Between 1990 and 2012, 144 patients diagnosed with stage IIIA, B or C1 endometrial cancer were treated in our institution. All were treated with total hysterectomy, bilateral salpingo-oophorectomy ± lymph 2-NBDG dissection. Post-operatively, 67 patients received adjuvant RT alone, 37 CRT, 21 chemotherapy alone and 19 had no adjuvant therapy. This analysis focuses on the 104 patients treated with RT or CRT.
    Conclusions. In patients with stage III endometrial cancer confined to the pelvis, the addition of adjuvant che-motherapy with RT significantly improved OS in grade 3 disease. Grade 3 histology is a strong predictor for poor outcome. Further randomized studies aiming specifically at stage III disease are warranted. © 2018 Elsevier Inc. All rights reserved.
    1. Introduction
    Endometrial cancer is the most common gynecologic malignancy in developed countries and its incidence is increasing, particularly in the USA, Western Europe and Canada [1]. This increase can partially be ex-plained by the aging population, but the prevalence of obesity and met-abolic syndrome in these regions certainly contributes [2]. The majority of endometrial cancer patients present with early stage disease and good prognosis. However, about 16% of patients are initially diagnosed with more advanced disease [3]. International Federation of Gynecology
    Corresponding author at: McGill University Health Centre, Cedars Cancer Centre, 1001 Decarie Boulevard, DS1-1620, Montreal, Quebec H4A 3J1, Canada.
    E-mail address: [email protected] (L. Souhami).
    and Obstetrics (FIGO) stage III disease accounts for 7% of all endometrial cancer [3] and its 5-year overall survival (OS) is 57–85% [4–9]. In pa-tients with high risk stage I–III disease, the recently reported PORTEC-3 trial demonstrated no overall survival (OS) benefit from the addition of chemotherapy to the radiotherapy [4]. In a subgroup analysis of stage III disease only (confined or not to the pelvis), the study showed a significant failure-free survival advantage for the combined approach, but at the expense of significant toxicity.
    The optimal management of stage III endometrial cancer confined to the pelvis remains controversial. The purpose of this study was to re-view our institutional experience in the post-operative treatment of pa-tients with stage III endometrial cancer confined to the pelvis with either adjuvant pelvic radiotherapy (RT) alone or sequential chemora-diotherapy (CRT).
    2. Materials and methods
    After obtaining authorization from the institutional Research Ethics Board, we retrospectively identified patients treated for endometrial cancer at our institution between 1990 and 2012, diagnosed with FIGO stage IIIA, B or C1. Re-staging was done retrospectively in patients treated prior 2009, peritoneal cytology was disregarded and patients with para-aortic lymph node (LN) involvement (stage IIIC2) were ex-cluded. All eligible patients were diagnosed and treated with either open or laparoscopic total hysterectomy, bilateral salpingo-oophorectomy with or without pelvic/para-aortic lymph node dissec-tion. Surgical resection was either followed by adjuvant RT alone, CRT, chemotherapy alone, or no further adjuvant treatment.