Source: DGNews  |  Posted 3 years ago

By Gabe Waggoner

SAN ANTONIO, Tex -- February 6, 2009 -- For patients with advanced-stage endometrial cancer, chemotherapy followed by radiation and then more chemotherapy (CRC) appears to confer better survival than either radiation followed by chemotherapy (RC) or chemotherapy followed by radiation (CR), researchers reported here at the Society of Gynecologic Oncologists (SGO) 40th Annual Meeting on Women's Cancer.

Researchers led by Angeles Alvarez Secord, MD, Department of Gynecologic Oncology, Duke University Medical Center, Durham, North Carolina, retrospectively evaluated the clinical significance of the sequence in which difference treatment modalities were applied from 1993 to 2007 in 109 patients with stage III and IV endometrial cancer.

The study findings were presented on February 6.

Patients had a comprehensive staging procedure that included hysterectomy, bilateral salpingo-oophorectomy (with or without selective pelvic/aortic lymphadenectomy), surgical debulking, as well as both adjuvant chemotherapy and radiation treatment.

Dr. Alvarez Secord and her colleagues used Pearson's x² test to analyse differences in adverse event frequency, and they calculated rates of overall survival and progression-free survival using the Kaplan-Meier method. They determined estimated hazard ratios from multivariate Cox proportional hazard models.

A total of 45 patients (41%) in the cohort received CRC, 18 patients (17%) received RC, and 46 patients (42%) received CR. They had a median age of 62 years. Forty-eight percent of patients had endometrioid tumours, and 90% had optimal debulking.

There were no differences among the 3 sequencing modalities in terms of adverse event frequency due to chemotherapy (P = .35), radiotherapy (P = .14), dose modifications (P = .055), or delays (P = .80).

However, patients treated with CRC had better rates of 3-year overall survival and progression-free survival compared with either RC or CR.

Compared with patients treated with CRC, those treated with RC had a 5.53% increased risk of dying, whereas CR-treated patients had a 2.64% increased risk of dying.

When the researchers restricted their analysis to patients whose tumours that had been optimally debulked, they found a significantly higher risk for disease progression and death for patients receiving either RC or CR compared with patients treated with CRC.

"Despite the retrospective nature of this study ... our data yield some clinically significant observations," Dr. Alvarez Secord said. "CRC was associated with improved survival compared to other regimens."

[Presentation title: A Multicenter Evaluation of Sequential Multimodality Therapy and Clinical Outcome for the Treatment of Advanced Endometrial Cancer. Abstract 23]