Retrospective Analysis of Adjuvant Therapy in Intermediate and High Risk Endometrial Cancer Patients

Abstract

Introduction: Endometrial cancer is the most common gynecologic malignancy in developed countries. The most significant prognostic factors are tumor stage, histological grade and type, depth of myometrial invasion, lympho-vascular space or nodal involvement. The optimal adjuvant therapy in high and intermediate risk endometrial cancer is still controversial. Aim of the work: Evaluating the impact of adjuvant chemotherapy in addition to radiotherapy on prognosis of high and intermediate risk endometrial cancer. Patients and methods: Forty six patients with high and intermediate risk endometrial cancer presenting to Kuwait Cancer Control Center (KCCC) underwent total abdominal hysterectomy, bilateral salpingo-ophorectomy, and 18 patients underwent lymphadenectomy (39.1%). All patients received adjuvant chemotherapy followed by adjuvant radiotherapy. According to GOG risk stratification, 28 patients (60.9%) were high risk, 6 (13%) high intermediate and 12 (26.1%) low intermediate. At the end of follow up period, 34.71% of patients relapsed, 21.71% locally and 13% systemic. Median PFS was 38.06 months(ms) (95% CI 36.94 - 39.18 ms). There was a statistically significant effect of lympho-vascular space invasion (LVSI), grade and near statistically significant effect of patients age on PFS (p = 0.01, 0.05, 0.06 respectively). Median OS for all patients was not reached; estimated survival at 3 years was 87.5%. There was no statistically significant effect of age, pathological subtype, grade, LVSI on survival (p = 0.35, 0.95, 0.53 and 0.09 respectively). On stratifying patients into high and intermediate risk based on GOG risk stratification, there was a statistically significant difference on PFS and near statistically significant difference on OS between those groups (p = 0.02 and 0.09 respectively). Conclusion: The most effective adjuvant treatment regimen for patients with intermediate and high risk endometrial cancer is still an area of controversy. Sequential chemotherapy and radiotherapy is both efficacious and well tolerated. Large-scale randomized controlled trials are necessary in the future.