Clinical Outcome of Patients with High-Risk Endometrial Carcinoma after Treatment with Chemotherapy only

Abstract

Objectives: Adjuvant treatment of high-risk endometrial cancer (EC) is still controversial. Several studies have tried to clarify the best treatment strategy, and guidelines have been made, but no study to date has shown a survival benefit for radiation over chemotherapy. We aimed to evaluate the outcome of high-risk EC patients treated with adjuvant chemotherapy only in a population where the routine administration of adjuvant radiotherapy was omitted. Methods/Materials: This is a retrospective study including 230 EC patients with FIGO stage I type II, Ib type I/G3, stage II and IIIc treated at the Oslo University Hospital between 2005-2012. Standard treatment was hysterectomy, bilateral salphingo-ooforectomy and at least pelvic lymphadenectomy followed by adjuvant chemotherapy. Results: Of the 230 high-risk patients patients, standard treatment was given to 146 patients (63.5%); 60 patients in stage I, 10 patients in stage II and 76 patients in stage IIIc. Only 10% of patients with stage I disease relapsed, with 3.3% loco-regional relapses and 6.7% distant relapses. Recurrence rate in stage IIIc was 39.5%, with 7.9% isolated vaginal and 31.6% distant relapses. The 3-year DFS was 92% for stage I, 80% for stage II and 60% for stage IIIc disease. In the total population, 55 patients had FIGO stage Ia, 43 Ib, 42 stage II, and 90 IIIc disease. Recurrence rate in the total population was 29.6%, with 9.6% isolated vaginal recurrences, 1.7% recurrences located in the pelvis and 18.3% distant recurrences. Conclusions: Patients with high-risk EC have acceptable vaginal/pelvic control rates after adjuvant chemotherapy. However, prognosis remains poor for patients with stage IIIc disease, also after chemotherapy.