Introduction/Background PORTEC-3 study has illustrated failure-free survival benefit in the subgroup of patients with stage III endometrial cancer. This study reports the toxicities and pattern of relapse for patients with high risk endometrial cancer after adjuvant chemo-irradiation and sequential chemotherapy in Tuen Mun Hospital.
Methodology Patients with endometrial cancer with concurrent adjuvant chemo-irradiation from 1st January 2015 to 9th May 2019 were reviewed. Those with planned sequential chemotherapy with four cycles of paclitaxel (P)-carboplatin (J) were included.
Results 25 patients were included. All patients received radiotherapy 45–50.4 Gy in 1.8–2 Gy per fraction. 76% received concurrent weekly cisplatin 40 mg/m2, while after a protocol change in 2018 based on PORTEC-3, 24% of patients received concurrent cisplatin 50 mg/m2 every 3 weeks. Vaginal brachytherapy was performed in 76% of the patients. After completion of chemo-irradiation, 72% received at least 1 cycle of 3-weekly P 175 mg/m2 and J AUC5, the rest declined further chemotherapy. 72% of those who received PJ had chemotherapy delay, among which 62% was due to treatment related complications (6 patients had at least G2 decrease in white cell count, 1 had non-neutropenic respiratory infection). There was a statistically significant increase in delay in first cycle PJ in those who received weekly cisplatin compared with PORTEC-3 regime (median 35 days versus 28 days, p=0.01). Among those on PORTEC-3 regime, 50% received PJ cycle 1 with delay. 56% of all patients completed 4 cycles of PJ. 68% had G3-4 neutropenia and 28% had neuropathy. 20% had residual neuropathy 6 months after treatment. After excluding 3 patients with carcinocarcoma and 2 with initial stage IV disease, 15% had a relapse, all occurred within the first year post treatment.
Conclusion Weekly concurrent cisplatin should be phased out in this setting due to increased marrow toxicity. Further studies comparing chemotherapy first then chemo-irradiation versus PORTEC-3 regime to increase chemotherapy completion rate should be done.