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Adjuvant chemotherapy and radiation for patients with high-risk stage I endometrial cancer treated with curative intent surgery: impact on recurrence and survival
  1. Rachelle Findley1,
  2. Joni Kooy1,
  3. Beverley Lester2,
  4. Nhu D Le3,
  5. Gale Bowering4,
  6. Christie Rugayan2,
  7. Aalok Kumar5,
  8. Sarah Glaze1 and
  9. Jenny Ko6
  1. 1 Department of Gynecologic Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
  2. 2 Radiation Oncology, BC Cancer - Abbotsford, Abbotsford, British Columbia, Canada
  3. 3 Biostatistics, BC Cancer Research Centre, Vancouver, British Columbia, Canada
  4. 4 Innomar Strategies Inc, Brandon, Manitoba, Canada
  5. 5 Medical Oncology, BC Cancer - Surrey, Surrey, British Columbia, Canada
  6. 6 Medical Oncology, BC Cancer - Abbotsford, Abbotsford, British Columbia, Canada
  1. Correspondence to Dr Jenny Ko, BC Cancer Agency Abbostford Centre, Abbotsford, BC V2S 0C0, Canada; jenny.ko{at}


Background Survival benefits of post-operative systemic and radiation therapy in high-risk stage I endometrial cancer are uncertain.

Objective To compare recurrence patterns and survival outcomes of post-surgical treatment in patients with high-risk stage I endometrial cancer and to determine whether adjuvant therapy significantly improves outcomes.

Methods High-risk stage I endometrial cancer was defined as either stage IB grade 3 endometrioid histology or myoinvasive non-endometrioid histology. Consecutive patients diagnosed between January 2000 and December 2010 in eight cancer centers were included. Patients, disease, and treatment characteristics were summarized by descriptive statistics. Overall survival, disease-specific survival, and relapse-free survival were examined using Cox’s proportional hazards regression and log-rank test. Survival curves were estimated using the Kaplan-Meier method.

Results Of 2317 patients with stage I endometrial cancer, 414 patients had high-risk disease. Use of chemotherapy did not improve overall survival (relative risk (RR) 0.70, 95% CI 0.46 to 1.14, p=0.13) or disease-specific survival (RR 1.06, 95% CI 0.61 to 1.85, p=0.84). Significant improvement in recurrence-free survival was observed in patients who received chemotherapy (RR 0.61, 95% CI 0.39 to 0.95, p=0.03). Use of radiation therapy did not improve overall survival, recurrence-free survival, or disease-specific survival. Patients who received four cycles or fewer of chemotherapy versus five to six cycles had similar overall survival, disease-specific survival, and recurrence-free survival.

Conclusions Post-operative chemotherapy or radiation in stage I high-risk endometrial cancer is not associated with improved cancer-specific or overall survival. More than four cycles of chemotherapy did not improve survival compared with four cycles or fewer.

  • radiotherapy
  • endometrial neoplasms
  • endometrium

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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  • RF and JoK are joint first authors.

  • Contributors JeK oversaw the conduct of the study, designed the study concept, and acts as guarantor of the study content. JeK, AK, and SG created the study protocol and participated in data curation. BL, GB, CR, AK, and JeK collected data by patient chart review. JeK, AK, and NDL were involved in statistical analysis. JoK, RF, JeK, AK, and SG analyzed and interpreted data. JoK and RF wrote the manuscript. All authors contributed to the manuscript by providing feedback and edits. All authors approved the final draft of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.