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Abstract
Introduction/Background The primary treatment for endometrial cancer is surgery followed by tailored postoperative adjuvant therapy. However, there is no consensus on the management of advanced unresectable disease seen in about 30% of cases. NeoAdjuvant ChemoTherapy (NACT) has been explored as an effective alternative option to optimize outcomes and improve survival in these patients.
The objectives of this study were to review the use of NACT in unresectable advanced endometrial cancer patients and to evaluate the overall survival of these patients.
Methodology This was a retrospective study conducted in our department from 1st January 2017- 31st December 2022. It included endometrial cancer patients who received NACT. Clinical and surgical variables, imaging, and NACT regimens were analyzed. RECIST 1.1 criteria was used to assess response to NACT. Descriptive statistics and Kaplan-Mier curves were used for survival analysis.
Results A total of 41 patients were included in the study. The mean age was 55.9 years. Endometrioid histology was seen in 82.9% and serous in 12.2%.43.9% of them had Stage 3b disease. The most common reason for ineligibility for primary surgery was unresectable disease due to parametrial involvement in 53.7% .80.5% of the patients received carboplatin and paclitaxel. Response to NACT was complete (17%), partial (36%), stable (17.1%), and progression (26.8%). Patients with complete response had a survival of 85.7% at 72 months. (p=0.035)
20/41 of patients underwent surgery and 65% of them had optimal surgery. The overall survival rate was 65.9%. The patients who had optimal surgery had significantly improved survival compared to those who did not (p=0.015) Patients who had completed adjuvant therapy had a survival of 72.2% at 20 months.
Conclusion NACT is an effective treatment modality in clinically advanced endometrial cancer not amenable to surgery. Patients with endometrioid histology who underwent optimal surgery post NACT had improved survival rates in comparison to serous histology.
Disclosures Funding: none.
Competing interests: None declared.
Ethics committee approval obtained from Institutional Ethics Committee.
