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990 The impact of altered adjuvant treatments in endometrial cancer during the COVID-19 pandemic: a retrospective analysis
  1. Tarun Kumar,
  2. Asma Sarwar and
  3. Gemma Eminowicz
  1. UCLH, London, UK


Introduction/Background The COVID-19 pandemic prompted unforeseen shifts in clinical management. This retrospective study assesses the repercussions of modifications in adjuvant treatment for endometrial cancer amid the pandemic.

Methodology Identification of patients with altered adjuvant treatment protocols from March 2020 to March 2021 was conducted through our hospital's electronic health record (EPIC) and radiotherapy electronic record (Aria). The analysis focused on changes in chemotherapy and radiotherapy (RT) regimens, disease-free survival (DFS), overall survival (OS), toxicity and patterns of relapse

Results Thirty patients, median age 72 years (range 53–89), were analysed over a median follow-up of 41 months. 18 patients were high risk, 6 high intermediate, 4 intermediate and 2 low risk. Notably, 16 patients did not receive RT, 9 did not receive paclitaxel carboplatin chemotherapy (PC), with 4 missing vaginal vault brachytherapy. Alterations in external beam RT included 9 patients receiving 40 Gy in 15 fractions instead of the standard 45 Gy in 25 fractions. No grade ≥3 acute or late toxicities were reported with this fractionation. Thirteen patients received less than the standard 6 cycles of PC, of which 11 received ≥4 cycles.

OS and DFS for all patients at 2 years was 91.03% and 71.7% respectively.

Nine patients experienced relapse: 3 with local pelvic recurrence, 3 distant metastasis, and 3 with both local and distant metastasis. Salvage therapy was possible for 3 of these patients. Eight relapsed patients had high-risk disease and aggressive histologies.

Conclusion A shorter dose fractionation with 40 Gy in 15 fractions did not significantly increase toxicity. Although the omission of radiotherapy correlated with a higher pelvic relapse rate, many cases were salvageable. Overall, 33% experienced either local or distant recurrence with the altered regimen, emphasizing the critical importance of chemotherapy adherence in preventing distant recurrences, as 33% of such instances were associated with missed sessions

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