Article Text
Abstract
Introduction Endometrial cancer (EC) is on the rise in developing countries like India. These cancers, which have high-risk factors, carry an increasing risk of recurrence and metastasis. This study investigates the impact of adjuvant therapy on survival in high-risk EC patients.
Methods A retrospective analysis of 97 high-risk EC patients treated (2011-2018) at our institute with follow-up until May 2022 was conducted. Patients underwent surgery and adjuvant therapy (chemoradiation, radiotherapy, chemotherapy, or none). We compared survival and toxicity based on cancer type (endometrioid vs. non-endometrioid) and treatment received.
Results The mean age of the patients in this study was 57.5 years (range 36-81 years). Endometrioid carcinoma and non-endometrioid carcinoma accounted for 76.3% and 23.6%, respectively. Type of surgery, clear margins, perineural invasion, adjuvant treatment received, RT (EBRT & VBT) were statistically significant (p <0.05). Most of the patients were FIGO stage III disease (32.9%). Chemotherapy followed by radiotherapy was given in 63.9% of patients, radiotherapy alone (15.5%), chemotherapy (10.3%), no adjuvant therapy (9.3%) and only hormonal therapy (1%). Post-operative adjuvant treatment showed significant improvement in Disease-free survival(DFS) (p=0.002) & Overall survival (OS) (p=0.013). Median OS was 61 months (95% CI 36.8 -85.2), and Median DFS was 43 months (95% CI 15 - 71).
Conclusion/Implications Sequential chemotherapy followed by radiotherapy is as tolerable as radiotherapy alone for high-risk early-stage endometrial cancer. The efficacy of this sequence needs to be studied further compared with the PORTEC-3 protocol of chemoradiotherapy followed by chemotherapy in high-risk endometrial cancer