@article {Narasimhuluijgc-2020-002158, author = {Deepa Maheswari Narasimhulu and Matthew S Block and Amy L Weaver and Michaela McGree and Amanika Kumar and Carrie Langstraat and Ivy Petersen and Andrea Mariani and Gretchen Glaser}, title = {Sequencing chemotherapy before radiotherapy for women with stage IIIC endometrial cancer}, elocation-id = {ijgc-2020-002158}, year = {2021}, doi = {10.1136/ijgc-2020-002158}, publisher = {BMJ Specialist Journals}, abstract = {Objective It is unclear how to best sequence adjuvant chemotherapy and radiotherapy for advanced endometrial cancer. We studied the outcomes for women treated with chemotherapy before radiotherapy in a chemotherapy-first (chemotherapy for 6 cycles followed radiotherapy) or {\textquoteleft}sandwich{\textquoteright} approach (chemotherapy for 3 cycles followed by radiotherapy and subsequently chemotherapy for 3 cycles).Methods Women with stage IIIC endometrial cancer and no gross residual disease treated with chemotherapy before radiotherapy between April 2003 and April 2016 were included. The Kaplan-Meier method was used to estimate recurrence and survival. We performed a meta-analysis of endometrial cancer trials comparing chemotherapy and radiotherapy versus radiotherapy alone.Results A total of 102 patients were included. The mean (SD) age was 63.8 (10.6) years; 84 patients received the chemotherapy-first approach and 18 patients received the {\textquoteleft}sandwich{\textquoteright} approach. Pelvic and para-aortic nodes were removed in 99\% and 88.2\%, respectively. Among all the patients, we observed 1 pelvic (1\%), 1 para-aortic (1\%), and 5 vaginal (4.9\%) recurrences. At 3 years, for the {\textquoteleft}sandwich{\textquoteright} and chemotherapy-first approaches, the vaginal recurrence was 11.8\% and 4.2\%, pelvic recurrence was 0\% and 1.5\%, para-aortic recurrence was 0\% and 1.2\%, distant recurrence was 42.9\% and 24.4\%, and overall survival was 70.3\% and 81.7\%, respectively. With {\textquoteleft}chemotherapy before radiotherapy{\textquoteright} 94.9\% completed 4+ chemotherapy cycles (vs 71{\textendash}90\% reported in the literature for {\textquoteleft}radiotherapy before chemotherapy{\textquoteright}). In a meta-analysis of endometrial cancer trials, distant recurrence rates were reduced with 4+ chemotherapy cycles but not with 3 cycles (p=0.01).Conclusion Chemotherapy before radiation sequencing for stage IIIC endometrial cancer was associated with a high proportion of patients completing 4+ chemotherapy cycles and low locoregional lymphatic recurrence rate, despite delaying radiotherapy until after 3{\textendash}6 cycles of chemotherapy and not administering concurrent cisplatin.}, issn = {1048-891X}, URL = {https://ijgc.bmj.com/content/early/2021/03/24/ijgc-2020-002158}, eprint = {https://ijgc.bmj.com/content/early/2021/03/24/ijgc-2020-002158.full.pdf}, journal = {International Journal of Gynecologic Cancer} }