The Addition of Sequential Locoregional Radiation Therapy after Adjuvant Chemotherapy for Endometrial Cancer Patients with Para-Aortic Involvement - The Impact on Recurrence and Survival

Purpose: The benefit of adjuvant Radiation Therapy (RT) after surgical resection and chemotherapy is not well defined for patients with endometrial cancer patients with Para-Aortic (PA) nodal involvement (FIGO stage IIIC2). The purpose of this study was to compare survival and patterns of failure after treatment with or without adjuvant RT. Methods and Materials: Consecutive patients with FIGO stage IIIC2 endometrial cancer treated from 2000-2010 were identified across three cancer centers, 1 of which does not routinely offer adjuvant RT in this setting. Characteristics and outcomes of patients treated with or without RT (RT vs. NRT) were compared with descriptive and multivariable analyses. Results: 65 patients were identified. Median follow-up was 114 months. 55 (85%) received chemotherapy and 33 (51%) received adjuvant RT. Rates of freedom from locoregional relapse at 5 years was 58.8% in the RT group and 42.3% in the NRT group (p = 0.18). Median DFS trended in favour of the RT group (not reached vs. 26.9 months, p = 0.18), while median OS significantly favoured the RT group (91.2 vs. 29.7 months, p = 0.04). Trends remained similar after excluding non-endometrioid histologies and after excluding patients without pathological PA nodes. However, after adjusting for age, histology, and myometrial invasion, OS and DFS for RT were numerically but not statistically better than NRT (HR for DFS 0.59, 95% CI 0.23-1.51, p=0.27; HR for OS 0.58, 95% CI 0.24-1.40, p=0.23). RT-associated toxicities consisted of grade 1 and 2 gastrointestinal and genitourinary symptoms and fatigue; grade 3 toxicities were uncommon (5%). Conclusions: Adjuvant RT after chemotherapy in FIGO stage IIIC2 endometrial cancer was associated with numerically better but not statistically significant OS, DFS and freedom from locoregional relapse after adjusting for risk factors.

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