title: Adjuvant therapy in stage III endometrial cancer: treatment outcomes and survival. a single-institution retrospective study.
abstract: OBJECTIVE
  As adjuvant treatment of advanced-stage endometrial cancer remains undefined, we sought to review and describe the outcomes of patients with International Federation of Obstetrics and Gynecology stage III endometrial cancer treated with chemotherapy and/or radiotherapy after primary surgery.
  
  
  METHODS
  We conducted a retrospective cohort study of patients with stage III disease treated at University College London Hospitals from 2002 to 2009. Patients were eligible if they received adjuvant treatment at our center. We excluded those with any synchronous gynecologic tumor and patients who underwent surgery but not adjuvant treatment at the center.
  
  
  RESULTS
  Stages IIIA, IIIB, and IIIC tumors accounted for 60%, 10%, and 30%, respectively. The median age was 67 years (range, 37-94 years). Sixty-five percent were pure endometrioid tumors, and 65% were high-grade (grade 3) tumors. Eighty-one patients received adjuvant treatment, 9% received chemotherapy alone, 28% received radiotherapy alone, and 63% received sequential combined chemotherapy followed by external beam radiotherapy with vaginal vault brachytherapy. In multivariate analysis, there was a significant difference between the adjuvant treatment groups for disease-free survival (DFS) and overall survival (OS) with those who received chemotherapy (DFS: P = 0.0001; hazard ratio [HR], 6.2; 95% confidence interval [CI], 2.47-15.8; OS: P = 0.003; HR, 6.0; CI, 2.2-16.6) or radiotherapy alone (DFS: P = 0.06; HR, 1.88; CI, 0.97-3.7; OS: P = 0.025; HR, 2.1; CI, 1.1-4.1) having a poorer survival compared to combined treatment. Overall survival at 3 years and 5 years were 57% and 47%, respectively, for all 81 patients who received any adjuvant treatment.
  
  
  CONCLUSIONS
  Sequential combined adjuvant chemotherapy and radiotherapy may be associated with a significant improvement in survival compared with chemotherapy or radiotherapy alone. Univariate and multivariate analysis showed that advanced age, high grade, and presence of lymphovascular space invasion were associated with poor DFS and OS. For patients with documented recurrence (n = 41), there was no clear relationship between site of recurrence and type of adjuvant treatment given.
authors.affiliation: Department of Gynaecological Oncology, University College London Hospitals, 250 Euston Rd., London, United Kingdom. Stephanie.kuku@uclh.nhs.uk
authors.forename: Stephanie
authors.initials: S
authors.lastname: Kuku
authors.forename: Matt
authors.initials: M
authors.lastname: Williams
authors.forename: Mary
authors.initials: M
authors.lastname: McCormack
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002291:Carcinoma, Papillary / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D016889:Endometrial Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D008207:Lymphatic Metastasis; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015996:Survival Rate