title: Adjuvant sequential chemo and radiotherapy improves the oncological outcome in high risk endometrial cancer.
abstract: OBJECTIVE
  Evaluation of the impact of sequential chemoradiotherapy in high risk endometrial cancer (EC).
  
  
  METHODS
  Two hundred fifty-four women with stage IB grade 3, II and III EC (2009 FIGO staging), were included in this retrospective study.
  
  
  RESULTS
  Stage I, II, and III was 24%, 28.7%, and 47.3%, respectively. Grade 3 tumor was 53.2% and 71.3% had deep myometrial invasion. One hundred sixty-five women (65%) underwent pelvic (+/- aortic) lymphadenectomy and 58 (22.8%) had nodal metastases. Ninety-eight women (38.6%) underwent radiotherapy, 59 (23.2%) chemotherapy, 42 (16.5%) sequential chemoradiotherapy, and 55 (21.7%) were only observed. After a median follow-up of 101 months, 78 women (30.7%) relapsed and 91 women (35.8%) died. Sequential chemoradiotherapy improved survival rates in women who did not undergo nodal evaluation (disease-free survival [DFS], p=0.040; overall survival [OS], p=0.024) or pelvic (+/- aortic) lymphadenectomy (DFS, p=0.008; OS, p=0.021). Sequential chemoradiotherapy improved both DFS (p=0.015) and OS (p=0.014) in stage III, while only a trend was found for DFS (p=0.210) and OS (p=0.102) in stage I-II EC. In the multivariate analysis, only age (≤ 65 years) and sequential chemoradiotherapy were statistically related to the prognosis.
  
  
  CONCLUSIONS
  Sequential chemoradiotherapy improves survival rates in high risk EC compared with chemotherapy or radiotherapy alone, in particular in stage III.
authors.affiliation: Clinic of Obstetrics and Gynecology, University of Milan-Bicocca, San Gerardo Hospital, Monza, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Signorelli
authors.affiliation: Clinic of Obstetrics and Gynecology, University of Milan-Bicocca, San Gerardo Hospital, Monza, Italy.
authors.forename: Andrea Alberto
authors.initials: AA
authors.lastname: Lissoni
authors.affiliation: Medical Physics Department, University of Milan-Bicocca, San Gerardo Hospital, Monza, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: De Ponti
authors.affiliation: Clinic of Obstetrics and Gynecology, University of Milan-Bicocca, San Gerardo Hospital, Monza, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Grassi
authors.affiliation: Clinic of Obstetrics and Gynecology, University of Milan-Bicocca, San Gerardo Hospital, Monza, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Ponti
authors.affiliation: Clinic of Obstetrics and Gynecology, University of Milan-Bicocca, San Gerardo Hospital, Monza, Italy. robert.fruscio@unimib.it.
authors.forename: Robert
authors.initials: R
authors.lastname: Fruscio
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy / Q000379:methods*; D017024:Chemotherapy, Adjuvant / Q000379:methods; D016889:Endometrial Neoplasms / Q000628:therapy*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008197:Lymph Node Excision / Q000379:methods; D008207:Lymphatic Metastasis; D008875:Middle Aged; D018714:Radiotherapy, Adjuvant / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Endometrial Neoplasms; Lymph Node Excision; Multivariate Analysis; Retrospective Studies; Survival rate