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Does post-operative radiochemotherapy improve survival in high-grade endometrial cancer patients? Results of a population-based cohort analysis of a cancer registry

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Adjuvant treatment of high-grade endometrial cancer varies greatly due to the lack of definitive results from controlled randomized trials on the subject. In a retrospective study, we sought to investigate the influence of post-operative radio-, chemo, and radiochemotherapy on survival time and recurrence rates among high-grade endometrial cancer patients.

Methods

284 high-grade endometrial cancer patients (FIGOI–III, or unknown classification) diagnosed between 1998 and 2015 were retrospectively analyzed. All patients underwent surgery. Overall survival (OS), recurrence-free survival (RFS), and recurrence rates were compared for post-operative treatment modalities of radiotherapy alone (RT), chemotherapy alone (CTX), radiochemotherapy (RCT), and observation (OBS).

Results

Post-operative RCT and RT resulted in a significantly improved 5-year OS of 94.1% (HR 0.104, CI 0.013–0.809) and 62.1% (HR 0.615, CI 0.390–0.969), respectively, compared to 43.6% for OBS. CTX did not significantly improve OS leading to a 5-year OS of 56.5% (HR 0.783, CI 0.224–2.740). 5-year recurrence rate was lowest for patients treated with RCT (5.3%). 5-year RFS was 94.1% for the RCT group and proved to be significantly superior to 58.8% for RT (HR 9.034, CI 1.184–68.948), 56% for CTX (HR 12.738, CI 1.337–121.346), and 37.4% for OBS (HR 16.407, CI 2.127–126.575), respectively. In comparison with OBS, RT alone resulted in a significant improvement in RFS (HR 0.551, CI 0.354–0.856).

Conclusions

Our retrospective population-based study indicates a survival benefit from treating high-grade endometrial cancer with post-operative RCT. Randomized controlled trials are needed to minimize potential confounding parameters and further clarify the subject.

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Authors and Affiliations

  1. Klinik und Poliklinik für Strahlentherapie und RadioOnkologie, Klinikum rechts der Isar, Technische Universität München (TUM), Ismaninger Straße 22, 81675, Munich, Germany

    Sophia Scharl

  2. Frauenklinik, Klinikum St. Marien Amberg, Mariahilfbergweg 7, 92224, Amberg, Germany

    Thomas Papathemelis & Anton Scharl

  3. Tumorzentrum Regensburg, Institut für Qualitätssicherung und Versorgungsforschung der, Universität Regensburg, Am Biopark 9, 93053, Regensburg, Germany

    Karin Kronberger, Michael Gerken & Monika Klinkhammer-Schalke

  4. Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93051, Regensburg, Germany

    Oliver Kölbl

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  1. Sophia Scharl
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  2. Thomas Papathemelis
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  3. Karin Kronberger
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  4. Michael Gerken
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  5. Anton Scharl
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  7. Monika Klinkhammer-Schalke
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Contributions

Protocol/project development: Scharl S, Papathemelis T, Scharl A, Kölbl O, and Klinkhammer-Schalke M. Data collection or management: Kronberger K and Gerken M. Data analysis: Kronberger K, Gerken M, and Scharl S. Manuscript draft: Scharl S. Manuscript revision: Papathemelis T, Scharl A, Kölbl O, and Klinkhammer-Schalke M

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Correspondence to Sophia Scharl.

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The authors declare that they have no conflict of interest.

Ethics approval

Ethics approval and consent to participate: due to the analysis of data from a clinical cancer registry, no ethics approval was necessary. This was confirmed by the Ethics Committee at the Regensburg University, Regensburg, Germany.

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Scharl, S., Papathemelis, T., Kronberger, K. et al. Does post-operative radiochemotherapy improve survival in high-grade endometrial cancer patients? Results of a population-based cohort analysis of a cancer registry. Arch Gynecol Obstet 297, 1245–1253 (2018). https://doi.org/10.1007/s00404-018-4708-6

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  • DOI: https://doi.org/10.1007/s00404-018-4708-6

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