Concurrent cisplatin / radiation followed by adjuvant cisplatin / paclitaxel in treatment of patients with stage IB grade 3,IC and IIA endometrial carcinoma

ABSTRACT

Postoperative radiotherapy [RT] is the most commonly used adjuvant treatment in high risk endometrial carcinoma [HREC], it reduces the incidence of pelvic relapses but doesn't improve survival. This study was conducted to evaluate the efficacy and safety of concomitant weekly cisplatin and postoperative RT in HREC [stages IB grade 3, 1C and IIA] followed by adjuvant cisplatin and weekly paclitaxel. Eighteen patients with pathologically confirmed endometrial carcinoma were enrolled in this study. All patients underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy [TAH-BSO] and surgical staging. Five patients [28%], 4 patients [22%] and 9 patients [50%] presented with stages IB grade 3, 1C and IIA respectively. All patients received cisplatin once weekly during the 6 weeks of RT. After the chemo-radiation course, 4 additional adjuvant courses of cisplatin and paclitaxel were administered. Between May 2000 and March 2002, a total of 18 patients with pathologically confirmed endometrial carcinoma, presented to Radiation Oncology and Nuclear Medicine Department, Ain Shams University Hospitals, were enrolled in this study. Their median age was 59 years. No severe toxicity was encountered during concomitant chemoradiation. Grade 3 hematological toxicities, leucopenia, neutropenia and anemia were recorded in one patient [5.6%] each during adjuvant chemotherapy. Two patients [11%] relapsed with distant metastases and one patient [5.6%] developed pelvic recurrence. Median time to progression was 67 months. Five year disease free survival and the 5 year overall survival were 89% [95%, CI 74-100]. Concomitant cisplatin and postoperative RT followed by adjuvant cisplatin and weekly paclitaxel is safe and acceptable treatment in patients with HREC. This study verifies the feasibility of this treatment to potentially reduce the incidence of local and distant relapses in order to improve survival. Randomized phase III studies with large number of patients are necessary to evaluate the benefits of this approach: