Study Analyzes Adjuvant Chemoradiotherapy vs Adjuvant Chemotherapy for Patients with Stage III Endometrial Cancer Following Radical Surgery
A group of researchers recently published a meta-analysis evaluating whether adjuvant chemoradiotherapy (ACR) is more effective than adjuvant chemotherapy (AC) for the treatment of patients with stage III endometrial cancer after undergoing primary radical surgery (BMC Cancer. 2023;23[1]:31. doi:10.1186/s12885-022-10482-x).
For these patients, radical surgery that includes total hysterectomy and bilateral salpingo-oophorectomy (TH/BSO) is the usual treatment. Following these major procedures, the National Comprehensive Cancer Network recommends the use of adjuvant therapies such as chemo- and radiotherapy. The combination of the two therapies into ACR may have better patient outcomes than utilizing AC alone, but current available data from clinical trials comparing ACR with AC treatment is limited in this patient group.
For their study, Si-yu Cao, MD, Department of Gynecology and Obstetrics, West China Second Hospital, Sichuan University, Sichuan, China, and colleagues searched for relevant clinical trials, including randomized controlled trials (RCTs), that were published between January 1, 2012, and March 1, 2022, in PubMed Central, Embase, and the Cochrane Central Register of Controlled Trials. The researchers selected studies to include in the meta-analysis where the patients had been diagnosed with endometrial carcinoma stage III using the International Federation of Gynecology and Obstetrics (FIGO) staging system and had TH/BSO surgery.
The researchers extracted data from the studies including the study type, type of AC or ACR, rate of recurrence (local, distant, and total), progression-free survival (PFS), disease-free survival (DFS), overall survival (OS), type of primary surgery, and median length of follow-up. They used the I2 test to assess heterogeneity, where I2 ≥50% was considered high. In addition, they identified other possible sources of heterogeneity through a subgroup analysis using FIGO substage (IIIA, IIIB, or IIIC) or histological type.
In total, 16 articles consisting of 18,375 patients were used in the meta-analysis. Of these articles, one was an RCT and the remainder were retrospective studies. Overall, Dr Cao and colleagues found that when comparing cancer recurrence rates and survival between the patients who received AC or ACR after surgery, those who received ACR had significantly lower risk of total and local recurrence (odds ratio: 0.72 and 0.43, respectively; 95% confidence interval [CI]: 0.58-0.89 and 0.32-0.59, respectively). In addition, patients who received ACR had significantly better OS, PFS, and DFS (hazard ratio: 0.66, 0.56, and 0.66, respectively; 95% CI: 0.57-0.76, 0.39-0.81, and 0.53-0.83, respectively).
The researchers acknowledged that the study had a few limitations, which included that the pooled OS data were significantly homogenous; they could not account for factors such as post-surgery residual tumor volume, regimen differences for chemo- or radiotherapy, lymph node dissection, or other variables that could have impacted patients’ survival; the studies included in their meta-analysis were mostly retrospective, which may have contributed to selection bias; and they could not exclude from their analysis 22 patients in the RCT who were had stage I, II, or IV endometrial cancer.
“Despite these limitations, our meta-analysis provides strong evidence that ACR is superior to AC for preventing recurrence and improving survival of patients with stage III endometrial cancer,” wrote Dr Cao and colleagues.
The authors suggest that ACR treatment may be recommended for patients with stage III endometrial cancer, particularly those who are at greater risk of recurrence, based on the results from their study.
