Association of chemotherapy and radiotherapy sequence with overall survival in locoregionally advanced endometrial cancer

Chelain R. Goodman, Saleh Hatoum, Brandon Luke L. Seagle, Eric D. Donnelly, Emma L. Barber, Shohreh Shahabi, Daniela Matei, Jonathan B. Strauss

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective: The optimal adjuvant management of women with FIGO Stage III-IVA endometrial cancer (EC) is unclear. While recent prospective data suggest that treatment with pelvic radiotherapy (RT) prior to chemotherapy (CT) is not associated with a survival benefit compared to CT alone, no prospective randomized trial has included a treatment arm in which CT is given before RT. Methods: An observational cohort study was performed on women with FIGO Stage III-IVA Type 1 (grade 1–2, endometrioid) EC who underwent hysterectomy and received multi-agent CT and/or RT from 2004 to 2014 at Commission on Cancer-accredited hospitals. Multivariable parametric accelerated failure time models were performed to estimate the association of sequence of adjuvant CT and RT with overall survival (OS) using propensity score-adjusted matched cohorts. Results: Of 5795 women identified, 1260 (21.7%) received RT only, 2465 (42.5%) received CT only, 593 (9.7%) received RT before CT, and 1506 (26.0%) received RT after CT. Women who received RT after CT experienced significantly longer 5-year OS than women who received RT before CT (5-year OS: 80.1% vs 73.3%; time-ratio (TR) = 1.37, 95% CI = 1.18–1.58, P < 0.001), CT only (68.9%; TR = 1.33, 95% CI = 1.19–1.48, P < 0.001), or RT only (64.5%, TR = 1.50, 95% CI = 1.32–1.70, P < 0.001). Conclusions: For women with advanced EC, treatment with multi-agent CT followed by RT is associated with longer OS compared with treatment with RT followed by CT or either treatment alone. These hypothesis-generating data support inclusion in future prospective trials of regimens in which multi-agent CT starts prior to RT.

Original languageEnglish (US)
JournalGynecologic Oncology
DOIs
StateAccepted/In press - Jan 1 2019
Externally publishedYes

Fingerprint

Endometrial Neoplasms
Radiotherapy
Drug Therapy
Survival
Therapeutics
Cancer Care Facilities
Propensity Score
Adjuvant Radiotherapy
Adjuvant Chemotherapy
Hysterectomy
Observational Studies
Cohort Studies

Keywords

  • Chemotherapy
  • Endometrial cancer
  • Radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Cite this

Goodman, C. R., Hatoum, S., Seagle, B. L. L., Donnelly, E. D., Barber, E. L., Shahabi, S., ... Strauss, J. B. (Accepted/In press). Association of chemotherapy and radiotherapy sequence with overall survival in locoregionally advanced endometrial cancer. Gynecologic Oncology. https://doi.org/10.1016/j.ygyno.2019.01.007

Association of chemotherapy and radiotherapy sequence with overall survival in locoregionally advanced endometrial cancer. / Goodman, Chelain R.; Hatoum, Saleh; Seagle, Brandon Luke L.; Donnelly, Eric D.; Barber, Emma L.; Shahabi, Shohreh; Matei, Daniela; Strauss, Jonathan B.

In: Gynecologic Oncology, 01.01.2019.

Research output: Contribution to journalArticle

Goodman, Chelain R. ; Hatoum, Saleh ; Seagle, Brandon Luke L. ; Donnelly, Eric D. ; Barber, Emma L. ; Shahabi, Shohreh ; Matei, Daniela ; Strauss, Jonathan B. / Association of chemotherapy and radiotherapy sequence with overall survival in locoregionally advanced endometrial cancer. In: Gynecologic Oncology. 2019.
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abstract = "Objective: The optimal adjuvant management of women with FIGO Stage III-IVA endometrial cancer (EC) is unclear. While recent prospective data suggest that treatment with pelvic radiotherapy (RT) prior to chemotherapy (CT) is not associated with a survival benefit compared to CT alone, no prospective randomized trial has included a treatment arm in which CT is given before RT. Methods: An observational cohort study was performed on women with FIGO Stage III-IVA Type 1 (grade 1–2, endometrioid) EC who underwent hysterectomy and received multi-agent CT and/or RT from 2004 to 2014 at Commission on Cancer-accredited hospitals. Multivariable parametric accelerated failure time models were performed to estimate the association of sequence of adjuvant CT and RT with overall survival (OS) using propensity score-adjusted matched cohorts. Results: Of 5795 women identified, 1260 (21.7{\%}) received RT only, 2465 (42.5{\%}) received CT only, 593 (9.7{\%}) received RT before CT, and 1506 (26.0{\%}) received RT after CT. Women who received RT after CT experienced significantly longer 5-year OS than women who received RT before CT (5-year OS: 80.1{\%} vs 73.3{\%}; time-ratio (TR) = 1.37, 95{\%} CI = 1.18–1.58, P < 0.001), CT only (68.9{\%}; TR = 1.33, 95{\%} CI = 1.19–1.48, P < 0.001), or RT only (64.5{\%}, TR = 1.50, 95{\%} CI = 1.32–1.70, P < 0.001). Conclusions: For women with advanced EC, treatment with multi-agent CT followed by RT is associated with longer OS compared with treatment with RT followed by CT or either treatment alone. These hypothesis-generating data support inclusion in future prospective trials of regimens in which multi-agent CT starts prior to RT.",
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T1 - Association of chemotherapy and radiotherapy sequence with overall survival in locoregionally advanced endometrial cancer

AU - Goodman, Chelain R.

AU - Hatoum, Saleh

AU - Seagle, Brandon Luke L.

AU - Donnelly, Eric D.

AU - Barber, Emma L.

AU - Shahabi, Shohreh

AU - Matei, Daniela

AU - Strauss, Jonathan B.

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N2 - Objective: The optimal adjuvant management of women with FIGO Stage III-IVA endometrial cancer (EC) is unclear. While recent prospective data suggest that treatment with pelvic radiotherapy (RT) prior to chemotherapy (CT) is not associated with a survival benefit compared to CT alone, no prospective randomized trial has included a treatment arm in which CT is given before RT. Methods: An observational cohort study was performed on women with FIGO Stage III-IVA Type 1 (grade 1–2, endometrioid) EC who underwent hysterectomy and received multi-agent CT and/or RT from 2004 to 2014 at Commission on Cancer-accredited hospitals. Multivariable parametric accelerated failure time models were performed to estimate the association of sequence of adjuvant CT and RT with overall survival (OS) using propensity score-adjusted matched cohorts. Results: Of 5795 women identified, 1260 (21.7%) received RT only, 2465 (42.5%) received CT only, 593 (9.7%) received RT before CT, and 1506 (26.0%) received RT after CT. Women who received RT after CT experienced significantly longer 5-year OS than women who received RT before CT (5-year OS: 80.1% vs 73.3%; time-ratio (TR) = 1.37, 95% CI = 1.18–1.58, P < 0.001), CT only (68.9%; TR = 1.33, 95% CI = 1.19–1.48, P < 0.001), or RT only (64.5%, TR = 1.50, 95% CI = 1.32–1.70, P < 0.001). Conclusions: For women with advanced EC, treatment with multi-agent CT followed by RT is associated with longer OS compared with treatment with RT followed by CT or either treatment alone. These hypothesis-generating data support inclusion in future prospective trials of regimens in which multi-agent CT starts prior to RT.

AB - Objective: The optimal adjuvant management of women with FIGO Stage III-IVA endometrial cancer (EC) is unclear. While recent prospective data suggest that treatment with pelvic radiotherapy (RT) prior to chemotherapy (CT) is not associated with a survival benefit compared to CT alone, no prospective randomized trial has included a treatment arm in which CT is given before RT. Methods: An observational cohort study was performed on women with FIGO Stage III-IVA Type 1 (grade 1–2, endometrioid) EC who underwent hysterectomy and received multi-agent CT and/or RT from 2004 to 2014 at Commission on Cancer-accredited hospitals. Multivariable parametric accelerated failure time models were performed to estimate the association of sequence of adjuvant CT and RT with overall survival (OS) using propensity score-adjusted matched cohorts. Results: Of 5795 women identified, 1260 (21.7%) received RT only, 2465 (42.5%) received CT only, 593 (9.7%) received RT before CT, and 1506 (26.0%) received RT after CT. Women who received RT after CT experienced significantly longer 5-year OS than women who received RT before CT (5-year OS: 80.1% vs 73.3%; time-ratio (TR) = 1.37, 95% CI = 1.18–1.58, P < 0.001), CT only (68.9%; TR = 1.33, 95% CI = 1.19–1.48, P < 0.001), or RT only (64.5%, TR = 1.50, 95% CI = 1.32–1.70, P < 0.001). Conclusions: For women with advanced EC, treatment with multi-agent CT followed by RT is associated with longer OS compared with treatment with RT followed by CT or either treatment alone. These hypothesis-generating data support inclusion in future prospective trials of regimens in which multi-agent CT starts prior to RT.

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KW - Endometrial cancer

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