The 4-field box still rocks.
The Study: This week the full manuscript is finally ready for public viewing—or at least pay per viewing. As a reminder, GOG 249 was another one of those phase 3 trials evaluating how best to balance chances for cure and toxicity in the adjuvant management of at least high-intermediate risk, early-stage endometrial cancer. Here this was defined as any stage I-II serous or clear cell histology, any stage II, or high-risk stage I per GOG 33 (3 risk factors or age 50-69 with 2 risk factors or age 70+ with 1 risk factor: risk factors being LVSI, grade 2+, outer-third invasion). Over 600 women were randomized post-hysterectomy to  conventionally-fractionated whole pelvis radiation or  vaginal brachy followed by 3 cycles of carbo/Taxol. At 5 years, rates of recurrence-free (76%) and overall (85-86%) survival were virtually identical, with no separations emerging across different subset analyses. Increased toxicity and pelvic node recurrences, on the other hand, were standout downsides of the chemo arm.
Bottom Line: Adjuvant whole pelvis radiation remains the standard for high-intermediate risk endometrial cancer. | Randall, J Clin Oncol 2019