Time will tell.
The Study: As a reminder, this iteration of a high-risk endometrial cancer trial randomized 660 women to post-op pelvic radiation (1.8 Gy x 27 = 48.6 Gy) +/- chemo (concurrent cisplatin x 2 and adjuvant carbo/taxol x 4). At time of previous reporting, there were enough events to distinguish a failure-free survival (FFS) benefit overall, but particularly among the patients with stage III disease, and an overall survival (OS) benefit only among women over age 70. This updated report boasts a longer median follow-up time, now over 6 years, and splashier results. Both the co-primary endpoints of FFS and OS are now significantly better with the addition of chemo when looking at the overall (admittedly quite variable) study population. At 5 years, FFS was improved 69 → 77% and OS 76 → 81%. Here women with stage III disease (n=295) stood out with a big OS advantage with the addition of chemo (69 → 79%), outshined only by those with serous histology (n=105, 53 → 71%). Interestingly, when considering the NCCN-endorsed option for pelvic radiation plus vaginal brachytherapy alone for this patient population, the number of isolated vaginal recurrences was a whopping n=1 in each group, far outweighed by the rate of distant mets: 29% with radiation alone and 21% with chemoradiation.
TBL: There’s now a good argument to be made that post-op chemoradiation is the new standard of care for women with high-risk endometrial cancer, particularly those with stage III disease or serous histology. | de Boer, Lancet Oncol 2019