Top Line: How aggressive should you be with known para-aortic mets from endometrial cancer (i.e., stage IIIC2 disease per current staging)?
The Study: Most would say systemic therapy is needed, and PORTEC 3 would agree, though it’s tough to tell how many women with para-aortic nodal involvement were included. But is radiation spanning the pelvis all the way up to 2 cm superior to the highest known mets really worth it? Nihilists say probably not, and so does GOG 258. Too add to the debate, here’s an Italian retrospective look at outcomes specifically among women treated for (what is now) stage IIIC2 endometrial cancer spanning three decades. Among 105 women, roughly one quarter received chemo alone, another quarter radiation alone, and the remaining half received both with almost all of these receiving chemo first. Recurrences happened in 44% of women, and two-thirds were distant. Among those with endometrioid histology (n=60), combined chemo and radiation dramatically improved disease-free (HR 0.22) and overall (HR 0.28) survival versus either modality alone, but not so among those with non-endometrioid histology (n=45). That’s probably because the latter had a much worse prognosis regardless of therapy.
TBL: Retrospective data supports combined chemo and radiation for endometrioid IIIC2 disease, while the addition of radiation is less likely to put a dent in the poor prognosis of non-endometrioid IIIC2 disease. | Bogani, Int J Gynecol Cancer 2020