Research shows chemotherapy after surgery helps endometrial cancer patients
A new study, led by an ECU physician, shows that giving two chemotherapy drugs to women with advanced endometrial cancer after surgery reduces the risk of recurrence by 29 percent and extends survival by 32 percent compared with women who receive whole abdominal irradiation.
The findings could improve the care for the 15 to 20 percent of patients with endometrial cancer who have advanced disease. The study was published online this week in the Journal of Clinical Oncology.
Dr. Marcus Randall
“For the first time, adjuvant chemotherapy has been shown to extend survival in patients with advanced endometrial cancer,” said the study’s lead author, Dr. Marcus E. Randall, professor of radiation oncology at the Brody School of Medicine at East Carolina University and director of the Leo W. Jenkins Cancer Center, a joint venture of the medical school and Pitt County Memorial Hospital. “These findings were surprising, given that previous studies showed that single chemotherapy agents do not have a significant impact on the disease.”
Endometrial cancer is the most common gynecologic cancer in the United States. The American Cancer Society estimates that this year 40,880 women will be diagnosed with the disease and 7,310 will die.
Researchers from the Gynecologic Oncology Group compared the rate of recurrence and overall survival between 194 women with advanced endometrial cancer who received chemotherapy with the drugs doxorubicin and cisplatin over a period of five months and 202 women who received radiation therapy to the entire abdomen over a period of approximately six weeks. Patients were enrolled in the trial from 1992 until 2001. Researchers followed patients for a median of just over six years, and used a statistical model to estimate five-year recurrence and survival rates.
After five years, 50 percent of patients who received chemotherapy were estimated to be free of disease compared with 38 percent of those who received whole abdominal irradiation. Moreover, 55 percent of patients who received chemotherapy were estimated to be alive after five years, compared with 42 percent of patients in the radiation therapy group.
However, serious adverse side effects were more common in the chemotherapy group. The most common serious side effects included reduced blood cell counts and problems with the digestive and nervous systems, liver and heart. Treatment-related deaths were also twice as common in the chemotherapy group (4 percent vs. 2 percent of radiation patients).
Another study is underway to see if the chemotherapy drugs carboplatin and paclitaxel will be as effective but with fewer serious side effects. A less toxic regimen could help more patients with advanced disease, many of whom are elderly or have other illnesses that might prohibit the use of the aggressive chemotherapy regimen.
In addition, another GOG study evaluated the use of combination chemotherapy after “involved field” radiation therapy (radiation to less than the whole abdomen) to see if these patients might benefit more than those who receive either treatment alone. Results from this study are not yet available.
“This study represents a major advance in the treatment of advanced endometrial cancer,” noted Dr. Gini F. Fleming, director of the Medical Oncology Gynecologic and Breast Cancer Programs at the University of Chicago and author of an accompanying editorial. “Future trials need to address treatment of earlier-stage disease, optimization of chemotherapy regimen, integration of radiotherapy and application of newer targeted agents.”