Adjuvant Pelvic Radiotherapy vs.Sequential Chemoradiotherapy for High-Risk StageⅠ-ⅡEndometrial Carcinoma

<正>Objective To explore if the addition of adjuvant chemotherapy with paclitaxel and carboplatin to radiotherapy confers an advantage for overall survival（OAS）,and progression free survival（PFS）;to assess the incidence of relapses over standard pelvic radiotherapy; and to evaluate the related toxicity in high-risk stageⅠ-Ⅱendometrial carcinoma Methods Medical records were reviewed to identify high-risk stageⅠ-Ⅱendometrial carcinoma cases treated in the Clinical Oncology and Nuclear Medicine department between 2002 and 2008 with adjuvant radiotherapy alone（armⅠ）(57 patients) or with sequential carboplatin（AUC5-6） and paclitaxel（135-175 mg/m2） with radiotherapy（armⅡ）(51 patients).Radiotherapy was performed through the four-field box technique at doses of 45-50 Gy（1.8 Gy/day×5 days/week）. Results The toxicity was manageable and predominantly hematologic with a grade 3 neutropenia and thrombocytopenia in 9.8% and 6% of the patients in armⅠand armⅡ,respectively,without febrile neutropenia.All patients experienced hair loss. Chemoradiotherapy arm was associated with a lower incidence rate of relapse（9.8% vs.22.7% ）.After a median follow-up period of 48 months,the 5-year OAS and PFS rates for chemoradiotherapy-treated patients were significantly more favorable than those who did not receive chemotherapy（P=0.02 and 0.03,respectively）.In armⅠ,the OAS and PFS rates were 73.7% and 66.7% compared with those in armⅡ,whose rates were 90.2% and 84.3% . Conclusions Adjuvant chemoradiation with paclitaxel and carboplatin improved the survival rates and decreased the recurrence rates in patients with high-risk stageⅠ-Ⅱendometrial carcinoma.Chemotherapy was associated with an acceptable rate of toxicity. However,a prospective study with a larger number of patients is needed to define a standard adjuvant treatment for high-risk stageⅠ-Ⅱendometrial carcinoma.