Gynecological Cancer

PV QA 4 - Poster Viewing Q&A 4

TU_20_3517 - Sandwich/sequential but not concurrent chemoradiation therapy is associated with overall survival for advanced endometrial carcinomas

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

Sandwich/sequential but not concurrent chemoradiation therapy is associated with overall survival for advanced endometrial carcinomas
M. King1, D. D. Yang2, D. L. Buscariollo3, G. Alban4, T. Cheng3, B. Krechmer3, J. Pretz3, and L. J. Lee3; 1Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 2Harvard Medical School, Boston, MA, 3Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA, 4Brigham and Women's Hospital, Boston, MA

Purpose/Objective(s): The GOG 0258 randomized controlled trial demonstrated no benefit in relapse free survival with concurrent chemoradiation (CRT) versus chemotherapy (C) alone for stage III-IVA endometrial carcinomas. We sought to determine whether the delayed initiation of RT with sandwich or sequential CRT regimens is associated with improved overall survival (OS).

Materials/Methods: We utilized the National Cancer Center Database to identify all patients eligible for the GOG 0258 trial (predominantly stage III-IVA carcinomas). All patients underwent surgical staging and received adjuvant multi-agent C with or without RT within 90 days of surgery. Patients who received adjuvant RT were divided into three sequencing regimens: concurrent (RT within 14 days of C), sandwich (RT between 14 and 126 days after C), and sequential (RT between 126 and 180 days after C). A Cox proportional hazards multivariate model was used to determine the associations between each of the sequencing regimens against C alone as a baseline, after adjusting for clinical (histology, age ≥ 65, Charlson co-morbidity index, stage, nodal evaluation, lymphovascular invasion, peritoneal cytology, margin status) and demographic (facility type, race) factors. Subgroup analyses were conducted for the endometrioid and stage IIIC subgroups.

Results: We identified 11,644 patients who were diagnosed between 2006 and 2014. The median follow-up was 39.4 months (IQR 23.9, 63.3). The numbers of patients who received C alone, concurrent CRT, sandwich CRT, and sequential CRT were 6911 (59%), 486 (4%), 2634 (23%), and 1613 (14%). 5156 (44%) had grade endometrioid histology, and 7006 (60%) had stage 3C disease. With C alone as a baseline, sandwich (HR = 0.73; p < 0.01) and sequential (0.69; p < 0.01) CRT, but not concurrent CRT (0.87; p = 0.14), were associated with improved OS. Similar results were obtained for the endometrioid subgroup: concurrent (0.91; p = 0.48), sandwich (0.70; p < 0.01), and sequential (0.73; p < 0.01). For the stage IIIC subgroup, the association for concurrent CRT did not reach significance (0.81; p = 0.06), while sandwich (0.70; p < 0.01), and sequential (0.66; p < 0.01) regimens remained significant.

Conclusion: These results support the use of sandwich or sequential RT with multi-agent chemotherapy in the adjuvant treatment of women with advanced stage endometrial cancer. Further prospective clinical validation of these results is warranted.

Author Disclosure: M. King: None. D.D. Yang: None. D.L. Buscariollo: None. G. Alban: None. B. Krechmer: None. L.J. Lee: Employee; Brigham and Women's Physician Organization. Research Grant; Bridge Expansion Grant, Astra Zeneca, Joint Center of Radiation Therapy, Dana-Farber Cancer Institute.

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