الفهرس | Only 14 pages are availabe for public view |
Abstract • Endometrial cancer is the sixth most common malignancy worldwide. In our institution it represents approximately 31% of the female genital system tumors (Helal et al, 2015). • The majority of cases present at an early stage which have a good 5 years overall survival (Creasman et al, 2006). • Apart from the stage there are some prognostic features which make early stage EC at higher risk of recurrence and distant metastasis. Those risk factors are lymphovascular invasion, grade 3, deep myometrial invasion, tumor reaching the cervix or adenexa and serosa. Also older age is associated with worse prognosis (Tejerizo-Garcia et al ,2013). • Radiotherapy has proven to improve the local recurrence but did not affect the overall survival. • The EORTC/MaNGO trial showed a significant improvement of PFS with the addition of adjuvant chemotherapy to radiotherapy for patients with early stage high risk (Hogberg et al, 2010). • Also a retrospective study in British Columbia showed a PFS benefit of adding chemotherapy to those patients (Jutzi et al, 2013). • Our study provides an insight into the utility of chemotherapy for the higher risk subgroup of EC patients. Although disease free survival and the rate of recurrence seems better than other studies not using the adjuvant chemotherapy, a comparison of outcomes and getting final conclusion is difficult because of heterogenous patients’ collectives and different study designs. • Adjuvant RTH concomitant with cisplatin 50mg/m2 followed by 4 cycles of paclitaxel carboplatin is well tolerated and feasible regimen in patients with higher risk EC. • Giving the chemotherapy before or after Radiotherapy did not differ as regard the toxicity. • It is better to start the adjuvant radiotherapy within 6-8 weeks after surgery. • Further comparison of adjuvant chemotherapy and radiotherapy to radiotherapy alone is the subject of an ongoing clinical trial. PORTEC 3, a multicenteric phase III randomized trial evaluating the combination of chemotherapy and radiotherapy compared to radiotherapy alone for these high risk patients. (Creutzberg, NCT00411138).The final results of PORTEC3 will further define the role of chemotherapy in the adjuvant treatment of women with high risk early stage endometrial cancer. |