Radiation Therapy With or Without Cisplatin for Local Recurrences of Endometrial Cancer: Results From an NRG Oncology/GOG Prospective Randomized Multicenter Clinical Trial

Ann H. Klopp, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Danielle Enserro, Clinical Trials Development Division, Roswell Park Comprehensive Cancer Center, Buffalo, NY.
Matthew Powell, Washington University School of Medicine, Obstetrics & Gynecology, St Louis, MO.
Marcus Randall, University of Kentucky, Radiation Oncology, Lexington, KY.
Julian C. Schink, Cancer Treatment Centers of America, City of Hope, Gynecologic Oncology, Chicago, IL.
Robert S. Mannel, University of Oklahoma Health Sciences, Oklahoma City, OK.
Laura Holman, University of Oklahoma Health Sciences, Oklahoma City, OK.
David Bender, University of Iowa Hospitals & Clinics, Iowa City, IA.
Christina L. Kushnir, Women's Cancer Center of Nevada, Las Vegas, NV.
Floor Backes, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH.
Susan L. Zweizig, University of Massachusetts Memorial Health Care, Gynecologic Oncology, Worcester, MA.
Steven Waggoner, Cleveland Clinic Foundation, Medical Oncology, Cleveland, OH.
Kristin A. Bradley, University of Wisconsin Hospital and Clinics, Radiation Oncology, Madison, WI.
Lana DeSouza Lawrence, Delaware/Christiana Care, Radiation Oncology, Newark, DE.
Parviz Hanjani, Abington Memorial Hospital, Gynecologic Oncology, Abington, PA.
Christopher J. Darus, Maine Medical Center, Gynecologic Oncology, Scarborough, ME.
William Small, Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Cardinal Bernardin Cancer Center, Chicago, IL.
Higinia R. Cardenes, New York-Presbyterian Hospital, Weill Cornell Medicine, Clinical Radiation Oncology, New York, NY.
Jonathan M. Feddock, Baptist Health, Radiation Oncology, Lexington, KY.
David S. Miller, University of Texas Southwestern Medical Center, Gynecologic Oncology, Dallas, TX.

Document Type

Article

Publication Date

4-25-2024

Institution/Department

Oncology; Obstetrics & Gynecology

Journal Title

Journal of clinical oncology : official journal of the American Society of Clinical Oncology

Abstract

PURPOSE: Pelvic recurrence is a frequent pattern of relapse for women with endometrial cancer. A randomized trial compared progression-free survival (PFS) after treatment with radiation therapy alone as compared with concurrent chemotherapy. MATERIALS AND METHODS: Between February 2008 and August 2020, 165 patients were randomly assigned 1:1 to receive either radiation treatment alone or a combination of chemotherapy and radiation treatment. The primary objective of this study was to determine whether chemoradiation therapy was more effective than radiation therapy alone at improving PFS. RESULTS: The majority of patients had low-grade (1 or 2) endometrioid histology (82%) and recurrences confined to the vagina (86%). External beam with either the three-dimensional or intensity modulated radiation treatment technique was followed by a boost delivered with brachytherapy or external beam. Patients randomly assigned to receive chemotherapy were treated with once weekly cisplatin (40 mg/m). Rates of acute toxicity were higher in patients treated with chemoradiation as compared with radiation treatment alone. Median PFS was longer for patients treated with radiation therapy alone as compared with chemotherapy and radiation (median PFS was not reached for RT 73 months for chemoradiation, hazard ratio of 1.25 (95% CI, 0.75 to 2.07). At 3 years, 73% of patients treated definitively with radiation and 62% of patients treated with chemoradiation were alive and free of disease progression. CONCLUSION: Excellent outcomes can be achieved for women with localized recurrences of endometrial cancer when treated with radiation therapy. The addition of chemotherapy does not improve PFS for patients treated with definitive radiation therapy for recurrent endometrial cancer and increases acute toxicity. Patients with low-grade and vaginal recurrences who constituted the majority of those enrolled are best treated with radiation therapy alone.

First Page

JCO2301279

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