open access

Vol 17, No 2 (2021)
Research paper
Published online: 2021-01-08
Get Citation

Adjuvant chemotherapy and radiation therapy with the “sandwich” method for endometrial cancer: an institutional analysis

Yiqing Butler-Xu, Lori Spoozak, Julia Chapman, Andrea Jewell, Dineo Khabele, Andrew Hoover
DOI: 10.5603/OCP.2021.0003
·
Oncol Clin Pract 2021;17(2):53-58.

open access

Vol 17, No 2 (2021)
ORIGINAL ARTICLE
Published online: 2021-01-08

Abstract

Introduction. Choice of adjuvant therapy for high risk endometrial cancers is controversial. The so-called “sandwich” regimen of pelvic external beam radiation administered between cycles of Carboplatin/Paclitaxel (CT-RT-CT) is commonly used in clinical practice but has not been evaluated in randomized endometrial cancer trials. There is relatively little published data regarding toxicity, patient tolerance, and efficacy of this regimen. Here, we report our institutional experience of CT-RT-CT for locally advanced endometrial cancer, focusing on toxicity and rates of compliance with study therapy.

Material and methods. Medical records of consecutive patients treated for surgically staged endometrial cancer at a tertiary care academic medical center between 2010 and 2017 were reviewed. All patients received adjuvant CT-RT-CT. Progression-free and overall survival were recorded from the date of surgery. Toxicity data was obtained from patient medical records and graded according to Common Terminology for Adverse Events Criteria, version 3.0.

Results. Thirty-eight patients with histologically proven stage I–IV endometrial cancer were included. Eighty-four percent of patients were able to complete all 6 planned cycles of chemotherapy and 92% completed at least 4 cycles. Cumulative incidence of grade 3–4 hematologic toxicity was 55%. Locoregional recurrence was the first site of failure in 2 patients (5.1%) while distant failure was the first site of recurrence in 8 patients (21%). Two year overall survival and progression-free survival were 76% and 77% respectively.

Conclusion. Our results suggest that adjuvant chemotherapy and radiation therapy with the “sandwich” regimen is associated with acceptable toxicity and satisfactory rates of completion of planned therapy.

Abstract

Introduction. Choice of adjuvant therapy for high risk endometrial cancers is controversial. The so-called “sandwich” regimen of pelvic external beam radiation administered between cycles of Carboplatin/Paclitaxel (CT-RT-CT) is commonly used in clinical practice but has not been evaluated in randomized endometrial cancer trials. There is relatively little published data regarding toxicity, patient tolerance, and efficacy of this regimen. Here, we report our institutional experience of CT-RT-CT for locally advanced endometrial cancer, focusing on toxicity and rates of compliance with study therapy.

Material and methods. Medical records of consecutive patients treated for surgically staged endometrial cancer at a tertiary care academic medical center between 2010 and 2017 were reviewed. All patients received adjuvant CT-RT-CT. Progression-free and overall survival were recorded from the date of surgery. Toxicity data was obtained from patient medical records and graded according to Common Terminology for Adverse Events Criteria, version 3.0.

Results. Thirty-eight patients with histologically proven stage I–IV endometrial cancer were included. Eighty-four percent of patients were able to complete all 6 planned cycles of chemotherapy and 92% completed at least 4 cycles. Cumulative incidence of grade 3–4 hematologic toxicity was 55%. Locoregional recurrence was the first site of failure in 2 patients (5.1%) while distant failure was the first site of recurrence in 8 patients (21%). Two year overall survival and progression-free survival were 76% and 77% respectively.

Conclusion. Our results suggest that adjuvant chemotherapy and radiation therapy with the “sandwich” regimen is associated with acceptable toxicity and satisfactory rates of completion of planned therapy.

Get Citation

Keywords

endometrial cancer, sandwich therapy, radiation, carboplatin, paclitaxel

About this article
Title

Adjuvant chemotherapy and radiation therapy with the “sandwich” method for endometrial cancer: an institutional analysis

Journal

Oncology in Clinical Practice

Issue

Vol 17, No 2 (2021)

Article type

Research paper

Pages

53-58

Published online

2021-01-08

DOI

10.5603/OCP.2021.0003

Bibliographic record

Oncol Clin Pract 2021;17(2):53-58.

Keywords

endometrial cancer
sandwich therapy
radiation
carboplatin
paclitaxel

Authors

Yiqing Butler-Xu
Lori Spoozak
Julia Chapman
Andrea Jewell
Dineo Khabele
Andrew Hoover

References (17)
  1. Siegel RL, Miller KD, Jemal A. Cancer statistics. CA Cancer J Clin . 2018; 68: 7–30.
  2. Koh WJ, Abu-Rustum NR, Bean S, et al. Uterine Neoplasms, Version 1.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2018; 16(2): 170–199.
  3. Meyer LA, Bohlke K, Powell MA, et al. Postoperative Radiation Therapy for Endometrial Cancer: American Society of Clinical Oncology Clinical Practice Guideline Endorsement of the American Society for Radiation Oncology Evidence-Based Guideline. J Clin Oncol. 2015; 33(26): 2908–2913.
  4. Randall ME, Filiaci VL, Muss H, et al. Gynecologic Oncology Group Study. Randomized phase III trial of whole-abdominal irradiation versus doxorubicin and cisplatin chemotherapy in advanced endometrial carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol. 2006; 24(1): 36–44.
  5. Kupets R, Le T. SOGC-GOC-SCC POLICY AND PRACTICE GUIDELINES COMMITTEE, SPECIAL CONTRIBUTORS. The role of adjuvant therapy in endometrial cancer. J Obstet Gynaecol Can. 2013; 35(4): 375–376.
  6. Secord AA, Havrilesky LJ, O'Malley DM, et al. A multicenter evaluation of sequential multimodality therapy and clinical outcome for the treatment of advanced endometrial cancer. Gynecol Oncol. 2009; 114(3): 442–447.
  7. Greven K, Winter K, Underhill K, et al. Final analysis of RTOG 9708: adjuvant postoperative irradiation combined with cisplatin/paclitaxel chemotherapy following surgery for patients with high-risk endometrial cancer. Gynecol Oncol. 2006; 103(1): 155–159.
  8. Hogberg T, Signorelli M, de Oliveira CF, et al. Sequential adjuvant chemotherapy and radiotherapy in endometrial cancer--results from two randomised studies. Eur J Cancer. 2010; 46(13): 2422–2431.
  9. Matei D, Filiaci V, Randall ME, et al. Adjuvant Chemotherapy plus Radiation for Locally Advanced Endometrial Cancer. N Engl J Med. 2019; 380(24): 2317–2326.
  10. de Boer SM, Powell ME, Mileshkin L, et al. PORTEC study group. Adjuvant chemoradiotherapy versus radiotherapy alone for women with high-risk endometrial cancer (PORTEC-3): final results of an international, open-label, multicentre, randomised, phase 3 trial. Lancet Oncol. 2018; 19(3): 295–309.
  11. de Boer SM, Powell ME, Mileshkin L, et al. PORTEC Study Group. Adjuvant chemoradiotherapy versus radiotherapy alone in women with high-risk endometrial cancer (PORTEC-3): patterns of recurrence and post-hoc survival analysis of a randomised phase 3 trial. Lancet Oncol. 2019; 20(9): 1273–1285.
  12. Bie Y, Zhang Z, Wang X. Adjuvant chemo-radiotherapy in the "sandwich" method for high risk endometrial cancer--a review of literature. BMC Womens Health. 2015; 15: 50.
  13. Ouldamer L, Bendifallah S, Body G, et al. Predicting poor prognosis recurrence in women with endometrial cancer: a nomogram developed by the FRANCOGYN study group. Br J Cancer. 2016; 115(11): 1296–1303.
  14. Uharcek P. Prognostic factors in endometrial carcinoma. J Obstet Gynaecol Res. 2008; 34(5): 776–783.
  15. Glasgow M, Vogel RI, Burgart J, et al. Long term follow-up of a phase II trial of multimodal therapy given in a "sandwich" method for stage III, IV, and recurrent endometrial cancer. Gynecol Oncol Res Pract. 2016; 3: 6.
  16. Einstein MH, Frimer M, Kuo DYS, et al. Phase II trial of adjuvant pelvic radiation "sandwiched" between combination paclitaxel and carboplatin in women with uterine papillary serous carcinoma. Gynecol Oncol. 2012; 124(1): 21–25.
  17. Boothe D, Orton A, Kim J, et al. Does Early Chemotherapy Improve Survival in Advanced Endometrial Cancer? Am J Clin Oncol. 2019; 42(11): 813–817.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

Wydawcą serwisu jest  "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl