Endometrial Cancer_GEC ESTRO Handbook of Brachytherapy

Endometrial Cancer

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THE GEC ESTRO HANDBOOK OF BRACHYTHERAPY | Part II: Clinical Practice Version 1 - 25/04/2016

Figure 15.10: Meta-analysis of randomised trials for Local control and Survival after postoperative radiotherapy for endometrial cancer. (from ref 44)

a. Local control

b. Survival

92%). In contrast VBT+ chemo was associated with more acute toxicity. The authors conclude that combined VBT with chemo- therapy is not superior to EBRT in these high-intermediate to high risk patients. For patients with stage II disease, pelvic control and disease spe- cific survival is comparable to the corresponding risk groups with stage I disease after combination treatment with external beam therapy and vaginal brachytherapy. In contrast, for patients with stage III disease, the outcome is significantly worse. However, pelvic control after external beam therapy to the whole pelvis and vaginal brachytherapy is reported to be 80 to 90% particu- larly for patients with local extrauterine extension (infiltration of the serosa, adnexa and vaginal spread (IIIA,B)). The major site of treatment failure in these patients is related to distant failure which is separated into intra-abdominal spread and haemato­

genous spread. The overall 5 year disease specific survival rates are reported to range widely from 30 - 70%. Outcome in patients with lymph node involvement (IIIC) is also significantly worse with 5 year disease free survival for patients with positive nodes being 55% compared to 91% when nodes are negative. Because of the higher risk of distant metastasis in high-risk patients the role of adjuvant chemotherapy is under investigation. Two trials randomised high risk patients between EBRT and ad- juvant chemotherapy and did not show a benefit in overall or dis- ease free survival [50,51]. In contrast an analysis that combined patients from NSGO 9501/EORTC 55991 and MANGO–ILIA- DE III randomised trials in which EBRT was compared to EBRT with 4 cycles of adjuvant chemotherapy (paclitaxel carboplatin) [52], found an improved 5-year progression free survival (78% vs 69%, p=0.009), but only a trend for an improved overall survi­ val (82% vs 75%, p=0.07) [51]. PORTEC-3 randomised high risk