Purpose: To evaluate the efficacy and safety of the sequential chemoradiotherapy mode of chemotherapy-radiotherapy-consolidation chemotherapy and the concurrent chemoradiotherapy after operation for advanced (stage III-IV) endometrial cancer.
Methods: A total of 116 patients with stage III-IV endometrial cancer were divided into the Sequential group (n=58) and the Concurrent group (n=58) according to the different modes of postoperative adjunctive therapy. The levels of tumor markers in the serum and the occurrence of adverse reactions were compared between the two groups, and the survival and progression of the patients were followed up and recorded. Moreover, the factors influencing the tumor progression in patients were analyzed.
Results: The levels of serum carcino-embryonic antigen (CEA), cancer antigen (CA) 125, CA19-9 and adiponectin (APN) declined markedly after treatment with chemoradiotherapy in both groups compared with those before treatment (p<0.05). The median survival was 49.4±4.5 months and 47.9±4.0 months, and the median progression-free survival (PFS) was 47.1±4.6 months and 45.8±4.3 months, respectively, in the Sequential group and the Concurrent group. Besides, the 3-year overall survival (OS) rate in the Sequential group and the Concurrent group was 82.8% and 70.7%, respectively, and the 3-year PFS rate in the two groups was 79.3% and 58.6%, respectively. The 5-year OS rate was 60.3% and 48.3%, and the 5-year PFS rate was 51.7% and 32.8% in the two groups, respectively. Log-rank test indicated that the PFS in the Sequential group was evidently superior to that in the Concurrent group (p=0.017). The results of univariate and multivariate analyses manifested that surgical-pathological stage and postoperative Sequential chemoradiotherapy were independent risk factors for tumor progression in patients with advanced endometrial cancer.
Conclusions: Compared with the concurrent chemoradiotherapy, the sequential chemoradiotherapy can prominently delay the progression of advanced endometrial cancer, induce no apparent adverse reactions and has good tolerance. Low surgical-pathological stage and postoperative sequential chemoradiotherapy are independent protective factors against tumor progression.