Adjuvant Treatment For Advanced Stage Endometrial Cancer: Patterns Of Care And Outcomes At A Single Institution.

5133 Background: The prognosis for early stage endometrial cancer is excellent. However, 5-year survival in stage III-IV disease declines to 18–50%. Adjuvant treatment for advanced stage endometrial cancer has traditionally been multimodal utilizing hormonal therapy, radiation, and various chemotherapies. To date, no true standard of care exists. We set out to compare recurrence and mortality rates between advanced stage endometrial cancer patients staged and treated at our institution. Methods: We reviewed medical records of all patients with FIGO stage IIIA-IVB endometrial cancers staged and treated at Washington University between 1998 and 2003. Data on demographics, pathologic diagnoses, treatment, recurrence, and mortality rates was analyzed for overall and progression-free survival. Subgroup analyses on high risk/lower risk histologic subtypes, different treatment strategies, and other prognostic factors were performed. Results: Records were available on 124 patients including 72 with stage III and 52 with stage IV disease. 54 (43.5%) had low risk (grade 1 and 2) cancers while 70 (56.5%) had high risk histologic subtypes. Mean follow-up was 20.5 months. Overall, 54 patients (43.5%) recurred and 45 (36.3%) died. Similar proportions were found even in patients with minimal extrauterine disease. 97 patients received adjuvant treatment, 35% with RT alone, 34% with chemotherapy alone, and 10% with combination chemotherapy and RT. Recurrence rates in each group approached 50%, however, there was a trend toward improved OS in the combination therapy group (83.3% versus 62% with chemotherapy and 67% with RT alone). When stratified by histologic risk, survival benefit after RT alone or combination therapy was confined to patients with lower risk endometrioid adenocarcinomas (P<0.05). Conclusions: Adjuvant treatment for advanced stage endometrial cancer remains controversial. Our data suggests that a subgroup of patients may benefit from more aggressive treatment with combination chemotherapy and RT. Stratification by traditional prognostic factors did not identify a subgroup at lower risk for recurrence/progression. No significant financial relationships to disclose.