Top Line: Does adjuvant chemotherapy or chemoradiation result in superior survival in patients with locally advanced endometrial carcinoma?
The Study: The primary results of NRG (GOG) 258 showed that adjuvant chemoradiation (45 Gy with cisplatin followed by 4 cycles of carbo/taxol) did not result in superior recurrence free survival compared to chemotherapy alone (6 cycles of carbo/taxol x 6). The trial included any patient with stage III-IVA disease or stage I/II serous or clear cell histology and positive peritoneal washings. However, the majority (>90%) had stage III disease and endometrioid histology. In this long-term follow up, there was no difference in overall survival outcomes between groups. CRT had less grade 3+ toxicity (58% v 63%) and less grade 4+ toxicity (14% v 30%). CRT also had a lower risk of local and regional recurrence, but this risk was outweighed by the larger absolute risk of distant recurrence. Molecular stratification will likely play a big role going forward in individualizing adjuvant therapy in this population. Radiation will likely still play an important role in adjuvant therapy among molecular subsets with a higher risk of locoregional recurrence.
TBL: Long term results of NRG 258 show no difference in overall survival between patients with locally advanced endometrial cancer who received chemoradiation and those who received chemotherapy alone. | Matei, J Clin Oncol 2024
The Study: The primary results of NRG (GOG) 258 showed that adjuvant chemoradiation (45 Gy with cisplatin followed by 4 cycles of carbo/taxol) did not result in superior recurrence free survival compared to chemotherapy alone (6 cycles of carbo/taxol x 6). The trial included any patient with stage III-IVA disease or stage I/II serous or clear cell histology and positive peritoneal washings. However, the majority (>90%) had stage III disease and endometrioid histology. In this long-term follow up, there was no difference in overall survival outcomes between groups. CRT had less grade 3+ toxicity (58% v 63%) and less grade 4+ toxicity (14% v 30%). CRT also had a lower risk of local and regional recurrence, but this risk was outweighed by the larger absolute risk of distant recurrence. Molecular stratification will likely play a big role going forward in individualizing adjuvant therapy in this population. Radiation will likely still play an important role in adjuvant therapy among molecular subsets with a higher risk of locoregional recurrence.
TBL: Long term results of NRG 258 show no difference in overall survival between patients with locally advanced endometrial cancer who received chemoradiation and those who received chemotherapy alone. | Matei, J Clin Oncol 2024