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Cisplatin and Concomitant Radiotherapy Followed by Chemotherapy.Towards an Optimal Adjuvant Therapy Protocol for High-risk Endometrial Cancer Patients

Aly Azmy, Sherif Abdelwahab, Hany Abdel-Aziz and Hatem Salim

Background: As there are no current definite guidelines, there is still much debate about the best adjuvant therapy after surgery for endometrial cancer (EC). Radiotherapy (RT) alone does not seem to improve overall survival. We investigated whether concomitant Cisplatin (C) and RT gave better clinical results. Patients and methods: Ninety four patients with high-risk EC (stage II, IIIA or IB G3 without lymphadenectomy) underwent primary surgery and were then referred for adjuvant therapy. Cisplatin was given at a dose of 40 mg/m2 once weekly for five weeks during RT, which consisted of a total radiation dose of 50.4 Gy. Two cycles of cisplatin 75 mg/m2 and paclitaxel 175 mg/m2 were given after finishing the radiotherapy. Overall survival and disease-free survival were calculated from the time of surgery. Patterns of failure were recorded by the sites of failure. Results: Median overall Survival was 36 months. Median time to recurrence was 26 months (range 3-37). Relapses occurred in twenty nine patients (30.8%). Adverse events were mild with three cases having grade 3 neutropenia. Local recurrence was encountered in 14% and distant metastases in 8%. Conclusion: This phase II study demonstrates pelvic radiotherapy in combination with weekly cisplatin followed by two cycles of consolidation chemotherapy as a tolerable and efficient combined approach in high risk endometrial carcinoma patients.