‘Sandwich’ sequencing of adjuvant chemoradiation tied to less toxicity in advanced endometrial cancer

Survival and clinical outcomes in patients with advanced stage endometrial cancer are comparable among the different sequences of adjuvant chemotherapy and radiation therapy, a recent study has shown. However, “sandwich” therapy results in less chronic toxicity, which provides an opportunity for a better quality of life in survivorship.

The investigators compared outcomes and toxicities after sandwich chemoradiation (chemotherapy, then radiation, then chemotherapy) and nonsandwich sequences (chemotherapy then radiation, radiation then chemotherapy, or concurrent chemoradiation). They recorded baseline characteristics, adjuvant treatment details, clinical outcomes, and toxicities for stage III to IVA patients who underwent surgical staging followed by both adjuvant chemotherapy and radiation therapy at their institution.

Afterwards, they analysed the effects of adjuvant treatment order (sandwich or nonsandwich) on the abovementioned outcomes. Toxicities were graded according to Common Terminology Criteria for Adverse Events (CTCAE) v4.0.

A total of 107 patients were recruited, with a median follow-up of 3.2 years. Five-year local, regional, and distant recurrences were 7 percent, 15 percent, and 33 percent, while disease-free and overall survival were 61 percent and 68 percent, respectively. No difference in outcomes by sequence group was observed.

The overall rate of acute toxicity also did not differ by sequence group. Notably, patients in the sandwich group had significantly lower overall rate of chronic toxicity (p<0.001), as well as chronic genitourinary (p=0.048) and gynaecologic toxicities (p<0.001). No grade 4 or 5 acute or chronic toxicities occurred.

“Radiation is frequently added to chemotherapy for adjuvant treatment of advanced stage endometrial cancer,” the investigators said. “Multiple adjuvant therapy sequencing options exist, and little data is available to compare these.”