Adjuvant chemotherapy plus radiation for locally advanced endometrial cancer

Daniela Matei, Virginia Filiaci, Marcus E. Randall, David Mutch, Margaret M. Steinhoff, Paul A. DiSilvestro, Katherine M. Moxley, Yong M. Kim, Matthew A. Powell, David M. O’Malley, Nick M. Spirtos, William Small, Krishnansu S. Tewari, William E. Richards, John Nakayama, Ursula A. Matulonis, Helen Q. Huang, David S. Miller

Research output: Contribution to journalArticlepeer-review

241 Scopus citations


BACKGROUND Stage III or IVA endometrial cancer carries a significant risk of systemic and locoregional recurrence. METHODS In this randomized phase 3 trial, we tested whether 6 months of platinumbased chemotherapy plus radiation therapy (chemoradiotherapy) is associated with longer relapsefree survival (primary end point) than six cycles of combination chemotherapy alone in patients with stage III or IVA endometrial carcinoma. Secondary end points included overall survival, acute and chronic toxic effects, and quality of life. RESULTS Of the 813 patients enrolled, 736 were eligible and were included in the analysis of relapsefree survival; of those patients, 707 received the randomly assigned intervention (346 received chemoradiotherapy and 361 received chemotherapy only). The median followup period was 47 months. At 60 months, the Kaplan–Meier estimate of the percentage of patients alive and relapsefree was 59% (95% confidence interval [CI], 53 to 65) in the chemoradiotherapy group and 58% (95% CI, 53 to 64) in the chemotherapyonly group (hazard ratio, 0.90; 90% CI, 0.74 to 1.10). Chemoradiotherapy was associated with a lower 5year incidence of vaginal recurrence (2% vs. 7%; hazard ratio, 0.36; 95% CI, 0.16 to 0.82) and pelvic and paraaortic lymphnode recurrence (11% vs. 20%; hazard ratio, 0.43; 95% CI, 0.28 to 0.66) than chemotherapy alone, but distant recurrence was more common in association with chemoradiotherapy (27% vs. 21%; hazard ratio, 1.36; 95% CI, 1.00 to 1.86). Grade 3, 4, or 5 adverse events were reported in 202 patients (58%) in the chemoradiotherapy group and 227 patients (63%) in the chemotherapyonly group. CONCLUSIONS Chemotherapy plus radiation was not associated with longer relapsefree survival than chemotherapy alone in patients with stage III or IVA endometrial carcinoma.

Original languageEnglish
Pages (from-to)2317-2326
Number of pages10
JournalNew England Journal of Medicine
Issue number24
StatePublished - Jun 13 2019

Bibliographical note

Funding Information:
Supported by grants from the National Cancer Institute (NCI) to the Gynecologic Oncology Group Administrative Office (CA 27469), the Gynecologic Oncology Group Statistical and Data Center (CA 37517), NRG Oncology (1 U10 CA180822), NRG Operations (U10 CA180868), and the NCI Community Oncology Research Program (NCORP) (UG1 CA189867).

Publisher Copyright:
Copyright © 2019 Massachusetts Medical Society.

ASJC Scopus subject areas

  • Medicine (all)


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