Adjuvant Chemotherapy for Endometrial Cancer

Objective: To review the role of adjuvant chemotherapy in endometrial cancer and to identify the groups of patients who were most likely to have benefit from adjuvant chemotherapy. Methods: Bibliographic search was conducted for randomized trials involving chemotherapy given in an adjuvant setting for early stage endometrial cancer or advanced stage with minimal residual disease after surgery. The search included the National Library of Medicine's MEDLINE/PubMed database, studies cited in the reports, proceedings of international conferences, and registered clinical trials. Details of each trial were explored and summarized. Results: Seven reports from 8 randomized trials were identified. Two trials were reported together with separate and combined statistical analyses. Characteristic features of the patients and diseases, details of surgical treatment including lymph node resection, types and pattern of radiation and chemotherapy, and the results from each trial varied. Only 2 trials showed significant survival improvement in patients who had adjuvant chemotherapy alone or chemotherapy after radiation compared with radiation alone. Data from these trials showed that the patients who were likely to have survival benefit from adjuvant chemotherapy were those with the following high risk features: did not have or had limited lymph node surgical evaluation, metastatic nodal involvement, tumors of high-grade or aggressive histology, stage IC, stage II or IIIA with 50% or greater myometrial invasion, and stage IIIC to IV. Conclusions: The results from trials were inconsistent regarding a survival benefit of adjuvant chemotherapy in comparison to radiation alone or in addition to radiation. Only certain groups of patients with high risk features were likely to gain survival advantage from adjuvant chemotherapy. The physician must carefully evaluate risk features of each patient and her disease to select one who is most likely to gain advantage from chemotherapy.