While endometrial cancers are associated with favourable outcomes due to early symptomatic evaluation, patients with high-risk features are at a higher risk of recurrence. Although results of PORTEC-3 trial established the role of concurrent chemoradiation followed by adjuvant chemotherapy for high-risk endometrial cancer patients, its concordance data in South Asian populations is lacking. Present study aims to assess toxicity profiles and outcomes in this cohort of patients.
Patients planned for endometrial cancer treatment as per PORTEC-3 trial regimen from October 2016 to August 2022 at our institute were ambispectively analysed for toxicity with RTOG grading and treatment outcomes.
58 patients were included (Median age 61 years) with FIGO stages I (26, 44.8%), II (5, 8.6%) and III (27, 46.6%). Patients were surgically staged using robotic (33, 56.9%), laparoscopic (9, 15.5%) and open (16, 27.6%) methods. 40 patients (69%) had Type II histology, p53 and Napsin A positivity was seen in 38 and 3 patients respectively. IMRT was used in 44 patients (79.3%). Acute Toxicity analysis showed that most common complaint during CTRT was diarrhoea (38 patients, 65.5%) of which only 10 were Grade 2. Grade 2 hematological and GU toxicities were noted in 2 and 0 patients respectively. Regarding adjuvant chemotherapy; 2 patients withdrew consent, 14 had peripheral neuropathies (3 discontinued treatment) and 15 had Grade 2 hematological toxicities. No patient stopped treatment during CTRT, 4 discontinued adjuvant chemotherapy due to toxicities and further 6 required dose reduction. At median followup of 24 months, 15 patients recurred (Isolated paraaortic recurrences in 2, distant metastases in 13). Medication requiring neuropathies persisted in 11 patients, 1 needed surgery for bowel obstruction due to incisional hernia, and no late GU toxicities were seen.
There is good tolerance and compliance to adjuvant treatment with chemoradiation and chemotherapy in this South Asian cohort of patients, with no toxicity related treatment breaks during CTRT. Relapse was majorly seen at distant sites. These findings are in line with outcomes of PORTEC 3 trial.