Comparison Of Postoperative Radiotherapy And Chemotherapy For Endometrial Cancer

Background:Endometrial cancer is one of the most common malignant tumors in gynecology.Most of the patients were diagnosed as early stage.In the new cases,about 10%-15% of the patients with endometrial cancer whose focus had already extended outside the uterus.These patients account for 50% of uterine cancer-related deaths.Early patients without high-risk factors only need follow-up observation,on the contrary,they need to receive adjuvant chemotherapy and/or radiotherapy,but the efficacy and safety of adjuvant chemotherapy and radiotherapy for endometrial cancer are controversial.The purpose of this article is to explore the efficacy and safety of adjuvant radiotherapy and chemotherapy for endometrial cancer at different stages.The main outcome measures included 5-year overall survival rate(5-OS),5-year progression-free survival rate(5-PFS),3-year overall survival rate(3-OS),3-year progression-free survival rate(3-PFS),recurrence rate?The secondary outcome measures included adverse reactions(grade 3/4 neutropenia,thrombocytopenia,grade 3/4 hematological toxicity).Methods:Five databases were searched,including PubMed,Cochrane Library,Mayo Clinic,Wanfang Medical Network and China HowNet.According to the keywords "endometrial cancer","chemotherapy" and "radiotherapy",the five databases were searched systematically,using fuzzy search,not limited to languages.The retrieval time range is from 1997 to 2019.The types of literature include randomized controlled trials,retrospective case-control studies,reviews and guidelines.All statistical analyses were performed using Revman 5.3 software.Result:Finally,16 papers were selected and divided into three parts.The first part contains 5 articles.A total of 2997 patients with endometrial cancer with high risk factors in FIGO stage I-II were collected.Among them,1442 were treated with radiotherapy and 1555 were followed up closely.The characteristics of endometrial cancer with high risk factors in stage I-II included endometrial cancer grade 2-3,lymphatic vessel invasion(LVSI)or deep muscle invasion.Histological types include serous and clear cell carcinomas.The 5-OS,5-PFS,5-PFS and recurrence rates were 85% and 82%,80% and 76% respectively in the radiotherapy group and close follow-up group.The analysis showed that radiotherapy could reduce the recurrence rate of endometrial cancer with high risk factors for I-II,but had no significant effect on the 5-OS.In the second part,we collected a total of 9 literatures,including 1 201 patients with FIGO stage II I-IV endometrial cancer.Histological types included type I(endometrioid carcinoma,mucinous carcinoma,adenosquamous carcinoma and non-subtype adenocarcinoma),type II(serous carcinoma,clear cell carcinoma,mixed cell carcinoma),and carcinosarcoma.There were 422 in the chemotherapy group,478 in the radiotherapy group,167 in the chemotherapy-radiotherapy-chemotherapy(CRC)group and 134 in the chemotherapy-radiotherapy(CR)group.5-OS was 50.5% in chemotherapy group and 39.5% in radiotherapy group,with recurrence rates of 43.1% and 49.5% respectively.The 5-OS in the chemotherapy group was significantly higher(RR=0.75,95% CI 0.64-0.87,P=0.0001).The 3-OS of CRC group and CR group were 92% and 72% respectively.3-PFS was 79% and 62% respectively.CRC could significantly improve the overall survival rate and progression-free survival rate of patients with stage III-IV endometrial cancer.The third part compares the adverse reactions of chemotherapy and radiotherapy.The incidence of grade 3/4 neutropenia in chemotherapy group and radiotherapy group was 54.0% and 0.6%(RR=0.01,95% CI 0.00-0.03,P<0.00001),respectively.The incidence of thrombocytopenia was 10.0% and 1.4%(RR=0.15,95% CI 0.07-0.31,P<0.00001).Conclusion:Radiotherapy can reduce the recurrence rate of stage I-II endometrial cancer patients with high risk factors(grade 2-3 endometrial cancer,lymphatic vessel invasion(LVSI)or deep myometrial invasion),but it has no significant impact on the overall 5-year survival rate.CRC can significantly improve the overall survival rate and progression-free survival rate of patients with stage III-IV endometrial cancer.Although the side effects are obvious,the patients are able to receive chemotherapy and tolerate it.