Research Article Open Access Nuclear Medicine & Radiation Therapy Tunio et al., J Nucl Med Radiat Ther 2012, S:6 http://dx.doi.org/10.4172/2155-9619.S6-010 J Nucl Med Radiat Ther Cancer Radiation Therapy ISSN:2155-9619 JNMRT an open access journal *Corresponding author: Mutahir Tunio, MBBS, FCPS (Radiation Oncology), Assistant Consultant, Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City (KFMC), Riyadh 59046, Saudi Arabia, Tel: +966 1 2889999; Fax: 966 1 4614006; E-mail: drmutahirtonio@hotmail.com Received June 14, 2012; Accepted June 23, 2012; Published June 25, 2012 Citation: Tunio M, Asiri MA, Alhadab AR, Bayoumi Y, Alsaeed E, et al. (2012) Sequential Adjuvant Chemotherapy and Radiotherapy in Treatment of Early Stage Endometrial Carcinoma: Single Institutional Experience. J Nucl Med Radiat Ther S6:010. doi:10.4172/2155-9619.S6-010 Copyright: © 2012 Tunio M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Sequential Adjuvant Chemotherapy and Radiotherapy in Treatment of Early Stage Endometrial Carcinoma: Single Institutional Experience Mutahir Tunio 1 , Mushabbab Al Asiri 1 , Abdul Rehman Alhadab 1 , Yasser Bayoumi 1 , Eyad Alsaeed 1 , Khalid Riaz 1 , Abdullah Amro 1 , Abdel Salam Ismail 2 and Abdel Aziz AlObaid 3 1 Radiation oncology, King Fahad Medical City (KFMC), Riyadh, Saudi Arabia 2 Medical Oncology, King Fahad Medical City (KFMC), Riyadh, Saudi Arabia 3 Gynecology Oncology, King Fahad Medical City (KFMC), Riyadh, Saudi Arabia Abstract Background: Aim was to evaluate the additional beneit of adjuvant chemotherapy in patients of early stage endometrial carcinoma (EC) with adverse features. Materials and methods: Between June 2006 and July 2011, 56 patients with EC after surgery were randomized to receive either adjuvant radiotherapy (RT) [35 patients] or adjuvant sequential chemotherapy and radiotherapy (CRT) [21 patients]. Median age was 57.6 years (40-80). Predominant stages were FIGO IB (44.6%) and IIA (26.7%). Mean body mass index was 35.9 kg/m 2 (23-72). Results: Median follow-up was 55 months (6-60). The Kaplan-Meier estimates for loco regional control (LRC), distant metastasis control (DMC) and overall survival (OS) for RT and CRT arms were; 85.7% vs. 74.2% (p 0.04), 85.7% vs. 85.7% (p 0.9) and 82.8% vs. 81% (p 0.8) respectively. Patients in CRT arm had earlier and higher pelvic recurrences {hazard ratios of 2.21 (1.45-7.85)}. Acute hematological grade3 toxicity was higher in CRT arm (9.5%) and no difference in acute or delayed non-hematological toxicities was seen between two arms. Conclusion: Adjuvant chemotherapy in patients with EC after surgery is associated with inferior LRC and no additional beneit in DMC and OS. If adjuvant chemotherapy is considered it shall be given after adjuvant radiotherapy. Keywords: Early stage; Endometrial carcinoma; Adjuvant radiotherapy; Adjuvant chemotherapy; Treatment outcomes Abbreviations: EC: Endometrial Carcinoma; RT: Radiotherapy; CRT: Chemotherapy Radiotherapy; FIGO: International Federation of Gynecology and Obstetrics; LRC: Loco Regional Control; DMC: Distant Metastasis Control; PFS: Progression Free Survival; OS: Overall Survival; PORTEC: Post-Operative Radiation herapy in Endometrial Cancer; GOG: Gynecologic Oncology Group; IRB: Institutional Ethical Review; CT: Computed Tomography; CTV: Clinical Target Volume; PTV: Planning Target Volume; 3DCRT: hree Dimensional Conformal Radiation herapy; BMI: Body Mass Index Introduction Endometrial carcinoma (EC) is the tenth most common and the second most common gynecologic malignancy in women in the Saudi Arabia [1]. Surgery is the primary treatment involving a total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, and pelvic washings, with ive year survival rates of 78% [2,3]. Randomized trials by Post-operative Radiation therapy in endometrial cancer (PORTEC) and Gynecological Oncology Group 99 (GOG-99) have shown signiicant reduction of the risk of pelvic and vaginal recurrence by adjuvant radiotherapy, although a survival beneit is not yet proven [4,5]. hus radiotherapy remains mainstay of adjuvant treatment. he role of chemotherapy alone in postoperative management of EC has remained controversial. Large randomized trial of Gynecologic Oncology Group (GOG 122) has shown the improvement in both progression free survival (PFS) and overall survival (OS) at 52 months with the use of adjuvant chemotherapy alone compared with adjuvant radiotherapy in stage III and IV patients (without evidence of hematogenous metastases) ater surgery [6]. Contrary, two large randomized trials have shown that adjuvant chemotherapy alone was not better than adjuvant radiotherapy alone with no diference in PFS and OS rates in patients with early stage EC [7,8]. Beneit of sequential adjuvant chemotherapy and radiotherapy was seen in advanced stage endometrial carcinoma by NSGO/EORTC and MaNGO studies with 36% reduction in the risk for relapse (hazard ratio (HR) 0.64, 95% conidence interval (CI) 0.41-0.99; p 0.04) [9]. However, both trials of sequential adjuvant treatment failed to see any signiicant diferences in the OS. heoretically, adjuvant chemotherapy ater surgery may delay the curative radiotherapy which may result in locoregional control. he aim of our study was to evaluate impact of sequential chemotherapy and radiotherapy in patients with early stage endometrial carcinoma with adverse features. Materials and Methods Ater approval from Institutional Ethical Review Board (IRB) committee, patients referred to our department between June 2007 and July 2011 were selected when they met the following eligibility criteria: