Adjuvant chemotherapy for endometrial cancer after hysterectomy
Evidence Summaries Level of Evidence = A
Postoperative platinum based chemotherapy is effective for increasing slightly progression-free survival and overall survival irrespective of radiotherapy as well as decreasing the risk of developing a metastasis in endometrial cancer.
A Cochrane review 1 included 8 studies with a total of 2197 subjects. Five RCTs compared no additional treatment with additional chemotherapy after hysterectomy and radiotherapy. Four trials compared platinum based combination chemotherapy directly with radiotherapy. Indiscriminate pooling of survival data from 2197 women shows a significant overall survival advantage from adjuvant chemotherapy (RR 0.88, 95% CI 0.79 to 0.99)). Sensitivity analysis focused on trials of modern platinum based chemotherapy regimens and found the relative risk of death to be 0.85 (95% CI 0.76 to 0.96; 5 trials); number needed to treat for an additional beneficial outcome (NNT) = 25; absolute risk reduction = 4% (1% to 8%)). The HR for overall survival is 0.74 (0.62 to 0.89; 5 trials, n=1654), significantly favouring the addition of postoperative platinum based chemotherapy. The HR for progression-free survival is 0.75 (0.64 to 0.89). This means that chemotherapy reduces the risk of being dead at any censorship by a quarter. Chemotherapy reduces the risk of developing the first recurrence outside the pelvis (RR = 0.79 (0.68 to 0.92), 5% absolute risk reduction; NNT = 20). The analysis of pelvic recurrence rates is underpowered but the trend suggests that chemotherapy may be less effective than radiotherapy in a direct comparison (RR = 1.28 (0.97 to 1.68)) but it may have added value when used with radiotherapy (RR = 0.48 (0.20 to 1.18)).
1. Johnson N, Bryant A, Miles T et al. Adjuvant chemotherapy for endometrial cancer after hysterectomy. Cochrane Database Syst Rev 2011;(10):CD003175. [PMID:21975736]
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