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ASTRO 2017: Endometrial Cancer Treatment

Standard of care should remain the same for women with certain types of endometrial cancer, according to results of phase 3 clinical trial announced this week.

By
Jason Socrates Bardi, Editor-in-Chief
Friday, September 29, 2017

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SAN DIEGO -- The standard of care for treating high-risk stage I or stage II endometrial cancer should remain the same, according to the results of a phase 3 clinical trial announced this week.

Surgery with adjuvant external beam pelvic radiation has been the standard of care for this type of cancer ever since clinical trials in the early 2000s showed that women with early-stage cancer were less likely to suffer recurrent tumors following this treatment plan.

In recent years, an alternative approach has emerged. Many doctors have turned to treating women at high risk of recurrence with vaginal cuff brachytherapy followed by chemotherapy. But not so fast, said one doctor this week at the American Society for Radiation Oncology (ASTRO) meeting in San Diego.

Announcing the results of the GOG-249, a phase 3 randomized clinical trial designed to test the two approaches for treating high-risk endometrial cancer head-to-head, radiation oncologist Marcus Randall of the University of Kentucky in Lexington said the alternative approach is not supported by clinical evidence and that adjuvant external beam pelvic radiation should remain the standard of care.

The trial enrolled 601 women with a median age of 63 who had undergone a hysterectomy prior to adjuvant treatment in one of the two arms of the trial. The women received follow-up a median of 53 months after the adjuvant treatment. Women who received the alternative brachytherapy with chemotherapy did not benefit from better outcomes, such as greater overall survival or recurrence-free survival, but they did suffer worse side effects from the treatment.

"This [knowledge] is important for patients and providers," said Paul Harari, chair of radiation oncology at the University of Wisconsin-Madison. "We want to serve our patients with the highest quality treatment, and we're also conscious of the side effect profile and the cost value of treatment."

Harari was not involved in the study, and he moderated a press conference at which the results were announced. He said that the study will encourage practitioners to revisit "complex, costly and cumbersome" approaches adopted over simple pelvic radiation.