Adjuvant chemotherapy and radiation therapy with the “sandwich” method for endometrial cancer: An institutional analysis

Introduction. Choice of adjuvant therapy for high risk endometrial cancers is controversial. The so-called “sandwich” regimen of pelvic external beam radiation administered between cycles of Carboplatin/Paclitaxel (CT-RT-CT) is commonly used in clinical practice but has not been evaluated in randomized endometrial cancer trials. There is relatively little published data regarding toxicity, patient tolerance, and efficacy of this regimen. Here, we report our institutional experience of CT-RT-CT for locally advanced endometrial cancer, focusing on toxicity and rates of compliance with study therapy. Material and methods. Medical records of consecutive patients treated for surgically staged endometrial cancer at a tertiary care academic medical center between 2010 and 2017 were reviewed. All patients received adjuvant CT-RT-CT. Progression-free and overall survival were recorded from the date of surgery. Toxicity data was obtained from patient medical records and graded according to Common Terminology for Adverse Events Criteria, version 3.0. Results. Thirty-eight patients with histologically proven stage I-IV endometrial cancer were included. Eighty-four percent of patients were able to complete all 6 planned cycles of chemotherapy and 92% completed at least 4 cycles. Cumulative incidence of grade 3-4 hematologic toxicity was 55%. Locoregional recurrence was the first site of failure in 2 patients (5.1%) while distant failure was the first site of recurrence in 8 patients (21%). Two year overall survival and progression-free survival were 76% and 77% respectively. Conclusion. Our results suggest that adjuvant chemotherapy and radiation therapy with the “sandwich” regimen is associated with acceptable toxicity and satisfactory rates of completion of planned therapy.