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Non-endometrioid endometrial cancer: Analysis of different adjuvant treatment modalities

Abstract Background Adjuvant treatment for patients (pts) with endometrial cancer (EC) is decided based on risk assessment of recurrence and distant metastasis. Carcinomas of non-endometrioid (NE) histologies are rare, classified as high-risk and adjuvant treatment is recommended. Methods Retrospective analysis of EC pts diagnosed and treated in two units during 10 years (2009-2018) with a focus on pts with NEEC. After surgery and multidisciplinary discussion, pts had either no further treatment, radiotherapy (RT), chemotherapy (CT) followed by RT or CT. We compared these approaches using survival analysis. Results From a total of 330 pts with EC, 66 pts with surgery for NEEC were analyzed. Median age was 68.5 yrs (43-88). Serous histology was found in 34 (51.5%) pts, clear-cell in 13 (19.7%), in 18 (27.3%) carcinosarcoma and one pt had an undifferentiated tumor. Based on the International Federation of Gynecology and Obstetrics (FIGO) staging system, 32 pts (48.5%) were diagnosed at early stage (IA-II) and 34 (51,5%) at advanced stage (IIIA-IV). After surgery, 16 pts (24.4%) had no further treatment, while 11 (16.7%) received CT, 28 (42.4%) CT + RT and 11 (16.7%) only RT. RT included external beam RT and/or brachytherapy. In the survival analysis, the median DFS was significantly higher in the CT + RT group, 31 months (m), compared to both the RT alone group, 14m and the isolated CT group, 11m. For patients without further treatment DFS was 6m, p = 0.03. The median OS showed similar results: pts submitted to CT + RT had favorable survival (78m) compared to the other groups, RT group (64m), CT group (37m) and the group of pts with no further treatment (47m), p = 0.005. Conclusions The best survival results are for pts treated with CT+RT. Patients treated with RT had better results when compared with pts treated with CT or with pts without further treatment. These results show us that pts treated with CT are those with higher FIGO stages that were not considered for adjuvant RT. The worse survival results for untreated pts reflects deteriorated PS, extensive comorbidities or early progression. Due to aging and lifestyle risk factors, like obesity, EC remains the most prevalent gynecological carcinoma where better selection and implementation of adjuvant treatment modalities are needed. Legal entity responsible for the study Author and co-authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.