Choosing the right adjuvant therapy for stage III–IVA endometrial cancer: A comparative analysis of chemoradiotherapy and chemotherapy

The optimal adjuvant treatment for patients with locally advanced endometrial cancer (EC) remains debatable. We comparatively analyzed recurrence patterns and survival outcomes in patients with stage III–IVA EC treated with adjuvant chemotherapy (CT) exclusively or combined with radiotherapy (CRT). We retrospectively analyzed 184 patients treated for stage III–IVA EC at 2 tertiary institutions between 2010 and 2021. All patients underwent standard primary surgery and received either CT alone (n = 89) or CRT (n = 95) as an adjuvant treatment. We compared the failure patterns, recurrence-free survival (RFS), and overall survival (OS) between the CT and CRT groups. The median follow-up period was 54.8 months. Most patients underwent pelvic (94.6%) or para-aortic (75.5%) lymphadenectomies. The 5-year RFS was 69.2% with CRT versus 56.3% with CT (P = 0.038), and 5-year OS was 86.1% versus 78.9% (P = 0.357). Pelvic and para-aortic recurrence rates were significantly higher in the CT group (pelvic: 29.2%; para-aortic: 20.2%) than in the CRT group (pelvic: 10.5%; para-aortic: 6.3%). The CRT group showed a higher rate of distant recurrence (CRT, 23.2% vs. CT, 14.6%) however, the 5-year cumulative incidence of distant recurrence was not significantly different between the two groups (CRT, 28% vs. CT, 35%). This study highlights the potential benefits of adjuvant CRT in patients with stage III–IVA EC. The incorporation of molecular classification is necessary to derive optimal personalized adjuvant treatment strategies for this patient population. •Chemoradiotherapy significantly improved recurrence-free survival of patients with stage III–IVA endometrial cancer.•The majority of patients received chemoradiotherapy in the form of sequential chemotherapy plus radiotherapy.•Predominant recurrence pattern after chemotherapy involved failures in the pelvic and para-aortic regions.•The 5-year cumulative incidence of distant recurrence was not significantly different between the two groups.•Our findings highlight the potential benefits of chemoradiotherapy as an adjuvant treatment in stage III-IVA EC.