Adjuvant chemotherapy followed by adjuvant radiotherapy for treatment of high risk endometrial cancers: A retrospective review.
Notice bibliographique
Résumé
e17626 Background: Endometrial cancer is the most common gynecologic malignancy in North America (1-3). Patients who are considered to be high risk for recurrence are commonly treated with a combination of adjuvant chemotherapy and radiation. However, the optimal sequence of these therapies has not been defined. The purpose of this study is to review our progression-free survival (PFS) outcomes and recurrence rates and compare to established outcomes in the literature. Methods: A retrospective chart review was performed on all patients diagnosed with endometrial cancer who received adjuvant chemotherapy and radiation between Jan. 1, 2005 to Dec. 31, 2017 at The Ottawa Hospital. Main inclusion criteria for the study were stage III endometrial cancers of any histology, stage I-II endometrial cancers with serous or clear cell histology and stage IV endometrioid adenocarcinomas of the endometrium. The primary outcome of interest is the overall progression-free survival (PFS), defined as the time from surgery to disease recurrence or death by any cause. Results: A total of 140 patients were included in the study. Of these, 52 (37.1%) had endometrioid histology, 75 (53.6%) had serous, and 11 (7.9%) had clear cell histology. Of the total sample, 41 (29.3%) were stage 1 at diagnosis, 24 (17.1%) were stage 2, 68 (48.6%) were stage 3 and 7 (5.0%) were stage 4. The median start time to chemotherapy was 49 days after initial surgery. 130 (92.9%) completed a total of 6 cycles of chemotherapy (majority treated with carboplatin and paclitaxel). 92% of the patients completed radiation following chemotherapy; majority received external beam radiation +/- a brachytherapy boost. Radiation was started withing 4-6 weeks of completing chemotherapy. 42 (30.0%) patients were diagnosed with a recurrence during the time of follow-up and 7 were diagnosed with progressive disease on treatment. Of the recurrences, 2 (4.8%) were local, 5 (11.9%) were locoregional, 8 (19.0%) were isolated para-aortic, and 27 (64.3%) were distant. The median follow-up time for our sample was 63.9 months. The median PFS and overall survival for our sample was not reached. The estimated mean 5 year PFS was 0.69 and OS was 0.66. Conclusions: Although radiation prevents locoregional recurrences, chemotherapy improves survival outcomes in locally advanced and aggressive histology endometrial cancer. Previous reported outcomes have been based on giving adjuvant radiation first, followed by chemotherapy (4,5). Our results demonstrate that giving adjuvant chemotherapy first and then delivering radiation after may be the optimal approach since it leads to survival outcomes that compare favourably with the published literature and very few locoregional relapses.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,007 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,003 | 0,007 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».