The benefit of adjuvant chemotherapy combined with postoperative radiotherapy for endometrial cancer: a meta-analysis

Abstract

The objective of our study was to determine whetheradjuvant chemotherapycombinedwithpostoperativeradiotherapywould have benefits for the disease-free survival and overall survival in patients with high-riskendometrial cancer. Electronic searches for studies ofadjuvant chemotherapycombinedwithpostoperativeradiotherapyinendometrial cancerpatients between March 1971 and March 2012 were made on MEDLINE, SCOPUS, and the Cochrane library. Articles with more than 4 stars on the Newcastle-Ottawa scale or a score of more than 4 on the modified Jadad scale were included. Ameta-analysiswas performed, and pooled hazard ratios (HR) of progression-free survival (PFS) and overall survival (OS) between patients whoseadjuvant chemotherapywascombinedwithradiotherapy(the CTx+RTx group) and patients withadjuvantradiotherapyonly (the RTx group) were derived from the fixed effect model or random effect model. Three observational studies and 3 randomized clinical trials (RCTs) were included in the final analysis. Subgroup analysis for FIGO stage showed that the CTx+RTx group had a more significant survivalbenefitcompared to that of the RTx group in advanced stageendometrial cancer(OS HR 0.53, 95% CI 0.36-0.80; PFS HR 0.54, 95% CI 0.37-0.77), but no significantbenefitin early stageendometrial cancer(OS HR 0.96, 95% CI 0.70-1.32; PFS HR 1.00, 95% CI 0.39-2.58). Thismeta-analysissuggests thatadjuvant chemotherapycombinedwithpostoperativeradiotherapycould probably reduce disease progression and overall death in patients with advanced-stage disease. In order to examine whether the multimodal treatment hasbenefitin high-riskendometrial cancer, we need further large-scale RCTs.