radiation therapy compared with combination chemotherapy in treating patients with advanced endometrial cancer

Conditions: Endometrial Cancer; Psychosocial Effects of Cancer and Its Treatment

Summary: rationale: radiation therapy uses high-energy x-rays to damage tumor cells. drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. it is not yet known which treatment regimen is more effective for endometrial cancer. purpose: randomized phase iii trial to compare radiation therapy with chemotherapy in treating patients who have advanced endometrial cancer.

objectives: i. compare overall survival, progression-free interval, and patterns of failure of maximally debulked patients with stage iii/iv endometrial carcinoma treated with whole-abdominal irradiation vs. doxorubicin/cisplatin. ii. compare the incidence and type of acute and late adverse events observed with these two treatment regimens. iii. compare changes in fatigue, elimination, and neurologic impairment that impact on quality of life in patients treated with these two regimens. iv. assess the difference in short-term versus long-term impact on quality of life between the two treatment groups. v. compare quality-of-life outcomes over time between these two treatment groups. outline: randomized study. arm i: radiotherapy. whole-abdominal irradiation using equipment with photon energies ranging from 6 to 25 mv. arm ii: 2-drug combination chemotherapy. doxorubicin, dox, nsc-123127; cisplatin, cddp, nsc-119875. projected accrual: it is anticipated that 355 patients will be entered over 7.4 years.

Eligibility criteria:
disease characteristics: pathological stage iii/iv endometrial carcinoma of any histology (including clear cell and serous papillary carcinomas) the following extent of disease eligible: positive adnexa tumor invading the serosa positive pelvic nodes positive para-aortic nodes involvement of the bowel mucosa intra-abdominal metastases positive pelvic washings vaginal involvement within the radiotherapy field hysterectomy and bilateral salpingo-oophorectomy (bso) required with residual tumor not greater than 2 cm at any site selective pelvic and para-aortic lymph node sampling optional for patients with stage iii/iv disease by other criteria if para-aortic nodes are positive, scalene nodes must be negative on biopsy and chest ct must be negative for intrathoracic disease the following disease conditions exclude: parenchymal liver metastasis lung metastasis positive inguinal nodes positive scalene nodes recurrent disease protocol therapy must begin within 8 weeks after surgery patient characteristics: age: not specified performance status: gog 0-3 hematopoietic: wbc at least 3,000/mm3 absolute granulocyte count at least 1,500/mm3 platelet count at least 100,000/mm3 hepatic: bilirubin no greater than 1.5 times normal ast no greater than 3 times normal renal: creatinine no greater than 2.0 mg/dl cardiovascular: left ventricular ejection fraction normal other: no past or concomitant malignancy other than nonmelanomatous skin cancer prior concurrent therapy: biologic therapy: no prior biologic therapy chemotherapy: no prior chemotherapy endocrine therapy: prior progestational agents allowed no other prior endocrine therapy radiotherapy: no prior pelvic or abdominal radiotherapy surgery: hysterectomy and bso required pelvic and para-aortic lymph node sampling optional (see disease characteristics)

Keywords: stage iii endometrial carcinoma stage iv endometrial carcinoma endometrial adenocarcinoma endometrial adenosquamous cell carcinoma endometrial adenoacanthoma endometrial papillary serous carcinoma endometrial clear cell carcinoma psychosocial effects of cancer and its treatment