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Adjuvant Chemoradiotherapy Superior to Radiotherapy Alone in Women With High-Risk Endometrial Cancer

LisaPizza's picture
LisaPizza
Posts: 208
Joined: Feb 2018

Link to a detailed PDF:

 https://www.thelancet.com/action/showPdf?pii=S1470-2045%2819%2930395-X

 

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TeddyandBears_Mom's picture
TeddyandBears_Mom
Posts: 1517
Joined: Jun 2015

Thanks for sharing Lisa. I was stage 1A / Grade 3 Serous and had Carbo/Taxol and Brachy. I'm so glad I did! It will be 4 years post treatment in January. So far, so good. Also, I believe doing what my doctors recommended has given me peace of mind. ( Which I think is important to get back to any kind of normalcy. )

Love and Hugs,

Cindi

zsazsa1
Posts: 311
Joined: Oct 2018

The PORTEC 3 should be weighed against the GOG 258 (which showed no improvement in survival when radiation was added to chemotherapy for stage III/IV endometrial cancer).  I was swayed by the PORTEC 3 to add external beam pelvic IMRT.  I don't know whether it improved my chances or not, but the GI toxicity was significant, and I fear long term side effects.

LisaPizza's picture
LisaPizza
Posts: 208
Joined: Feb 2018

They weren't really comparing the same thing. 

 

GOG 258 was only stage 3/4.

***external rads with 2 concurrent cycles of cisplatin, followed by 4 cycles of taxol/carbo

VS

***6 cycles of taxol/carbo (no radiation)

 

PORTEC 3 included stage 3/4, but also high risk stage 1/2

**external rads with 2 concurrent cycles of cisplatin, followed by 4 cycles of taxol/carbo

VS

***external rads (no chemo)

 

I hope I copied that correctly, no guarantees! I will correct if needed.

zsazsa1
Posts: 311
Joined: Oct 2018

Yes, you are correct.  PORTEC 3 added in high risk pathology FIGO stage 1 and 2. I was high risk (UPSC/clear cell), supposedly stage 1a, but isolated tumor cells in one of the two sentinel nodes they took made me seek an interpretation as 3c1, so that I would be eligible for Herceptin.  After consulting a number of specialists, I decided to go with the recommendation by two different academic radiation oncology centers, to add external beam pelvic, after I'd already had 6 rounds of carbo/taxol, because of the high risk pathology, and the fact that cells were out in the node.  The medical oncologists recommended only vaginal brachytherapy.  It does seem, when looking at the GOG-258, that the issue was that the cat was already out of the bag - because the problem was recurrence as distal metastases.  Local recurrence in the irradiated field was reduced in the GOG-258, but relapses occurred distally and survival was not improved.  So maybe I was right to do the whole pelvic IMRT.  In any event, it's done.  I honestly don't know what I would recommend to someone newly diagnosed with the exact same staging/pathology as mine.

Soup52's picture
Soup52
Posts: 900
Joined: Jan 2016

I’ve posted about my agressive treatment before, but it was radiation internal and external with  6 rounds of carbo/taxol. Treatments ended July 2016. So far allclear. Side effects neuropathy, fear of lymphedema , so,e gastro problems. So far I, glad I did it. I really didn’t have many choices. I was grade 3 clear cell, stage 3 C. I know many of you live in larger cities where you could choose different oncologists etc, but that isn’t true here. At one time we only had one gynechological oncologist. Now we are lucky to have 2. I so,etc,we feel out of it that others could pick and choose treatments. I just couldn’t do that considering insurance travel expenses etc. I am happy and alive.

zsazsa1
Posts: 311
Joined: Oct 2018

Soup, it's so encouraging to hear that you're doing well three years out from end of treatment!

barnyardgal
Posts: 204
Joined: Oct 2017

Thank you for posting. I was stage3a, grade 2, and had 7 rounds of adriamyacin/carboplatin and Imrt radiation (25). Fortunately, no issues so far except for a hemorrhoid from radiation. I have no regrets so far. I had surgery 10/17 and finished treatment 6/18. I have a yearly PET scan, scheduled in October but so far so good as far as I know.

MoeKay
Posts: 201
Joined: Feb 2004

In case you haven't seen it, I came across this Comment, published in The Lancet, discussing PORTEC-3, GOG-258, and GOG-249.  I thought some of you who are following these studies might be interested:

https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(19)30416-4/fulltext

 

 

Armywife's picture
Armywife
Posts: 276
Joined: Feb 2018

MoeKay, thank you - I've been reading all the articles noted in this one as well.  Thought I'd throw out a question before I googled - does anyone know what constitutes the Grade 3 and Grade 4 non-hematologic and hematologic toxicities noted as a result of the treatments?

MoeKay
Posts: 201
Joined: Feb 2004

Hi Armywife, here's a link to the National Cancer Institute's Common Toxicity Criteria Manual, which spells out all the hematalogic and non-hematologic toxicities by grade and explains the various grades:

https://ctep.cancer.gov/protocolDevelopment/electronic_applications/docs/ctcmanual_v4_10-4-99.pdf

This manual is from 1999, so someone may come across a later version.  

 

Armywife's picture
Armywife
Posts: 276
Joined: Feb 2018

Thank you, MoeKay!  I learn so much from all of you.  Very grateful.

LisaPizza's picture
LisaPizza
Posts: 208
Joined: Feb 2018

In general terms,  cancer treatment side effects are graded:

1 - Mild (no treatment required)

2 - Moderate

3 - Severe

4 - Life-threatening

5 - Death

 

Research and doctors tend to write off grade 1 and grade 2 side effects, which sucks, because they still have major impact on iur lives, especially when permanent. 

Armywife's picture
Armywife
Posts: 276
Joined: Feb 2018

Thanks for distilling it down, Lisa!  

zsazsa1
Posts: 311
Joined: Oct 2018

Thank you.  In addition to the editorial's main point, which, after a review of recent studies,  was, "We're not there yet", meaning, we haven't yet found a definitively better treatment protocol, there is a valuable list of references after the editorial, listing a lot of recent studies.

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