Highlights
- •Use of neoadjuvant chemotherapy is increasing for advanced stage uterine cancer.
- •There is no difference in survival between neoadjuvant chemotherapy and primary cytoreductive surgery.
- •Neoadjuvant chemotherapy associated with lower perioperative medical complications.
Abstract
Objective
Neoadjuvant chemotherapy (NACT) has emerged as an alternative to primary cytoreductive
surgery (PCS) for stage IV uterine cancer. We examined utilization, perioperative
outcomes and survival for NACT and PCS for stage IV uterine cancer.
Methods
The Surveillance, Epidemiology, End Results-Medicare database was used to identify
women with stage IV uterine cancer treated from 2000 to 2015. Women were classified
as NACT or PCS. Interval cytoreductive surgery (after NACT) or chemotherapy (after
PCS) were recorded. The extent of surgery and perioperative outcomes were estimated
for the groups. Multivariable proportional hazards models and Kaplan-Meier analyses
were used to examine survival.
Results
Among 3037 women, 1629 (53.6%) were treated with primary cytoreductive surgery, 554
(18.2%) with NACT, and 854 (28.1%) received no treatment. Use of NACT increased from
9.5% to 29.2%. After NACT, interval hysterectomy was performed in 159 (28.6%), while
within the PCS group, 1052 (64.6%) received chemotherapy. Extended cytoreductive procedures
were performed in 71.7% of women who received NACT vs. 79.1% after PCS (P = 0.03). The complication rate was 52.8% for NACT versus 56.2% for PCS (P = 0.42); medical complications were more frequently seen in the PCS group (39.4%
versus 28.9%; P = 0.01). There was no difference in cancer specific (P = 0.48) or overall survival (P = 0.25) in women who received both chemotherapy and surgery regardless of whether
the initial treatment was NACT or PCS.
Conclusion
Use of NACT is increasing for advanced stage uterine cancer. There was no difference
in survival between NACT and primary cytoreductive surgery and NACT was associated
with fewer perioperative medical complications.
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Article info
Publication history
Published online: June 19, 2021
Accepted:
June 13,
2021
Received:
April 28,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
