Chemotherapy after Whole Abdominal Radiation for Endometrial Cancer
Dear OncoLink "Ask The Experts,"
My partner has endometrial cancer - stage IIIA. She had a radical hysterectomy and has now completed whole abdominal and pelvic radiation. She is scheduled to have 3 rounds of brachytherapy starting next week. My question is that her radiation oncologist has suggested chemotherapy also. I know this is more experimental, but wanted to know what information you had on chemo after whole abdominal radiation.
Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:
Among the gynecologic cancers, endometrial cancer has more options for treatment than any other. After surgery, patients often are treated with chemotherapy, radiation, or hormonal therapy. These can be given alone, or in various combinations. Radiation can consist of pelvic radiation, brachytherapy (internal vaginal radiation), or whole abdominal therapy. Chemotherapy may be given before, after, or during these radiation treatments--and sometimes all three.
Even in regards to chemotherapy, several different regimens are employed. The Gynecologic Oncology Group recently published the results of a Phase I trial looking at one specific regimen of whole abdominal radiation given with concurrent cisplatin, followed by doxorubicin/cisplatin chemotherapy. This study found that without the use of supportive cytokines (like Neupogen or Neulasta injections to bolster the white blood cell count), the treatment had too many side effects. Please keep in mind that this study only covered one particular chemo regimen, and only included patients with stage IIIC and stage IV disease. These results cannot be interpreted to mean that all chemotherapy following whole abdominal radiation has too many side effects. I would recommend that you discuss your concerns with your physician and ask what side effects and benefits can be expected with treatment.