The role of neoadjuvant chemotherapy in clinically advanced endometrial cancer: a real-world retrospective single-institutional study
Evidence on neoadjuvant chemotherapy in clinically advanced endometrial cancer is limited, with most of the data from high-income countries. To address this gap, we evaluated the treatment responses and survival outcomes in these patients at a tertiary cancer center in India. This retrospective study included patients with International Federation of Gynecology and Obstetrics 2009 stage III to IVB endometrial cancer treated at Gujarat Cancer Research Institute between January 1, 2017 and December 31, 2022. Patients deemed unfit for primary surgery and who received neoadjuvant chemotherapy were analyzed. Data collected included age, Eastern Cooperative Oncology Group performance status, tumor histology, CA125 levels, and chemotherapy regimens. Radiologic response to neoadjuvant chemotherapy was assessed using the Response Evaluation Criteria in Solid Tumours (RECIST) version 1.1 criteria. Interval debulking surgery outcomes were categorized as optimal (residual tumor ≤1 cm) or sub-optimal. Post-operative therapies and survival outcomes were evaluated. The median overall survival was estimated using the Kaplan-Meier method. A total of 41 patients met inclusion criteria. The mean age was 55.6 years (standard deviation 12.1), and the majority (83%) had endometrioid histology. Most patients had stage III disease (78%). The primary reason for inoperability was parametrial invasion (46.3%). After neoadjuvant chemotherapy, 22 patients (53.7%) underwent interval debulking, 14 of these (63.6%) achieved optimal cytoreduction. Based on RECIST, complete response occurred in 6 patients (14.6%) and progressive disease in 10 (24.4%). Overall, 39% experienced recurrence. The 5-year overall survival rate was 58.2% (95% confidence interval 41.75% to 81.3%). Patients who underwent surgery had significantly better survival than those who received chemoradiotherapy (5-year overall survival 77.1% vs 26.1%) (95% confidence interval 58.90% to 100%, p = .014). Neoadjuvant chemotherapy, followed by interval debulking surgery, is a feasible and effective treatment approach with unresectable advanced-stage endometrial cancer. Although a small sample size, favorable survival outcomes are observed, particularly, in patients achieving optimal cytoreduction. Further prospective studies are needed to validate these findings and refine patient selection.