Long-Term Quality of Life after Adjuvant Sequential Chemotherapy and/or Radiotherapy in Endometrial Cancer Survivors

Author(s): Coraline DUBOT, Mathilde SMALL, Patricia PAUTIER, Emeline MERIAUX, Thibault de la Motte Rouge, Stéphanie Bécourt, Marianne LEHEURTEUR, Jean Michel GRELLARD, Bénédicte CLARISSE, François GERNIER, Justine LEQUESNE, and Florence JOLY

Background: Multimodal treatments for high-risk endometrial cancer (EC) combining surgery followed by chemotherapy (CT) and radiotherapy (RT) (either concomitant RTCT or sequential CT followed by RT) have numerous side-effects that can negatively impact EC survivor’s quality of life (QoL). Objective: We aimed to evaluate the long-term impact on QoL of sequential adjuvant radio-chemotherapy (RTCT) for women treated for localized EC. Methods: A retrospective study was conducted among patients with FIGO stage II or III endometrial cancer treated with surgery followed by sequential carboplatin-paclitaxel based chemotherapy and radiotherapy (RTCT), or by radiotherapy alone (RT), without recurrence within 5 years after surgery. Concomitant chemotherapy was not allowed. Quality of life was evaluated at least 2 years after the end of treatment by EORTC QLQ-C30, EN24, CIPN20 and HADS questionnaires. Results: Of 97 eligible patients, 69 (71%) accepted to participate and 51 (53%) fulfilled the questionnaires. 50 patients were finally included, with 20 RTCT patients and 30 RT patients. Mean age was 67.9 years old, median time between the end of treatment and inclusion was 46.8 months [range: 30.47-55.7?. Quality of life was significantly deteriorated in RTCT group (global QOL score 61.7 for RTCT vs 71.1 for RT, p=0.019). Scores of fatigue (38.9 vs 22.7; p=0.023), lymphedema (36.7 vs 19.1; p=0.051) and sensitive chemotherapy induced neuropathy (20.04 vs 6.86; p<0.001) were significantly higher in RTCT group. No difference in depression and anxiety rates was observed. RTCT and sensory neuropathy were associated with deteriorated quality-of-life in univariate analysis. Conclusions: RTCT durably deteriorates quality of life more than 2 years after the end of treatment with persistent fatigue, chemo-induced neuropathy and lymphedema.