Given the final results of GOG258, what regimen do you recommend use to treat Stage III endometrial cancer?  

Full dose chemotherapy is important in stage III+ patients to prevent risk of distant failure. However, patients in GOG 258 who received chemotherapy alone had an unacceptably high risk of developing locoregional recurrence (27% 5-year incidence combining vaginal + pelvic/para-aortic).  Despit...

The benefit of radiation reducing locoregional relapse, with HR 0.36 and 0.43 for vaginal and nodal relapses, respectively, is more salient currently, over a decade after the first patients were accrued on this trial and who were treated with IMRT only 30% of the time vs most centers now treating ex...

We should remember that in PORTEC-3 the patients with stage III EC had a 5 yr overall survival of 82% with post op chemotherapy and 77% with pelvic RT (modest benefit).In GOG 258, 5 yr OS was 59% with CT-RT and 58% with CT alone, but vaginal recurrences were 2% vs 7% and pelvic-PA recurrences were 1...

My preferred approach for most of these patients is "sandwich" therapy, with 3 cycles of chemo first, then pelvic +/- PA RT to microscopic disease doses, then more chemo if tolerable (which it usually is). When GOG 258 was designed, I favored chemo vs "sandwich" but I was barely outvoted in committe...

Thank you for the response @Carlos A. Perez. A small correction, the grade 3-5 incidence of adverse effects was 58% vs 63% respectively in "favor" of chemoRT.  Grade 4-5 also favored chemoRT (14% vs 30%).  QOL measures at 16 and 70 weeks however favored the chemotherapy alone arm. The low...