Randomized trial results of quality of life comparing whole abdominal irradiation and combination chemotherapy in advanced endometrial carcinoma: A gynecologic oncology group study

Abstract

Objective: To prospectively compare quality of life (QOL) outcomes in patients with advanced endometrial cancer treated with whole abdominal irradiation (WAI) or doxorubicin-cisplatin (AP) chemotherapy.

Methods: Using the Fatigue Scale (FS), Assessment of Peripheral Neuropathy (APN), Functional Alterations due to Changes in Elimination (FACE), and Functional Assessment of Cancer Therapy-General (FACT-G), QOL was measured at: pre-treatment, end of treatment (EOT), and 3 and 6 months post-treatment.

Results: 317 of 396 eligible patients provided a baseline QOL assessment. The AP arm produced a statistically significant survival benefit along with greater toxicities, including peripheral neuropathy persisting up to 6 months. WAI patients reported worse FS (p < 0.001) and FACE (p < 0.001) scores at EOT and poorer FACE scores 3 months post-treatment (p = 0.004) compared to AP patients. APN scores were significantly worse among AP patients at EOT, and 3 and 6 months post-treatment (p < 0.001 for all). There is no indication that FACT-G scores differed between the two arms at any assessment point.

Conclusions: The trade-off for increased survival with AP is its potential for clinically significant peripheral neuropathy. This should be discussed with patients, particularly those who work with their hands or on their feet, in weighing therapeutic choices. Further research is needed to manage side effects having an enduring impact on QOL.