Evaluating Treatment Strategies in Advanced Endometrial Cancer: Primary Cytoreductive Surgery Versus Neoadjuvant Chemotherapy Followed by Interval Debulking Surgery-A Ten-Year Single-Centre Experience.

Abstract

Introduction/Background: Management of advanced endometrial cancer (EC) presents a significant therapeutic challenge, with ongoing debate regarding optimal treatment sequencing. Primary cytoreductive surgeries (PCSs) with adjuvant therapy and neoadjuvant chemotherapy followed by interval Debulking surgery (NACT-IDS) are both employed as treatment strategies. This study analyses outcomes of both treatment strategies in Nottingham University Hospitals Cancer Centre. Methodology: We conducted a retrospective cohort analysis of patients with advanced EC (FIGO Stages III-IV) treated at our centre between 2013 and 2023. Patients who received either PCS with adjuvant therapy or neoadjuvant chemotherapy followed by interval Debulking surgery (NACT-IDS) are included in the study. Data collection included demographic characteristics, treatment approaches, surgical parameters, and outcome measures. Primary outcomes were progression-free survival (PFS) and overall survival (OS). Secondary outcomes included perioperative outcomes and recurrence patterns. Results: Treatment pathways included NACT-IDS (n = 8) and PCS with adjuvant therapy (n = 57). Stage IV disease was notably more prevalent in patients who received NACT-IDS therapy compared to the PCS group (75.0% versus 5.3%, p < 0.001). Analysis revealed a PFS duration of 18.5 months for NACT-IDS patients, whilst PCS patients demonstrated a longer duration of 35.5 months (HR 1.18, 95% CI: 0.56-2.48, p=0.328). Median OS was 22.0 months in the NACT-IDS group versus 41.0 months in the PCS group (HR 1.35, 95% CI: 0.64-2.83, p=0.145). Mean operative time was longer in the NACT-IDS group (239.7 vs 165.5 min, p=0.209). All NACT-IDS procedures were performed via open laparotomy compared to 49.1% in the PCS group (p < 0.001). Hospital stay was significantly longer in the NACT-IDS group (median 8 vs 3 days, p=0.036). Radiotherapy was administered to 25.0% (n = 2) of NACT-IDS patients and 59.6% (n = 34) of PCS patients. Recurrence rates were higher in the NACT-IDS group, 37.5%, compared to 33.3% in the PCS patients (p=0.823). Conclusion: This comprehensive analysis provides valuable insights into treatment outcomes and surgical parameters for advanced EC. Whilst the small sample size of the NACT-IDS cohort limits the ability to draw definitive conclusions, the study provides meaningful evidence that can inform clinical decision-making. The findings lay important groundwork for future prospective, multicentre studies aimed at optimising patient selection and treatment sequencing in this challenging disease.