Effect of prior adjuvant radiotherapy on immunotherapy outcomes in recurrent endometrial cancer.

Objective: This study aimed to investigate the impact of adjuvant external beam radiotherapy (EBRT) following initial surgery on the efficacy of immunotherapy in patients with recurrent endometrial cancer.

Methods: This is a single-institution retrospective cohort study. Patients who underwent initial surgery for endometrial cancer and received immunotherapy for recurrence between January 2020 and December 2023 were recruited. Patients who received post-operative EBRT were assigned to the EBRT group. Patients who did not undergo EBRT or who received brachytherapy without EBRT were assigned to the control group. Progression-free survival was used as the end point. Kaplan-Meier curves were used for comparing progression-free survival. The multi-variate analysis was performed using the Cox proportional hazards regression model.

Results: A total of 91 patients were included in the analysis; 33 had a history of EBRT, while 58 had not received prior EBRT. In Kaplan-Meier curves, patients who did not receive EBRT showed a numerically lower risk of disease progression (HR 0.47, 95% CI 0.25 to 0.90, p = .010). In multi-variate analysis, EBRT (HR 5.28, 95% CI 1.54 to 22.06) and proficient mismatch repair/micro-satellite instability-low/micro-satellite stable status (HR 3.15, 95% CI 1.19 to 8.90) were risk factors for disease progression during immunotherapy.

Conclusions: In patients with recurrent endometrial cancer who received immunotherapy, the therapeutic efficacy may be compromised by prior post-operative adjuvant EBRT.