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Adding chemotherapy to radiation after surgery helped women with high-risk endometrial cancer, especially those whose tumours have a broken p53 gene.
5-year OS 81.4% vs 76.1% (HR 0.70) and failure-free survival 76.5% vs 69.1% in the updated analysis (Lancet Oncology 2019); the benefit was largest in stage III and serous cancers. Molecular analysis (de Boer/León-Castillo, JCO 2020) showed strong benefit in p53-abnormal tumours and none in POLE-mutated tumours, the basis for molecular-class-directed adjuvant therapy now tested in RAINBO.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
660 enrolled.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Overall survival at 5 years | Chemoradiation + chemotherapy | 330 | 81.4% | 0.7 (0.51 to 0.97) | - | link |
| Radiotherapy alone | 330 | 76.1% |
Molecular class is now a predictive factor for adjuvant therapy: chemotherapy for p53-abnormal disease, de-escalation for POLE-mutated tumours, and trials of immunotherapy for mismatch repair-deficient disease.
Chemoradiotherapy is the standard for stage III and for p53-abnormal or serous endometrial cancer; for other stage I to II tumours radiotherapy alone or brachytherapy suffices.
Shares POLE-ultramutated endometrial cancer, Uterine carcinosarcoma, p53-abnormal endometrial cancer, including uterine serous carcinoma, Endometrial cancer with no specific molecular profile.
Shares POLE-ultramutated endometrial cancer, p53-abnormal endometrial cancer, including uterine serous carcinoma, Endometrial cancer with no specific molecular profile, Mismatch-repair-deficient endometrial cancer.
Shares Endometrial cancer molecular classes (POLEmut, MMRd, p53abn, NSMP), Uterine carcinosarcoma, p53-abnormal endometrial cancer, including uterine serous carcinoma, TP53.
Shares Uterine carcinosarcoma, p53-abnormal endometrial cancer, including uterine serous carcinoma, Endometrial cancer with no specific molecular profile, Mismatch-repair-deficient endometrial cancer.
Shares POLE-ultramutated endometrial cancer, Endometrial cancer with no specific molecular profile, Endometrial cancer.
Shares POLE-ultramutated endometrial cancer, Endometrial cancer with no specific molecular profile, Endometrial cancer.
Shares Endometrial cancer molecular classes (POLEmut, MMRd, p53abn, NSMP), POLE-ultramutated endometrial cancer, Uterine carcinosarcoma.
Shares POLE-ultramutated endometrial cancer, Mismatch-repair-deficient endometrial cancer, IMRT / IGRT (modern external beam).