Objective. Randomized clinical trials have suggested that adjuvant chemotherapy improves survival for women with advanced stage (III-IV) endometrial cancer. Despite the fact the endometrial cancer is common in the elderly, a minority of women >65 years of age were represented in these trials. We performed a population-based analysis to determine the use and impact on survival of adjuvant chemotherapy in elderly women with advanced stage endometrial cancer. Methods. The Surveillance Epidemiology, and End Results (SEER)-Medicare database was utilized to identify women diagnosed with stage III-IV endometrial cancer diagnosed from 1998-2007. Only those patients who had undergone a hysterectomy were included. The use of chemotherapy within 6 months of diagnosis and its impact on survival was examined using multivariable logistic regression and Cox proportional hazards models. Results. A total of 1819 women including 1193 with stage III and 626 with stage IV tumors were identified. Adjuvant chemotherapy was given to 46% of women. Use of chemotherapy increased with time from 42% in 1998 to 63% in 2007 (P<0.0001). By 2007, 54% of women with endometrioid tumors, 82% with serous tumors and 80% with carcinosarcomas received adjuvant chemotherapy. Use of whole pelvic radiotherapy decreased slightly from 40% in 1998 to 37% in 2007 while use of brachytherapy was stable at 22%. In a multivariable regression model, later year of diagnosis, non-endometrioid histology, residence in the eastern U.S., and stage IV disease were associated with receipt of chemotherapy while older women were less likely to receive chemotherapy (P<0.05). In a multivariable model including clinical and demographic characteristics women who received chemotherapy, mortality was reduced by 17% (HR=0.83; 95% CI, 0.72-0.96) compared to those who did not receive chemotherapy. Conclusion. Although the use of chemotherapy for elderly women with advanced stage endometrial cancer is increasing, fewer than half of patients >65 years of age receive chemotherapy. In addition to year of diagnosis, stage and histology are the strongest predictors of receipt of chemotherapy. Among elderly women with endometrial cancer, chemotherapy is associated with a reduction in mortality.

Citation Format: Gunjal Garg, Zainab Siddiq, Gongfu Zhou, Matthew A. Powell, Thomas Herzog, David G. Mutch, Jason D. Wright. Temporal trends, predictors, and outcome of chemotherapy in elderly women with advanced stage endometrial cancer. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 169. doi:10.1158/1538-7445.AM2013-169