Ann H. Klopp, MD, PhD, an associate professor of radiation oncology at The University of Texas MD Anderson Cancer Center, discusses the future of chemotherapy in combination with radiation for the treatment of patients with endometrial cancer.

Going forward, the hope is to better distinguish subsets of patients based on their biology in order to give them a particular type of treatment, explains Klopp. For example, some patients may benefit from immunotherapy, whereas some may benefit from targeted therapy. According to Klopp, the current best evidence suggests that the standard of care should be chemotherapy and radiation combined.

For the patients who only receive chemotherapy and do not receive radiation, there is a 30% risk of having the cancer come back in the pelvis, Klopp says. Sometimes those patients can still get curative radiation treatment, but it is a more intensive type of radiation that does not always work.

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Dr. Klopp on the Future of Chemoradiation in Endometrial Cancer

Ann H. Klopp, MD, PhD, an associate professor of radiation oncology at The University of Texas MD Anderson Cancer Center, discusses chemoradiation in endometrial cancer.

Klopp says that the combination of chemotherapy and radiation is the best treatment for patients with stage III endometrial cancer. A trial comparing radiation to chemoradiation showed improved disease-free survival in patients who received chemoradiation. Chemoradiation also reduces the risk of recurrence in the pelvis, which is attributed to the radiation component of the therapy, says Klopp.

In a study comparing chemotherapy with chemoradiation, survival was equivalent, but there was a higher rate of pelvic relapse with chemotherapy alone. This is a symptomatic problem for patients and affects their quality of life, says Klopp.

Ann H. Klopp, MD, PhD, an associate professor of radiation oncology at The University of Texas MD Anderson Cancer Center, discusses chemoradiation in endometrial cancer.
 

Dr. Klopp Discusses Chemoradiation in Endometrial Cancer

Ann H. Klopp, MD, PhD, an associate professor of Radiation Oncology at The University of Texas MD Anderson Cancer Center discusses intensity-modulated radiation therapy (IMRT) for patients with gynecologic cancers.

Among patients who had standard radiation, almost 10% of them had trouble controlling bowel movements, whereas this occurred in only 2% of the patients who had IMRT. According to Klopp, it was surprising how severe the patient experience was.

The community is learning more about patient-reported outcomes that it is more sensitive to many forms of toxicity than physician-reported toxicity, explains Klopp.

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 Dr. Klopp on IMRT for Gynecologic Cancers

Ann H. Klopp, MD, PhD, an associate professor of Radiation Oncology at The University of Texas MD Anderson Cancer Center, discusses data from a trial comparing standard radiation therapy with intensity-modulated radiation therapy (IMRT) in patients with gynecologic malignancies.

Klopp specifically highlights findings from a randomized phase III trial in which patients with endometrial and cervical cancer reported significantly less acute gastrointestinal (GI) toxicity when treated with pelvic IMRT as opposed to standard pelvic radiation therapy.

The goal of the study, she says, was to look at these acute toxicities that occurred during the course of treatment with the use of an instrument called EPIC questionnaire, which is a measure of GI toxicity as evaluated by patients that fill out surveys about the extent of their symptoms.

The results showed a greater decline in GI function in the patients that had standard radiation. Patients treated with IMRT, on the other hand, had less decline, and this was associated with a better quality of life, Klopp explains.

Though the study is not powered to look at disease control, Klopp says they are continuing to monitor these patients' outcomes. Thus far, they have not seen any recurrences in either group of patients. If they did want to look at disease control in this study, she adds, then they would need to recruit several more patients in order to answer such questions.

Ann H. Klopp, MD, PhD, an associate professor of Radiation Oncology at The University of Texas MD Anderson Cancer Center, discusses data from a trial comparing standard radiation therapy with intensity-modulated radiation therapy in patients with gynecologic malignancies.

Dr. Klopp on Data Comparing Standard Radiation With IMRT in Gynecologic Malignancies

Ann H. Klopp, MD, PhD, an associate professor of Radiation Oncology at The University of Texas MD Anderson Cancer Center, discusses the next steps to take with pelvic intensity-modulated radiation therapy for patients with gynecological cancers.

The goal continues to be to reduce toxicity with this type of treatment, Klopp explains. A possible step toward combatting this would be to investigate how the patient's microbiome affects their toxicity. Technical ways to reduce toxicity could be lowering the number of fractions or lowering proton therapy. This could possibly improve outcomes.

Dr. Klopp on Goals With IMRT in Gynecological Cancers

Ann H. Klopp, MD, PhD, an associate professor of Radiation Oncology at The University of Texas MD Anderson Cancer Center, discusses the results of a study that compared the respective toxicities and quality of life outcomes associated with standard radiation and pelvic intensity-modulated radiation therapy (IMRT) for patients with various gynecologic malignancies.

The overall goal of this study was to look at acute toxicities that occurred during the course of a patient's treatment with the use of the bowel domain of the expanded prostate cancer index composite (EPIC) questionnaire, which evaluated patient bowel function and bowel bother.

According to Klopp, the researchers found that there was a greater decline in gastrointestinal function in patients that received standard radiation, whereas the patients who received experienced less of a decline. Moreover, this was also associated with improved quality of life.

Remaining questions regarding this research should focus on whether these differences in technique are persistent in a long-term sense, says Klopp.

Ann H. Klopp, MD, PhD, an associate professor of Radiation Oncology at The University of Texas MD Anderson Cancer Center, discusses the results of a study that compared the respective toxicities and quality of life outcomes associated with standard radiation and pelvic intensity-modulated radiation therapy for patients with various gynecologic malignancies.