Does a 57-year-old with endometrial cancer need chemo?

Question

Hello doctor,

I am reaching out about my mother, who is 57 and was recently diagnosed with endometrial cancer. Her MRI report says there is deep myometrial invasion. The tumor has gone beyond 50 percent of the myometrium, and there is some suggestion of possible serosal involvement.

Does deep invasion affect treatment in a 57-year-old female significantly compared to if the invasion were shallow?
Does deep myometrial invasion combined with positive lymph nodes always lead to both chemotherapy and radiation in endometrial cancer?
How do doctors adjust chemotherapy dosing for someone with reduced kidney function?

She had a total hysterectomy with lymph node dissection, and the surgeon said 2 out of 14 lymph nodes came back positive. Her pathology confirmed grade 2 endometrioid carcinoma. Her pre-surgery cancer antigen 125 (CA-125) was 112 units/milliliter.

She is a hypertensive patient on Telmisartan 40 milligrams, and her eGFR was 58 milliliters/minute, which the nephrologist said puts her in stage 3 CKD.

The oncology team is planning Carboplatin and Paclitaxel chemotherapy for 6 cycles plus radiation, but we are worried about whether her kidney function will tolerate Carboplatin.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

I wish you good health, and I wish your mother a speedy recovery.

First of all, after surgery, there are many cases in which the final histopathology report indicates the need for both chemotherapy and radiotherapy, and your mother's situation falls into a category where this is quite common.

Regarding her kidney function, since it is not optimal, Carboplatin is often chosen because it is less toxic to the kidneys. Under different circumstances, she might have received Cisplatin, but because of her renal condition, Carboplatin is a safer alternative.

Her kidney function should be monitored closely throughout treatment. Typically, she will receive six cycles, and before each cycle, kidney function tests should be performed. If there is evidence that Carboplatin is adversely affecting her kidneys, it may be discontinued, and treatment can continue with Paclitaxel as a single agent.

As for radiotherapy, it is very important because it helps eliminate any remaining malignant cells in the pelvic lymph node region and provides additional local control. This significantly reduces the risk of both recurrence and future spread of the disease.

After completing the six cycles of chemotherapy and receiving the full prescribed course of radiotherapy, whether external beam radiation therapy (EBRT) and/or brachytherapy as recommended by her treatment team, we can be very optimistic about the outcome and consider that she has received definitive treatment for her endometrial cancer.

I wish your mother the very best, and if you have any questions or concerns at any time, please do not hesitate to ask.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.