Pre-operative Assessment and Neoadjuvant Therapy Prior to Surgery for Advanced Endometrial Cancer: Survey of Practice among Thai Gynecologic Oncologists
Pitakkarnkul S, MD1, Chanpanitkitchot S, MD2, Srisomboon J, MD3, Tangjitgamol S, MD4, Thai Gynecologic Cancer Society (TGCS)5
Affiliation : 1 Department of Gynecologic Oncology, National Cancer Institute, Bangkok, Thailand 2 Department of Obstetrics and Gynecology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand 3 Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand 4 Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand 5 Office of the Thai Gynecologic Cancer Society, Bangkok, Thailand
Objective : To determine the methods that Thai gynecologic oncologists used to assess the operability and neoadjuvant treatment
in apparently advanced endometrial cancer.
Materials and Methods: This study was a part of the national survey project by the Thai Gynecologic Cancer Society on the
management of gynecologic cancer in Thailand. All Thai gynecologic oncologists who had been in practice for at least 1 year were
invited to respond about their practice to the online questionnaire open from August to October, 2019. Data on the methods to
assess the operability of advanced endometrial cancer and the type of neoadjuvant treatment before surgery were abstracted from
the database and analyzed.
Results : Among 170 respondents, 48.8% performed physical examination along with imaging study to assess the operability whereas
25.9% relied only on an imaging study. The most common imaging study was a computed tomography scan (84.1%). The respondents
who worked in training hospitals used special imaging studies (aside from ultrasonography) significantly more frequently than
those in service-only hospitals, 95.3% vs. 84.5% (p = 0.022). Regarding the neoadjuvant therapy before surgery, chemotherapy
(58.7%), chemotherapy combined with radiation (41.9%), and radiation therapy alone (33.5%) were selected as modes of treatment.
Radiation therapy was selected as an option more frequently among the respondents working in government and in training
hospitals compared to private and service-only hospitals: 36.2% vs. 5.6% (p = 0.009) and 40.7% vs. 25.0% (p = 0.022), respectively.
Combined radiation and chemotherapy were more frequently selected among the respondents who had been in practice >5 years
(48.5%) vs. <5 years (31.0%), p = 0.022.
Conclusion : An assessment of operability and neoadjuvant therapy before surgery in advanced endometrial cancer among the Thai
gynecologic oncologists varied. These were influenced by the hospital’s features and experience of the respondents.
Keywords : Survey, Practice, Endometrial cancer, Operability, Neoadjuvant therapy
