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Chemotherapy Before Surgery in Advanced Endometrial Cancer

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Neoadjuvant Chemotherapy in Advanced Stage Endometrial Cancer A Systematic Review and Meta-Analysis.DOI 10.3390medicina62010130

Endometrial cancer starts in the lining of the uterus. Many women are diagnosed early. Some are diagnosed later, when the cancer has already spread. This is called advanced endometrial cancer. Treatment decisions at this stage can be difficult.

The usual approach is surgery first, followed by chemotherapy or radiation. In some cases, doctors give chemotherapy before surgery. This is called neoadjuvant chemotherapy. The goal is to shrink the cancer, make surgery easier, and reduce surgical risks.

This study reviewed existing research to see if chemotherapy before surgery helps women live longer. The researchers analyzed data from more than 8,600 patients with advanced endometrial cancer. All the studies looked back at medical records rather than testing treatments in a controlled trial.

The results showed no clear survival difference between women who had chemotherapy first and those who had surgery first. On average, women lived a similar length of time with either approach. Chemotherapy before surgery did help in some practical ways. Tumors were sometimes smaller. Surgeries were sometimes shorter or less complex. These benefits did not translate into longer survival.

This finding is important for patients. It means chemotherapy before surgery is not a better option for everyone. Surgery first remains the standard choice for many women. Still, neoadjuvant chemotherapy may help certain patients.

Some women are too unwell for major surgery at diagnosis. Others have cancer that is too widespread to remove safely at first. In these situations, chemotherapy can help control the disease and improve strength before surgery is attempted.

The authors stress that the current evidence has limits. All the studies were retrospective and varied in how patients were treated. Stronger studies are needed to give clearer answers.

For patients, the key message is choice. Chemotherapy before surgery can be useful in selected cases. Decisions should be made with a cancer team that considers overall health, cancer spread, and personal goals. Care plans can and should be individualized.

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