Lee, Kuang-YenKuang-YenLeeTseng, Tzu-HsinTzu-HsinTsengWEN-CHUN CHANGYI-JOU TAIBOR-CHING SHEUCHIN-JUI WULIN-HUNG WEIYING-CHENG CHIANG2026-03-102026-03-102026-02-23https://scholars.lib.ntu.edu.tw/handle/123456789/736139Objective: To evaluate the survival outcomes of Sandwich (Chemo-RT-Chemo) versus Sequential (Chemo-RT) therapy in Stage III endometrial cancer, focusing on the interplay between treatment intervals, time toxicity, and molecular classification. Methods: We analyzed 119 patients with Stage III EC (2015–2025) receiving either Sequential (n = 42) or Sandwich (n = 77) regimens. Endpoints included overall survival (OS), progression-free survival (PFS), relative dose intensity (RDI), and overall treatment time (OTT). Outcomes were stratified by p53 and MMR status. Results: Among 119 patients (42 Sequential, 77 Sandwich) with well-balanced characteristics, no significant differences were observed in OS (P = .73) or PFS (P = .93). However, subgroup analysis favored the Sandwich regimen in pMMR tumors (PFS benefit, P = .026) and p53-mutant tumors (improved time-to-recurrence, P = .034). Regarding time toxicity, the Sandwich cohort demonstrated significantly shorter median overall treatment time (198.0 vs. 223.0 days; P < .001) and earlier radiotherapy initiation (77.0 vs. 171.5 days; P < .001). Chemotherapy dose intensity remained comparable (P = .878). While low-grade diarrhea was more frequent in the Sandwich arm (43% vs. 21%; P = .027), grade≧3 adverse events were rare and similar between groups. Conclusions: The Sandwich regimen offers a dual advantage: it reduces patient time toxicity and ensures earlier pelvic control without sacrificing chemotherapy intensity. This optimized temporal sequencing appears particularly beneficial for high-risk molecular subtypes (p53-mutant/pMMR) and supports the paradigm of molecular-directed adjuvant therapy.enChemotherapyEndometrial cancerMolecular classificationRadiation therapySandwich methodSequential methodjournal article10.1016/j.ygyno.2026.02.00741734477