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Wernicke AG, Parashar B, Samuel E, Sabbas A, Gupta D, Caputo T. Partial-Length Treatment With Brachytherapy in Patients With Endometrial Cancer With High-Risk Features Is as Effective as Full-Length Vaginal Brachytherapy but With Reduced Toxicity. Pract Radiat Oncol 2023; 13:e416-e422. [PMID: 37295725 DOI: 10.1016/j.prro.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/15/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE Full-length vaginal (FLV) brachytherapy for patients with endometrial cancer and high-risk features should be considered as per the American Brachytherapy Society to reduce distal vaginal recurrence in patients with endometrial cancers with papillary serous/clear cell histologies, grade 3 status, or extensive lymphovascular invasion. We sought to investigate this patient population and report outcomes of treatment with high-dose-rate (HDR) brachytherapy in women treated with FLV brachytherapy versus partial-length vaginal (PLV) brachytherapy. METHODS AND MATERIALS With institutional review board approval, we identified patients with endometrial cancer meeting American Brachytherapy Society criteria of high-risk features treated with adjuvant HDR between 2004 and 2010. HDR doses were 21Gy in 3 fractions delivered to either the full-length or partial-length vagina. Acute and late toxicities were evaluated using the Radiation Therapy Oncology Group scale and Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer grading, respectfully. Vaginal recurrences were assessed by physical examination and pap smears. Statistical analyses were performed using SPSS version 23 software. RESULTS Of 240 patients treated with HDR brachytherapy, 121 were treated with FLV brachytherapy, and 119, with PLV brachytherapy. The median follow-up was 9.5 years (range, 8-11 years) for FLV patients and 8.5 years (range, 7-10 years) for PLV patients; 0% of patients had vaginal recurrences, and 1.4% and 0.9% had proximal vaginal recurrences, respectively (P = .54). All patients treated with FLV brachytherapy developed grade 3 mucositis of the lower vagina/introitus (P < .0001) and had increased analgesics use compared with those treated with PLV brachytherapy (P < .0001). In total, 23% of patients treated with FLV brachytherapy developed grade 3 stenosis of the lower vagina/introitus, in contrast to 0% of patients treated with PLV brachytherapy (P < .0001). CONCLUSIONS PLV brachytherapy is as effective as FLV brachytherapy in reducing local recurrence and causes a significantly lower incidence of acute and late toxicities. The results of this study caution radiation oncologists regarding the careful use of FLV brachytherapy in patients with endometrial cancer and high-risk features.
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Affiliation(s)
- A Gabriella Wernicke
- Department of Radiation Oncology, Weill Medical College of Cornell University, New York, New York; Department of Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell Health, New York, New York.
| | - Bhupesh Parashar
- Department of Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell Health, New York, New York
| | - Eileen Samuel
- Department of Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell Health, New York, New York
| | - Albert Sabbas
- Department of Radiation Oncology, Weill Medical College of Cornell University, New York, New York
| | - Divya Gupta
- Senior Group Medical Directory, GlaxoSmithKline, Waltham, Massachusetts
| | - Thomas Caputo
- Department of Obstetrics and Gynecology, Division of Gynecological Oncology, Weill Medical College of Cornell University, New York, New York
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Dasanu CA, Lerner J, Ocampo MM, Iskandar AS, Kaur J, Tuler S, Codreanu I, Farrell S, Plaxe SC. Advanced uterine papillary serous cancer: Could there be a role for newer targeted therapeutic approaches or immune checkpoint inhibitors? J Oncol Pharm Pract 2021; 27:1181-1185. [PMID: 33983075 DOI: 10.1177/10781552211015769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although now available in oncology clinics, comprehensive germline mutation testing is being performed only in a minority of patients with advanced uterine papillary serous cancer (UPSC). Some of these patients might harbor various targetable mutations, either heritable or acquired.Data sources: We conducted a retrospective cohort study involving all consecutive patients with UPSC treated at our institution from 2009-2019. Data on epidemiology, with an accent on personal and family history of cancer, clinical presentation, disease stage, employed treatment modalities and cancer-specific survival (CSS) was sought. FINDINGS Thirteen patients were seventy years of age or younger (≤70) while 15 were older than seventy (>70), and the two arbitrary patient cohorts were well-balanced for the TNM stage. Four UPSC patients >70 had a personal history of metachronous breast cancer. We also identified five cases of breast cancer, two cases of colon cancer, and one of each ovarian and uterine cancer in the first-degree relatives of UPSC patients >70. More than 90% of patients had surgical excision/debulking, and nearly half of the patients in each group received systemic chemotherapy. The most common chemotherapy regimen was carboplatin-paclitaxel every three weeks. Compared to patients ≤70, the UPSC patients >70 were less likely to undergo postoperative radiation therapy (6% vs 61.5%; p = 0.001) and had a worse CSS (21.8 vs. 27.4 months; HR 0.61, p = 0.03). CONCLUSIONS Personal and family history in a cohort of older UPSC patients identified an excess of second primary cancers, and these patients displayed a shorter CSS. Comprehensive germline and tumor mutation analysis might identify optimal candidates for various targeted agents and immune checkpoint inhibitors, and ultimately improve survival. This may represent an unmet need in the UPSC patients, and further studies are needed to confirm the significance of our findings.
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Affiliation(s)
- Constantin A Dasanu
- Eisenhower Lucy Curci Cancer Center, Rancho Mirage, CA USA.,University of California San Diego Health, San Diego, CA, USA
| | - Jaren Lerner
- Department of Medicine, Eisenhower Health, Rancho Mirage, CA USA
| | | | | | - Jaspreet Kaur
- Department of Medicine, Eisenhower Health, Rancho Mirage, CA USA
| | - Shahat Tuler
- Department of Medicine, Eisenhower Health, Rancho Mirage, CA USA
| | - Ion Codreanu
- Department of Radiology and Medical Imaging, State University of Medicine and Pharmacy "Nicolae Testemitanu," Chisinau, Republic of Moldova
| | | | - Steven C Plaxe
- Eisenhower Lucy Curci Cancer Center, Rancho Mirage, CA USA.,University of California San Diego Health, San Diego, CA, USA
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Nasioudis D, Roy AG, Ko EM, Cory L, Giuntoli II RL, Haggerty AF, Kim SH, Morgan MA, Latif NA. Adjuvant treatment for patients with FIGO stage I uterine serous carcinoma confined to the endometrium. Int J Gynecol Cancer 2020; 30:1089-1094. [DOI: 10.1136/ijgc-2020-001379] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 01/25/2023] Open
Abstract
ObjectivesThe role of adjuvant treatment for early-stage uterine serous carcinoma is not defined. The goal of this study was to investigate the impact of adjuvant treatment on survival of patients with tumors confined to the endometrium.MethodsPatients diagnosed with stage I uterine serous carcinoma with no myometrial invasion between January 2004 and December 2015 who underwent hysterectomy with at least 10 lymph nodes removed were identified from the National Cancer Database. Adjuvant treatment patterns defined as receipt of chemotherapy and/or radiotherapy within 6 months from surgery were investigated and overall survival was evaluated using Kaplan–Meier curves, and compared with the log-rank test for patients with at least one month of follow-up. A Cox analysis was performed to control for confounders.ResultsA total of 1709 patients were identified; 833 (48.7%) did not receive adjuvant treatment, 348 (20.4%) received both chemotherapy and radiotherapy, 353 (20.7%) received chemotherapy only, and 175 (10.2%) received radiotherapy only. Five-year overall survival rates for patients who did not receive adjuvant treatment (n=736) was 81.9%, compared with 91.3% for those who had chemoradiation (n=293), 85.1% for those who received radiotherapy only (n=143), and 91.0% for those who received chemotherapy only (n=298) (p<0.001). After controlling for age, insurance status, type of treatment facility, tumor size, co-morbidities, and history of another tumor, patients who received adjuvant chemotherapy (HR 0.64, 95% CI 0.42, 0.96), or chemoradiation (HR 0.55, 95% CI 0.35, 0.88) had better survival compared with those who did not receive any adjuvant treatment, while there was no benefit from radiotherapy alone (HR 0.85, 95% CI 0.53, 1.37). There was no survival difference between chemoradiation and chemotherapy only (HR 1.15, 95% CI 0.65, 2.01).ConclusionAdjuvant chemotherapy (with or without radiotherapy) is associated with a survival benefit for uterine serous carcinoma confined to the endometrium.
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Gómez-Raposo C, Merino Salvador M, Aguayo Zamora C, Casado Saenz E. Adjuvant chemotherapy in endometrial cancer. Cancer Chemother Pharmacol 2020; 85:477-486. [PMID: 31950214 DOI: 10.1007/s00280-019-04027-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 12/28/2019] [Indexed: 01/30/2023]
Abstract
The role of adjuvant chemotherapy (CT) is controversial in endometrial carcinoma (EC). Surgery alone is usually curative for women who are at a low risk of disease recurrence. The treatment of EC following surgical staging is based on the risk of relapse, which is defined by the cancer stage at diagnosis, histology of the tumor and other prognostic factors such as grade differentiation, the presence of substantial lymphovascular invasion (LVSI), or depth of myometrial invasion (MI). External beam radiotherapy (EBRT) and/or vaginal brachytherapy (VBT) improved local control and are used as adjuvant treatment for early-stage disease. The role of adjuvant CT is controversial in early-stage EC, and there is no uniform approach to the treatment of women with stage III EC or early-staged non-endometrioid EC. Available evidence did not support the indication of adjuvant CT in stage I-II endometroid EC. In those cases at higher risk of relapse, defined as grade 3 tumors with substantial (no focal) LVSI, specifically with deep MI or cervical involvement, could be considered. Adjuvant CT should be administered to stage III EC patients. When RT is indicated (extensive lymph node involvement or deep MI), sequential treatment with RT or "sandwich" regimen may be considered rather than concurrent CRT. The patients with stage IA MI or IB USC may be offered adjuvant CT alone or in combination with VBT, whereas in stage II uterine serous carcinoma patients adding EBRT may be reasonable. Management approach for patients with stage IA without MI USC who underwent a comprehensive surgery remains controversial, and surveillance alone or CT plus VBT is an appropriate option. Early-stage clear-cell carcinoma patients might not benefit for adjuvant CT, but stage III patients might benefit from the combination of CT and EBRT. Stage I-III uterine carcinosarcoma patients might be offered adjuvant CT followed by RT or as a "sandwich" régimen.
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Affiliation(s)
- César Gómez-Raposo
- Medical Oncology Department, Hospital Universitario Infanta Sofía, Avenida de Europa 34, 28702, San Sebastián de Los Reyes, Madrid, Spain.
| | - María Merino Salvador
- Medical Oncology Department, Hospital Universitario Infanta Sofía, Avenida de Europa 34, 28702, San Sebastián de Los Reyes, Madrid, Spain
| | - Cristina Aguayo Zamora
- Medical Oncology Department, Hospital Universitario Infanta Sofía, Avenida de Europa 34, 28702, San Sebastián de Los Reyes, Madrid, Spain
| | - Enrique Casado Saenz
- Medical Oncology Department, Hospital Universitario Infanta Sofía, Avenida de Europa 34, 28702, San Sebastián de Los Reyes, Madrid, Spain
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Xiang M, English DP, Kidd EA. National patterns of care and cancer-specific outcomes of adjuvant treatment in patients with serous and clear cell endometrial carcinoma. Gynecol Oncol 2018; 152:599-604. [PMID: 30551884 DOI: 10.1016/j.ygyno.2018.12.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 12/02/2018] [Accepted: 12/06/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To investigate outcomes of adjuvant therapy for serous and clear cell endometrial carcinoma, as prior studies are limited by sample size and/or patient heterogeneity. National guidelines permit substantial variations in treatment, suggesting the need for additional data. METHODS Patients with FIGO stages I-III serous or clear cell uterine carcinoma who underwent at least total hysterectomy were identified in SEER-Medicare. Adjuvant external beam radiation, brachytherapy, and chemotherapy were determined using SEER fields and Medicare claims. The primary outcome was death from endometrial cancer (cancer-specific mortality [CSM]) evaluated using Gray's test (univariable analysis, UVA) and Fine-Gray regression (multivariable analysis, MVA). RESULTS A total of 1789 patients (1437 serous, 352 clear cell) were identified. In stages I-II patients (n = 1188), brachytherapy was significant for survival in UVA (P = 0.03) and MVA (P = 0.02). Additionally, in the subset with serous histology (n = 947), chemotherapy was also significant in UVA (P = 0.002) and approached significance in MVA (P = 0.05). The 4-year CSM for stages I-II serous cancers was 25% without brachytherapy or chemotherapy, 15% with one, and 9% with both (P ≤ 0.05 for all pairwise comparisons). In stage III patients (n = 601), chemotherapy was significant in UVA (P = 0.002) and MVA (P = 0.006). Most (81%) patients underwent lymph node dissection, which predicted lower CSM in stage III (P = 0.001) but not stages I-II patients. CONCLUSIONS Our results suggest brachytherapy benefits stages I-II serous/clear cell cancers, chemotherapy benefits stage III serous/clear cell cancers, and both chemotherapy and brachytherapy benefit stages I-II serous cancers.
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Affiliation(s)
- Michael Xiang
- Department of Radiation Oncology, Stanford University, Stanford, CA, United States of America
| | - Diana P English
- Department of Gynecology, Division of Gynecologic Oncology, Stanford University, Stanford, CA, United States of America
| | - Elizabeth A Kidd
- Department of Radiation Oncology, Stanford University, Stanford, CA, United States of America.
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Albuquerque K, Chino J, Klopp A, Kamrava M, Beriwal S. Defining the Place of Adjuvant Chemotherapy and Radiation for High-Risk Endometrial Cancer From Recent Randomized Clinical Trials: Some Answers, More Questions. Int J Radiat Oncol Biol Phys 2018; 102:473-477. [PMID: 30238893 DOI: 10.1016/j.ijrobp.2018.05.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 05/14/2018] [Indexed: 10/28/2022]
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Donovan E, Reade CJ, Eiriksson LR, Pond GR, Arora N, Elit L, Memon S, Voruganti S, Patel M, Jimenez W, John M, Kong I. Outcomes of Adjuvant Therapy for Stage IA Serous Endometrial Cancer. Cureus 2018; 10:e3387. [PMID: 30524915 PMCID: PMC6267614 DOI: 10.7759/cureus.3387] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
PURPOSE Serous adenocarcinoma is a rare, aggressive histologic subtype of endometrial cancer with a high rate of recurrence and a poor prognosis. The optimal adjuvant treatment for early-stage patients is unclear. Our objective was to evaluate the outcomes of stage IA serous endometrial cancers only treated at a single institution and determine whether our current approach of chemotherapy plus vaginal brachytherapy (VBT) is sufficient. METHODS A retrospective chart review of our institution's pathology database, including all cases of stage IA serous endometrial carcinoma from 2000-2014 was completed. Kaplan-Meier estimates were calculated for Overall and Recurrence-Free Survival (OS and RFS); hazard ratios were calculated using Cox proportional hazards modeling for independent prognostic factors. RESULTS There were 63 patients with stage IA serous endometrial cancer of whom 79.4% were surgically staged. Percent RFS was 76.5% at five years while OS was 84.7% for the whole cohort. One of the 23 patients receiving VBT and chemotherapy recurred at the vagina versus four of 32 patients who were observed. Two patients in the observation group recurred in the pelvis while there were no first pelvic recurrences in the VBT and chemotherapy group (non- significant). Overall survival was 95% in the brachytherapy and chemotherapy group versus 79.6% in the observation group (non-significant). Post-operative management included observation (n=33), combination VBT and chemotherapy (n=21), or chemotherapy with or without external beam radiation therapy (EBRT) (n=9). DISCUSSION We report one of the largest cohorts of serous endometrial cancer stage IA patients. Our results emphasize the inferior RFS and OS of stage IA serous versus endometrioid endometrial cancer patients. While some centers continue to use EBRT for these patients, our results demonstrate low pelvic recurrence rates with radiotherapy limited to VBT, as well as the high systemic risk regardless of treatment. We advocate for combination chemotherapy and brachytherapy given the poor outcomes in these patients.
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Affiliation(s)
- Elysia Donovan
- Radiation Oncology, Juravinski Cancer Centre-McMaster University, Hamilton, CAN
| | - Clare J Reade
- Obstetrics and Gynecology, Juravinski Cancer Centre-McMaster University, Hamilton, CAN
| | - Lua R Eiriksson
- Obstetrics and Gynecology, Juravinski Cancer Centre-McMaster University, Hamilton, CAN
| | - Gregory R Pond
- Epidemiology and Public Health, Juravinski Cancer Centre-McMaster University, Hamilton, CAN
| | - Nikita Arora
- Miscellaneous, Juravinski Cancer Centre-McMaster University, Hamilton, CAN
| | - Lorraine Elit
- Obstetrics and Gynecology, Juravinski Cancer Centre-McMaster University, Hamilton, CAN
| | - Sadaf Memon
- Pathology, Juravinski Cancer Centre-McMaster University, Hamilton, CAN
| | - Sachi Voruganti
- Radiation Oncology, Juravinski Cancer Centre-McMaster University, Hamilton, CAN
| | - Maltibehn Patel
- Radiation Oncology, Juravinski Cancer Centre-McMaster University, Hamilton, CAN
| | - Waldo Jimenez
- Obstetrics and Gynecology, Juravinski Cancer Centre-McMaster University, Hamilton, CAN
| | - Mazurka John
- Obstetrics and Gynecology, Juravinski Cancer Centre-McMaster University, Hamilton, CAN
| | - Iwa Kong
- Radiation Oncology, Juravinski Cancer Centre-McMaster University, Hamilton, CAN
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The role of adjuvant therapy in stage IA serous and clear cell uterine cancer: A multi-institutional pooled analysis. Gynecol Oncol 2018; 149:283-290. [PMID: 29544706 DOI: 10.1016/j.ygyno.2018.03.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/02/2018] [Accepted: 03/03/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE As the optimal adjuvant management of stage IA serous or clear cell endometrial cancer is controversial, a multi-institutional review was conducted with the objective of evaluating the appropriateness of various strategies including observation. METHODS Retrospective chart reviews for 414 consecutive patients who underwent hysterectomy for FIGO stage IA endometrial cancer with serous, clear cell or mixed histology between 2004 and 2015 were conducted in 6 North American centers. Time-to-event outcomes were analyzed by Kaplan-Meier estimates, log-rank test, univariable and multivariable cox proportional hazard regression models. RESULTS Post-operative management included observation (50%), chemotherapy and radiotherapy (RT) (27%), RT only (16%) and chemotherapy only (7%). The 178 RT patients received external beam (EBRT, 16%), vaginal vault brachytherapy (VVB, 56%) or both (28%). Among patients without any adjuvant treatment, 5-year local control (LC), disease free survival (DFS) and cancer-specific survival (CSS) were 82% (95% confidence interval: 74-88), 70% (62-78) and 90% (82-94), respectively. CSS in patients without adjuvant treatment was improved with adequate surgical staging (100% vs. 87% (77-92), log-rank p=0.022). Adjuvant VVB was associated with improved LC (5-year 96% (91-99) vs. 84% (76-89), log-rank p=0.007) and DFS (5-year 79% (66-88) vs. 71% (63-77), log-rank p=0.033). Adjuvant chemotherapy was associated with better LC (5-year 96% (90-98) vs. 84% (77-89), log-rank p=0.014) and DFS (5-year 84% (74-91) vs. 69% (61-76), log-rank p=0.009). On multivariable analysis, adjuvant chemotherapy and VVB were associated with improved LC while adjuvant chemotherapy and age were significant for DFS. CONCLUSIONS In stage IA serous or clear cell uterine cancer, adjuvant RT and chemotherapy were associated with better LC and DFS. Observation may be appropriate in patients who have had adequate surgical staging.
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Role of Adjuvant Therapy for Stage IA Serous and Clear Cell Uterine Cancer: Is Observation a Valid Strategy? Int J Gynecol Cancer 2016; 26:491-6. [PMID: 26825823 DOI: 10.1097/igc.0000000000000643] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES The adjuvant treatment of early stage IA serous and clear cell carcinomas of the uterus is controversial. The aims of the study were to report on a single institution experience treating these high-risk early uterine cancers and to identify women who may be suitable for observation alone. METHODS AND MATERIALS A retrospective review of patients presenting from 2003 to 2013 with pathologic stage IA (International Federation of Gynecology and Obstetrics 2009) serous or clear cell uterine carcinoma was performed. Patient and disease characteristics, surgical staging, treatment details, and recurrence data were collected. Recurrence rates and 5-year actuarial estimates of recurrence free survival (RFS) were the primary outcomes of interest. RESULTS A total of 77 patients with stage IA were identified. Median (range) follow-up was 34 (1-108) months. Staging lymphadenectomy was performed in 83%. Adjuvant treatment was given to 27 patients, whereas 50 underwent observation. There were 12 recurrences total, with the 5-year RFS 79% for the cohort, with no statistically significant difference between observation and adjuvant treatment. Only 4 patients received adjuvant chemotherapy and none recurred. In the observation cohort, the presence versus absence of myometrial invasion showed a trend to poorer 5-year RFS (75% vs 93%, P = 0.06). CONCLUSIONS Observation seems to be a valid strategy in those patients with stage IA serous and clear cell carcinoma without myometrial invasion. The presence of any myometrial invasion may confer a higher risk of recurrence, although further studies are needed to determine the optimal adjuvant treatment regimen.
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Reynaers E, Ezendam N, Pijnenborg J. Comparable outcome between endometrioid and non-endometrioid tumors in patients with early-stage high-grade endometrial cancer. J Surg Oncol 2015; 111:790-4. [DOI: 10.1002/jso.23871] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 11/20/2014] [Indexed: 11/11/2022]
Affiliation(s)
- E.A.E.M. Reynaers
- Division of Woman and Baby; University Medical Centre Utrecht; Utrecht The Netherlands
| | - N.P.M. Ezendam
- Comprehensive Cancer Centre South; Eindhoven The Netherlands
- Center of Research on Psychology in Somatic Diseases; Tilburg University; Tilburg The Netherlands
| | - J.M.A. Pijnenborg
- Comprehensive Cancer Centre South; Eindhoven The Netherlands
- Department of Obstetrics and Gynecology; Twee Steden Hospital; Tilburg The Netherlands
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Black JD, English DP, Roque DM, Santin AD. Targeted therapy in uterine serous carcinoma: an aggressive variant of endometrial cancer. ACTA ACUST UNITED AC 2014; 10:45-57. [PMID: 24328598 DOI: 10.2217/whe.13.72] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Uterine serous carcinoma (USC) is a highly aggressive variant of endometrial cancer. Although it only represents less than 10% of all cases, it accounts for a disproportionate number of deaths from endometrial cancer. Comprehensive surgical staging followed by carboplatin and paclitaxel chemotherapy represents the mainstay of USC therapy. Vaginal cuff brachytherapy is also of potential benefit in USC. Recent whole-exome sequencing studies have demonstrated gain of function of the HER2/NEU gene, as well as driver mutations in the PIK3CA/AKT/mTOR and cyclin E/FBXW7 oncogenic pathways in a large number of USCs. These results emphasize the relevance of these novel therapeutic targets for biologic therapy of chemotherapy-resistant recurrent USC.
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Affiliation(s)
- Jonathan D Black
- Yale University School of Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, Room 305 Laboratory for Surgery, Obstetrics & Gynecology, 333 Cedar Street; PO Box 208063, New Haven, CT 06520-8063, USA
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12
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van der Putten LJM, Hoskins P, Tinker A, Lim P, Aquino-Parsons C, Kwon JS. Population-based treatment and outcomes of Stage I uterine serous carcinoma. Gynecol Oncol 2013; 132:61-4. [PMID: 24219983 DOI: 10.1016/j.ygyno.2013.11.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 10/23/2013] [Accepted: 11/01/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Uterine serous carcinoma (USC) is a rare type of endometrial cancer that often recurs in patients with Stage I disease. Our objective was to evaluate treatment and outcomes in Stage I USC in the context of a population-based study. METHODS This was a population-based retrospective cohort study of all patients with Stage I USC in British Columbia, Canada from 2004 to 2012. The British Columbia Cancer Agency (BCCA) recommends three cycles of paclitaxel and carboplatin chemotherapy followed by pelvic radiotherapy for all women with Stage I USC and any myometrial invasion (Stage IA MI-). If no myometrial invasion (Stage IA MI-), no postoperative treatment is given. Patient and disease characteristics, surgery, adjuvant therapy, recurrence rates and sites, and 5-year disease-free survival rates were evaluated. RESULTS Of the 127 patients with Stage I USC, 41 were Stage IA MI-, 56 Stage IA MI+, and 30 Stage IB. Median follow-up was 25 months (2-98 months). Five year disease-free survival rates were 80.7%, 74.4%, and 48.5% for Stages IA MI-, IA MI+, and IB, respectively, and recurrence rates according to BCCA guidelines were 10%, 2.9% and 30%, respectively. Of the 18 with recurrences, 13 had a distant component (72.2%). There were no pelvic recurrences among those receiving adjuvant radiotherapy. CONCLUSION Our current protocol of observation alone postoperatively for Stage IA MI- and chemoradiotherapy for Stage IA MI+ is associated with a low recurrence rate. In contrast, those with Stage IB USC have a higher recurrence rate despite chemoradiotherapy, and likely require alternate treatment strategies.
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Affiliation(s)
- Louis J M van der Putten
- Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, The Netherlands
| | - Paul Hoskins
- Division of Medical Oncology, BC Cancer Agency, Vancouver, BC, Canada
| | - Anna Tinker
- Division of Medical Oncology, BC Cancer Agency, Vancouver, BC, Canada
| | - Peter Lim
- Division of Radiation Oncology, BC Cancer Agency, Vancouver, BC, Canada
| | | | - Janice S Kwon
- Division of Gynecologic Oncology, BC Cancer Agency, Vancouver, BC, Canada.
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