Chemotherapy With or Without Radiation Therapy Favorably Impacts Survival Outcomes in Stage I Uterine Papillary Serous Carcinoma

BACKGROUND: A study was undertaken to determine recurrence patterns and survival outcomes of stage I uterine papillary serous carcinoma (UPSC) patients. METHODS: A retrospective, multi-institutional study of stage I UPSC patients diagnosed from 1993 to 2006 was performed. Patients underwent comprehensive surgical staging; postoperative treatment included observation (OBS); radiotherapy alone (RT); or plati- num/taxane-based chemotherapy (CT) � RT. RESULTS: The authors identified 142 patients with a median follow-up of 37 months (range, 7-144 months). Thirty-three patients were observed, 20 received RT alone, and 89 received CTRT. Twenty-five recurrences (17.6%) were diagnosed, and 60% were extrapelvic. Chemotherapy-treated patients experienced significantly fewer recurrences than those treated without chemotherapy (P ¼ .013). Specifically, CTRT patients had a lower risk of recurrence (11.2%) compared with patients who received RT alone (25%, P ¼ .146) or OBS (30.3%, P ¼ .016). This effect was most pro- nounced in stage IB/IC (P ¼ .007). CT- and CT þ RT-treated patients experienced similar recurrence. After multivariate analysis, treatment with chemotherapy was associated with a decreased risk of recurrence (P ¼ .047). The majority of recurrences (88%) were not salvageable. Progression-free survival (PFS) and cause-specific survival (CSS) for chemotherapy-treated patients were more favorable than for those who did not receive chemotherapy (P ¼ .013 and .081). Five-year PFS and CSS rates were 81.5% and 87.6% in CT � RT, 64.1% and 59.5% in RT alone, and 64.7% and 70.2% for OBS. CONCLUSIONS: Stage I UPSC patients have significant risk for extrapelvic recurrence and poor survival. Recurrence and survival outcomes are improved in well-staged patients treated with platinum/taxane-based chemotherapy. This multi-institu- tional study is the largest to support systemic therapy for early stage UPSC patients. Cancer 2009;115:2119-27. V C 2009 American Cancer Society.

[1]  S. C. Cozad.  Stage II adenocarcinoma of the endometrium: adjuvant radiotherapy and recurrence patterns. , 2008, International journal of radiation oncology, biology, physics.

[2]  M. Einstein,et al.  Pilot phase II trial of radiation "sandwiched" between combination paclitaxel/platinum chemotherapy in patients with uterine papillary serous carcinoma (UPSC). , 2008, Gynecologic oncology.

[3]  A. Mariani,et al.  Role of systematic lymphadenectomy and adjuvant therapy in stage I uterine papillary serous carcinoma. , 2007, Gynecologic oncology.

[4]  G. Kristensen,et al.  A randomized phase-III study on adjuvant treatment with radiation (RT) {+/-} chemotherapy (CT) in early-stage high-risk endometrial cancer (NSGO-EC-9501/EORTC 55991) , 2007 .

[5]  Tina A. Ayeni,et al.  Outcomes in surgical stage I uterine papillary serous carcinoma. , 2007, Gynecologic oncology.

[6]  J. Chan,et al.  The effect of adjuvant chemotherapy versus whole abdominopelvic radiation on the survival of patients with advanced stage uterine papillary serous carcinoma. , 2006, Gynecologic oncology.

[7]  R. Kryscio,et al.  The efficacy of adjuvant platinum-based chemotherapy in Stage I uterine papillary serous carcinoma (UPSC). , 2005, Gynecologic oncology.

[8]  J. McAlpine,et al.  Improved survival in surgical stage I patients with uterine papillary serous carcinoma (UPSC) treated with adjuvant platinum-based chemotherapy. , 2005, Gynecologic oncology.

[9]  M. Kelly,et al.  Minimal uterine serous carcinoma: a clinicopathological study of 40 cases , 2005, Modern Pathology.

[10]  R. Burger,et al.  Phase III trial of doxorubicin plus cisplatin with or without paclitaxel plus filgrastim in advanced endometrial carcinoma: a Gynecologic Oncology Group Study. , 2004, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[11]  M. Carey,et al.  Optimal management for surgically Stage 1 serous cancer of the uterus. , 2004, Gynecologic oncology.

[12]  R. Broaddus,et al.  Uterine papillary serous carcinoma (UPSC): a single institution review of 129 cases. , 2003, Gynecologic oncology.

[13]  T. Herzog,et al.  Uterine papillary serous carcinoma: comparisons of outcomes in surgical Stage I patients with and without adjuvant therapy. , 2003, Gynecologic oncology.

[14]  P. Maisonneuve,et al.  Carcinoma of the corpus uteri , 2003, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[15]  B. Vikram,et al.  Patterns of failure after the multimodality treatment of uterine papillary serous carcinoma. , 2003, International journal of radiation oncology, biology, physics.

[16]  P. Gehrig,et al.  The role of omentectomy during the surgical staging of uterine serous carcinoma , 2002, International Journal of Gynecologic Cancer.

[17]  M. Markman,et al.  The use of paclitaxel and platinum-based chemotherapy in uterine papillary serous carcinoma. , 1999, Gynecologic oncology.

[18]  P. Rosenberg,et al.  A new aggressive treatment approach to high-grade endometrial cancer of possible benefit to patients with stage I uterine papillary cancer. , 1993, Gynecologic oncology.

[19]  M. Sherman,et al.  Uterine Serous Carcinoma A Morphologically Diverse Neoplasm With Unifying Clinicopathologic Features , 1992, The American journal of surgical pathology.

[20]  P. O'Brien,et al.  Evaluation of unfavorable histologic subtypes in endometrial adenocarcinoma. , 1990, American journal of obstetrics and gynecology.

[21]  R. Kempson,et al.  Uterine papillary serous carcinoma: A highly malignant form of endometrial adenocarcinoma , 1982, The American journal of surgical pathology.