Platinum/taxane‐based chemotherapy with or without radiation therapy favorably impacts survival outcomes in stage I uterine papillary serous carcinoma |
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| Authors: | Amanda Nickles Fader MD Richard D Drake MD David M O'Malley MD Heidi E Gibbons MS Warner K Huh MD Laura J Havrilesky MD Paola A Gehrig MD Erin Tuller MD Allison E Axtell MD Kristine M Zanotti MD |
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| Institution: | 1. Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Cleveland Clinic, Cleveland, Ohio;2. Fax: (216) 844‐8772;3. Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, the Ohio State University Medical Center, Columbus, Ohio;4. Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University Hospitals Case Medical Center;5. Department of Reproductive Biology, Case Western Reserve University School of Medicine, Cleveland, Ohio;6. Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Alabama Medical Center, Birmingham, Alabama;7. Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Duke University Medical Center, Durham, North Carolina;8. Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;9. Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma;10. Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of California Los Angeles Medical Center, Los Angeles, California |
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| Abstract: | 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 platinum/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 CT ± RT. Twenty‐five recurrences (17.6%) were diagnosed, and 60% were extrapelvic. Chemotherapy‐treated patients experienced significantly fewer recurrences than those treated without chemotherapy (P = .013). Specifically, CT ± RT patients had a lower risk of recurrence (11.2%) compared with patients who received RT alone (25%, P = .146) or OBS (30.3%, P = .016). This effect was most pronounced in stage IB/IC (P = .007). CT‐ and CT + RT–treated patients experienced similar recurrence. After multivariate analysis, treatment with chemotherapy was associated with a decreased risk of recurrence (P = .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 = .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‐institutional study is the largest to support systemic therapy for early stage UPSC patients. Cancer 2009. © 2009 American Cancer Society. |
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| Keywords: | uterine carcinoma papillary serous chemotherapy radiation therapy survival |
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