The importance of chemotherapy and radiation in uterine papillary serous carcinoma

• Published in: Gynecologic oncology Vol. 123; no. 3; pp. 542 - 547
• Main Authors: Viswanathan, Akila N, Macklin, Eric A, Berkowitz, Ross, Matulonis, Ursula
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-12-2011
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Carboplatin - administration & dosage; Carboplatin - adverse effects; Carcinoma, Papillary - drug therapy; Carcinoma, Papillary - pathology; Carcinoma, Papillary - radiotherapy; Chemotherapy; Cohort Studies; Combined Modality Therapy - adverse effects; Cyclophosphamide - administration & dosage; Cyclophosphamide - adverse effects; Cystadenocarcinoma, Serous - drug therapy; Cystadenocarcinoma, Serous - pathology; Cystadenocarcinoma, Serous - radiotherapy; Disease-Free Survival; Doxorubicin - administration & dosage; Doxorubicin - adverse effects; Female; Hematology, Oncology and Palliative Medicine; Humans; Middle Aged; Neoplasm Staging; Obstetrics and Gynecology; Paclitaxel - administration & dosage; Paclitaxel - adverse effects; Proportional Hazards Models; Radiation therapy; Retrospective Studies; Survival Rate; Uterine Neoplasms - drug therapy; Uterine Neoplasms - radiotherapy; Uterine papillary serous cancer; Uterine papillary serous cancer; Chemotherapy; Radiation therapy
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2011.09.005

Abstract Purpose To identify prognostic and predictive factors of overall survival (OS), relapse-free survival (RFS) and toxicity for patients with uterine papillary serous carcinoma (UPSC). Materials and methods Patient, tumor, treatment and relapse characteristics of 135 women with Stages I–IVA UPSC treated between 1980 and 2006 at Dana–Farber/Brigham and Women's Cancer Center (DF/BWCC) were analyzed using Cox regression models to determine prognostic and predictive factors for OS, RFS and toxicity. Results Mean follow-up was 5.5 years (range, 0.01–25.2). Median 5-year OS was 52%, and RFS was 42% for all patients. On Cox regression analysis, increasing age, stage, and myometrial invasion were prognostic factors associated with shorter OS and RFS. A paclitaxel–platinum chemotherapy regimen was significantly associated with longer OS (hazard ratio [HR] = 0.34, 95% confidence interval [CI] 0.15–0.74, p = 0.007) and RFS (HR = 0.45, 95% CI 0.22–0.92, p = 0.03). RFS was improved for patients treated with RT (HR = 0.44, 95% CI 0.25–0.77, p = 0.004). The 5-year grade 3+ toxicity rate was 3.5% for those who received RT and was 2.9% for those who did not (p = NS). Conclusion Uterine papillary serous cancer can be an aggressive tumor type with a poor prognosis. RFS was improved by radiation and chemotherapy with few grade 3 or higher complications. Using radiation and paclitaxel–platinum chemotherapy should be attempted whenever feasible for patients with UPSC who do not have distant metastases at diagnosis.