Patients with uterine papillary serous cancers may benefit from adjuvant platinum-based chemoradiation.
OBJECTIVE
The coexistence of minimal uterine disease and extrauterine metastases is common in patients with uterine papillary serous carcinoma (UPSC). Only complete surgical staging accurately depicts the extent of this disease. The purpose of this study was to evaluate different therapeutic options in surgically staged patients.


METHODS
We retrospectively reviewed all patients with UPSC histologically limited in the uterus to the endometrium treated at our institution between 1987 and 2002.


RESULTS
Twenty-three (45%) cases were International Federation of Gynecology and Obstetrics (FIGO) stage IA, seven (15%) were stage IIIA, one (2%) was stage IIIC, and nine (18%) stage IV. Additionally, 11 of these 51 patients (21%) were diagnosed with two cancers: a stage IA UPSC and concomitant advanced stage serous cancer of the ovary, fallopian tube, or peritoneum. Stage IA patients with no cancer in the hysterectomy specimen (defined as no residual uterine disease) had no recurrences (n = 10) regardless of treatment. There was a trend toward increased survival in stage IA patients with residual uterine disease who were treated with chemoradiation (concomitant vaginal brachytherapy and platinum-based chemotherapy). There were no recurrences in patients with locoregional disease (stages IA-IIIA) who received chemoradiation. All patients with advanced stage UPSC (stage IIIC or IV or two primary cancers) did poorly regardless of treatment.


CONCLUSIONS
Our findings suggest that stage IA patients with no residual uterine disease may be observed. Stage IA patients with residual uterine disease may benefit from chemoradiation. More effective treatment needs to be identified for advanced stage UPSC.
Kelly
M G
MG
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Yale University School of Medicine, 333 Cedar Street, PO Box 2080-63, New Haven, CT 06520-8063, USA. mgkelly74@aol.com
O'Malley
D
D
Hui
P
P
McAlpine
J
J
Dziura
J
J
Rutherford
T J
TJ
Azodi
M
M
Chambers
S K
SK
Schwartz
P E
PE
D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001918:Brachytherapy; D016190:Carboplatin / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant; D018283:Cystadenocarcinoma, Papillary / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D018284:Cystadenocarcinoma, Serous / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*
D016190:Carboplatin