title: Stage II uterine papillary serous carcinoma: Carboplatin/paclitaxel chemotherapy improves recurrence and survival outcomes.
abstract: OBJECTIVE
  To determine recurrence patterns and survival outcomes of stage II uterine papillary serous carcinoma (UPSC) patients treated by various modalities with an emphasis on carboplatin/paclitaxel-based chemotherapy (CT)+/-radiotherapy (RT).
  
  
  METHODS
  A retrospective, multi-institution study of women with stage II UPSC diagnosed from 1992 to 2006 was performed. All patients underwent comprehensive surgical staging. Treatment included observation (OBS), RT (vaginal brachytherapy, whole pelvic and/or whole abdominal therapy), or >or=3 cycles carboplatin/paclitaxel alone or with RT. Recurrence and survival outcomes were determined.
  
  
  RESULTS
  We identified 55 subjects: 10 treated with OBS, 26 with RT alone and 19 with CT+/-RT. After a median follow-up of 33 mos (range, 10-119), 20 recurrences (36%) were observed. There was an overall difference in recurrence based upon treatment (p=.013). Specifically, all CT+/-RT treated patients had a lower risk of recurrence (11%) compared to patients treated by RT alone (50%) or OBS (50%). No patients treated with both CT+RT (n=12) experienced a recurrence. Treatment with CT was also associated with a decreased risk of recurrence on multivariate analysis (p=.015). Most recurrences were extra-pelvic (70%), occurred within 2 years (85%) and were not salvageable (84%). Five-year progression-free survival was 86% in chemotherapy-treated patients versus 41% in those not receiving chemotherapy (p=.010); overall survival was 88% in chemotherapy-treated patients versus 64% in those not receiving chemotherapy (p=.115).
  
  
  CONCLUSIONS
  Stage II UPSC patients have a significant risk for unsalvageable, extra-pelvic recurrence. However, treatment with platinum/taxane therapy+/-RT appears to reduce this risk and is associated with improved progression free survival outcomes.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk A-81, Cleveland, Ohio 44195, USA. amanditan@yahoo.com
authors.forename: Amanda Nickles
authors.initials: AN
authors.lastname: Fader
authors.forename: Christa
authors.initials: C
authors.lastname: Nagel
authors.forename: Allison E
authors.initials: AE
authors.lastname: Axtell
authors.forename: Kristine M
authors.initials: KM
authors.lastname: Zanotti
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Kelley
authors.forename: Kathleen N
authors.initials: KN
authors.lastname: Moore
authors.forename: Angeles Alvarez
authors.initials: AA
authors.lastname: Secord
authors.forename: Christine S
authors.initials: CS
authors.lastname: Walsh
authors.forename: Warner K
authors.initials: WK
authors.lastname: Huh
authors.forename: Paola A
authors.initials: PA
authors.lastname: Gehrig
authors.forename: Heidi
authors.initials: H
authors.lastname: Gibbons
authors.forename: Peter G
authors.initials: PG
authors.lastname: Rose
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Havrilesky
authors.forename: Erin
authors.initials: E
authors.lastname: Tuller
authors.forename: Richard D
authors.initials: RD
authors.lastname: Drake
authors.forename: Justin
authors.initials: J
authors.lastname: Bottsford-Miller
authors.forename: David M
authors.initials: DM
authors.lastname: O'Malley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001918:Brachytherapy; D016190:Carboplatin / Q000008:administration & dosage; D002291:Carcinoma, Papillary / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D018284:Cystadenocarcinoma, Serous / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D017239:Paclitaxel / Q000008:administration & dosage; D012189:Retrospective Studies; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*
chemical_list: D016190:Carboplatin; D017239:Paclitaxel