title: Platinum/taxane-based chemotherapy with or without radiation therapy favorably impacts survival outcomes in stage I uterine papillary serous carcinoma.
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.
authors.affiliation: Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio, USA. amanditan@yahoo.com
authors.forename: Amanda Nickles
authors.initials: AN
authors.lastname: Fader
authors.forename: Richard D
authors.initials: RD
authors.lastname: Drake
authors.forename: David M
authors.initials: DM
authors.lastname: O'Malley
authors.forename: Heidi E
authors.initials: HE
authors.lastname: Gibbons
authors.forename: Warner K
authors.initials: WK
authors.lastname: Huh
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Havrilesky
authors.forename: Paola A
authors.initials: PA
authors.lastname: Gehrig
authors.forename: Erin
authors.initials: E
authors.lastname: Tuller
authors.forename: Allison E
authors.initials: AE
authors.lastname: Axtell
authors.forename: Kristine M
authors.initials: KM
authors.lastname: Zanotti
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001952:Bridged-Ring Compounds; D003131:Combined Modality Therapy; D018283:Cystadenocarcinoma, Papillary / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D010984:Platinum / Q000627:therapeutic use; D012008:Recurrence; D012189:Retrospective Studies; D043823:Taxoids; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy
chemical_list: D001952:Bridged-Ring Compounds; D043823:Taxoids; C080625:taxane; D010984:Platinum