title: Uterine papillary serous carcinoma: patterns of failure and survival.
abstract: OBJECTIVE
  To evaluate the outcome in patients with uterine papillary serous carcinoma (UPSC).
  
  
  METHODS
  A retrospective review of women treated for UPSC between 1995 and 2006 in Westmead Hospital, Sydney. The patients were treated with total abdominal hysterectomy, bilateral salpingo-oophorectomy and surgical staging. The majority of the patients had platinum-based adjuvant chemotherapy and radiotherapy. Sites of initial recurrence were documented. Overall survival (OS) and progression free survival (PFS) were estimated using Kaplan-Meier method. Univariate and multivariate analysis was performed using Cox regression analysis to test the effects of multiple prognostic factors on survival.
  
  
  RESULTS
  Two-year and five-year OS was 65% and 43%. The median OS was 39 months. Two-year and five-year PFS was 60% and 35%. Macroscopic residual disease at the completion of surgery was the only significant prognostic factor associated with worse OS on both univariate and multivariate analysis (P < 0.001). The median OS was only 11 months if patients had macroscopic residual disease, and all patients died within 18 months despite adjuvant therapies. Twenty-one patients relapsed. The site(s) of initial recurrence were: vagina (five patients), pelvic lymph nodes (four patients), abdomen (11 patients), para-aortic lymph nodes (six patients), inguinal lymph nodes (two patients) and distant metastases in seven patients. Only one of 16 patients who received vaginal brachytherapy failed in the vagina, but three of seven patients who received external beam pelvic radiotherapy failed in the vagina.
  
  
  CONCLUSIONS
  We recommend optimal cytoreduction surgery with the aim of leaving no macroscopic disease at the end of the operation. Vaginal brachytherapy should be considered as a component of adjuvant radiotherapy. Abdominal failure was the commonest mode of failure in our cohort of patients.
authors.affiliation: Department of Radiation Oncology, Westmead Hospital, Sydney, New South Wales, Australia. wangwei78@hotmail.com
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.forename: Viet
authors.initials: V
authors.lastname: DO
authors.forename: Russell
authors.initials: R
authors.lastname: Hogg
authors.forename: Gerard
authors.initials: G
authors.lastname: Wain
authors.forename: Alison
authors.initials: A
authors.lastname: Brand
authors.forename: Colin
authors.initials: C
authors.lastname: Bull
authors.forename: Annie
authors.initials: A
authors.lastname: Stenlake
authors.forename: Val
authors.initials: V
authors.lastname: Gebski
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001315:Australia; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy / Q000379:methods; D018283:Cystadenocarcinoma, Papillary / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D018284:Cystadenocarcinoma, Serous / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D017211:Treatment Failure; D014594:Uterine Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy