title: Adjuvant therapy of uterine clear cell carcinoma: a review.
abstract: OBJECTIVE
  Uterine clear-cell carcinoma (UCCC) is a rare subset of type II endometrial carcinoma with a poor prognosis relative to the most common type of endometrioid carcinoma. Due to its rarity, there has been limited direct evidence of the efficacy of specific adjuvant therapy posthysterectomy in women with UCCC. We present a review of current literature regarding adjuvant therapy of uterine clear cell carcinoma.
  
  
  METHODS
  We searched for English-language publications through Pubmed using a combination of the following key words: endometrial carcinoma, clear cell carcinoma, recurrence, prognosis, adjuvant therapy, radiation treatment and chemotherapy. Due to the rarity of UCCC, studies were not limited by design or number of patients.
  
  
  RESULTS
  There is a paucity of randomized prospective controlled studies focusing on UCCC adjuvant therapy. Findings have largely been derived from retrospective studies of type II endometrial carcinomas or all endometrial cancers as a group. Very few retrospective studies were found to focus on UCCC adjuvant therapy, although certain larger studies did have subset analyses of UCCC patients.
  
  
  CONCLUSIONS
  For early stage disease, locoregional radiotherapy, especially vaginal brachytherapy, has evidence of efficacy. The therapeutic gain of radiotherapy may be further improved with the addition of systemic chemotherapy. Evidence for combined radiation therapy with systemic chemotherapy in women with advanced stage UCCC has remained debatable. UCCC-specific studies are needed to determine the best adjuvant therapy for UCCC without the confounding effects of USC and other endometrial cancers.
authors.affiliation: Department of Radiation Oncology, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA.
authors.forename: Yiqing
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Division of Gynecologic Oncology, Department of Women' Health Services, Henry Ford Hospital, Detroit, MI, 48202, USA.
authors.forename: Rabbie K
authors.initials: RK
authors.lastname: Hanna
authors.affiliation: Department of Radiation Oncology, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA. melshai1@hfhs.org.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Elshaikh
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001918:Brachytherapy; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D016889:Endometrial Neoplasms / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*
keywords: Adjuvant; Chemotherapy; Clear cell; Endometrial carcinoma; Hysterectomy; Prognosis; Radiation therapy