title: Impact of Chemotherapy and Radiotherapy on Management of Early Stage Clear Cell and Papillary Serous Carcinoma of the Uterus.
abstract: The aim of the study was to assess interaction of lymph node dissection (LND), adjuvant chemotherapy (CT), and radiotherapy (RT) in stage I uterine papillary serous carcinoma (UPSC) and uterine clear cell carcinoma (UCC).
  
  
  
  The National Cancer Data Base was queried for women diagnosed with International Federation of Gynecology and Obstetrics stage I UPSC and UCC from 1998 to 2012. Overall survival (OS) was estimated for combinations of RT and CT by the Kaplan-Meier method stratified by histology and LND. Multivariate Cox proportional hazard models were generated.
  
  
  
  Uterine papillary serous carcinoma: 5432 women with UPSC were identified. Uterine papillary serous carcinoma had the highest 5-year OS with CT + RT with (83%) or without LND (76%). On multivariate analyses, CT [hazard ratio (HR), 0.77; P = 0.01] and vaginal cuff brachytherapy (HR, 0.68; P = 0.003) with LND were independently associated with OS. Without LND, vaginal cuff brachytherapy (HR, 0.53; P = 0.03), but not CT (HR, 1.21; P = 0.92), was associated with OS. Uterine clear cell carcinoma: 2516 women with UCC were identified. Uterine clear cell carcinoma with and without LND had comparable 5-year OS for all combinations of CT and RT on univariate and multivariate analyses.
  
  
  
  In stage I papillary serous uterine cancer, brachytherapy and CT were associated with increased survival; however, the benefit of chemotherapy was limited to those with surgical staging. In contrast, no adjuvant therapy was associated with survival in stage I uterine clear cell carcinoma, and further investigation to identify more effective therapies is warranted.
authors.affiliation: *Department of Radiation Oncology, †Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, ‡Department of Biostatistics, and §Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, NC.
authors.forename: Julian C
authors.initials: JC
authors.lastname: Hong
authors.forename: Jonathan
authors.initials: J
authors.lastname: Foote
authors.forename: Gloria
authors.initials: G
authors.lastname: Broadwater
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Gaillard
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Havrilesky
authors.forename: Junzo P
authors.initials: JP
authors.lastname: Chino
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001918:Brachytherapy; D016190:Carboplatin / Q000008:administration & dosage; D059248:Chemoradiotherapy; D017024:Chemotherapy, Adjuvant; D018283:Cystadenocarcinoma, Papillary / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D018284:Cystadenocarcinoma, Serous / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D008875:Middle Aged; D009367:Neoplasm Staging; D017239:Paclitaxel / Q000008:administration & dosage; D014481:United States / Q000453:epidemiology; D014594:Uterine Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*
chemical_list: D016190:Carboplatin; D017239:Paclitaxel