Stage IVB endometrial cancer confined to the abdomen: is chemotherapy superior to radiotherapy?

Purpose: To determine the impact of clinical variables and adjuvant therapy on survival in patients with Stage IVB endometrial cancer (EC) confined to abdomen. Methods and Methods: A total of 65 patients were included. Curative chemotherapy was defined as using only chemotherapy (platin based) or sandwich therapy. Patients receiving only radiotherapy had standard pelvic radiotherapy and extended-field radiotherapy when necessary. Results: The optimal cytoreduction was achieved in 89.3% of patients. With a median follow- up of 18 months, two-year progression free survival (PFS) and overall survival (OS) were calculated as 33.4% and 42.2%, respectively. Optimal cytoreduction provided more longer PFS and OS compared to suboptimal cytoreduction. In univariate analysis, curative chemotherapy instead of radiotherapy improved the two-year PFS and two-year OS. Type of adjuvant therapy, tumor grade, and peritoneal cytology were found as the independent prognostic factors for PFS. Peritoneal cytology, adnexal involvement, and adjuvant therapy were independent prognostic factor for OS. Conclusion: Curative chemotherapy significantly improved both two-year PFS and OS in patients with Stage IVB endometrial disease confined to abdomen over only radiotherapy.

Stage IVB endometrial cancer; Adjuvant therapy; Progression free survival; Overall survival.

[1] Ayhan A., Taskiran C., Celik C., Yuce K., Kucukali T.: “The influence of cytoreductive surgery on survival and morbidity in stage IVB endometrial cancer”. Int. J. Gynecol. Cancer, 2002, 12, 448.

[2] Colombo N., Preti E., Landoni F., Carinelli S., Colombo A., Marini C., et al.: “Endometrial cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up”. Ann. Oncol., 2013, 24, 33.

[3] Wang Y.C., McPherson K., Marsh T., Gortmaker S.L., Brown M.: “Health and economic burden of the projected obesity trends in the USA and the UK”. Lancet, 2011, 378, 815.

[4] Patsavas K., Woessner J., Gielda B., Rotmensch J., Yordan E., Bitterman P., et al.: “Optimal surgical debulking in uterine papillary serous carcinoma affects survival”. Gynecol. Oncol., 2011, 121, 581.

[5] Tirmazy S.H., Barthakur U., El-Modir A., Anwar S., Fernando I.: “Chemotherapy for advanced endometrial cancer with carboplatin and epirubicin”. Anticancer Res., 2014, 34, 3793.

[6] Polyzos N.P., Pavlidis N., Paraskevaidis E., Ioannidis J.P.: “Randomized evidence on chemotherapy and hormonal therapy regimens for advanced endometrial cancer: an overview of survival data”. Eur. J. Cancer, 2006, 42, 319.

[7] Wilkinson-Ryan I., Binder P.S., Pourabolghasem S., Al-Hammadi N., Fuh K., Hagemann A., et al.: “Concomitant chemotherapy and radiation for the treatment of advanced-stage endometrial cancer”. Gynecol. Oncol., 2014, 134, 24.

[8] Galaal K., Al Moundhri M., Bryant A., Lopes A.D., Lawrie T.A.: “Adjuvant chemotherapy for advanced endometrial cancer”. Cochrane Database Syst. Rev., 2014, 5, CD010681.

[9] Miller A.B., Hoogstraten B., Staquet M., Winkler A.: “Reporting results of cancer treatment”. Cancer, 1981, 47, 207.

[10] Homesley H.D., Filiaci V., Gibbons S.K., Long H.J., Cella D., Spirtos N.M., et al.: “A randomized phase III trial in advanced endometrial carcinoma of surgery and volume directed radiation followed by cisplatin and doxorubicin with or without paclitaxel: A Gynecologic Oncology Group study”. Gynecol. Oncol., 2009, 112, 543.

[11] Secord A.A., Havrilesky L.J., O'Malley D.M., Bae-Jump V., Fleming N. D., Broadwater G., et al.: “A multicenter evaluation of sequential multimodality therapy and clinical outcome for the treatment of advanced endometrial cancer”. Gynecol. Oncol., 2009, 114, 442.

[12] Randall M.E., Filiaci V.L., Muss H., Spirtos N.M., Mannel R.S., Fowler J., et al.: “Randomized phase III trial of whole-abdominal irradiation versus doxorubicin and cisplatin chemotherapy in advanced endometrial carcinoma: a Gynecologic Oncology Group Study”. J. Clin. Oncol., 2006, 24, 36.

[13] Hogberg T., Signorelli M., de Oliveira C.F., Fossati R., Lissoni A.A., Sorbe B., et al.: “Sequential adjuvant chemotherapy and radiotherapy in endometrial cancer--results from two randomised studies. Eur. J. Cancer, 2010, 46, 2422.

[14] Huang C.Y., Tang Y.H., Chiang Y.C., Wang K.L., Fu H.C., Ke Y.M., et al.: “Impact of management on the prognosis of pure uterine papillary serous cancer - a Taiwanese Gynecologic Oncology Group (TGOG) study”. Gynecol. Oncol., 2014, 133, 221.

[15] Hoskins W.J., McGuire W.P., Brady M.F., Homesley H.D., Creasman W.T., Berman M., et al.: “The effect of diameter of largest residual disease on survival after primary cytoreductive surgery in patients with suboptimal residual epithelial ovarian carcinoma”. Am. J. Obstet. Gynecol., 1994, 170, 974.

[16] Barlin J.N., Puri I., Bristow R.E.: “Cytoreductive surgery for advanced or recurrent endometrial cancer: a meta-analysis”. Gynecol. Oncol., 2010, 118, 14.

[17] Lee L.J., Demaria R., Berkowitz R., Matulonis U., Viswanathan A. N.: “Clinical predictors of long-term survival for stage IVB uterine papillary serous carcinoma confined to the abdomen”. Gynecol. Oncol., 2014, 132, 65-9.

[18] Bristow R.E., Zerbe M.J., Rosenshein N.B., Grumbine F.C., Montz F. J.: “Stage IVB endometrial carcinoma: the role of cytoreductive surgery and determinants of survival”. Gynecol. Oncol., 2000, 78, 85.

[19] Bristow R.E., Duska L.R., Montz F.J.: “The role of cytoreductive surgery in the management of stage IV uterine papillary serous carcinoma”. Gynecol. Oncol., 2001, 81, 92.

[20] Chi D.S., Welshinger M., Venkatraman E.S., Barakat R.R.: “The role of surgical cytoreduction in Stage IV endometrial carcinoma”. Gynecol. Oncol., 1997, 67, 56.

[21] Landrum L.M., Moore K.N., Myers T.K., Lanneau G.S. Jr., McMeekin D.S., Walker J.L., et al.: “Stage IVB endometrial cancer: does applying an ovarian cancer treatment paradigm result in similar outcomes? A case-control analysis. Gynecol. Oncol., 2009, 112, 337.