Adjuvant paclitaxel and carboplatin chemotherapy interposed with radiotherapy in a “sandwich” protocol for uterine papillary serous carcinoma: a single institution experience and review of literature

Aim: The optimal sequence of chemotherapy and radiotherapy for uterine papillary serous carcinoma (UPSC) treatment remains unknown. This study is to evaluate the efficacy and safety in treating UPSC with paclitaxel and carboplatin chemotherapy interposed with radiotherapy in a “sandwich” protocol. Materials and Methods: Patients diagnosed with pathologic UPSC (FIGO Stage I-IV) in Beijing Hospital from January 2005 to July 2013 were included. After surgical staging, all patients were treated with three cycles of chemotherapy, radiotherapy, and then three cycles of further chemotherapy. Progression free survival (PFS) and overall survival (OS) were calculated by Kaplan-Meier method. All toxicities and adverse events were recorded. Results: Of the 27 eligible patients, 12 patients (44%) were Stage I/II and 15 patients (56%) were Stage III/IV. Histology consisted of pure UPSC in 37% and mixed UPSC in 63%. With a median follow-up time of 49 (range 13-121) months, 11 patients relapsed, and eight patients died of their disease. At three years, the PFS and OS rates for all of the patients were 70% and 82%, for patients with Stage I/II were 75% and 85%, for patients with Stage III/IV were 67% and 80%, respectively. Most of the toxicities were treatable and reversible, with only 26% of patients having Grade 3/4 toxicities. No dose reductions, treatment delays or cessations were recorded. Conclusions: The “sandwich” protocol of carboplatin and paclitaxel chemotherapy interposed with radiation therapy is efficacious and safe for UPSC treatment. Larger, prospective, randomized clinical trials should be conducted in future to confirm the results.

Uterine papillary serous carcinoma; Chemotherapy; Radiotherapy; Uterine cancer.

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