The role of vaginal brachytherapy in stage I endometrial serous cancer: a systematic review

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Abstract

Purpose

Serous adenocarcinoma (uterine serous carcinoma – USC) is a rare and aggressive histologic subtype of endometrial cancer, with a high-rate of recurrence and poor prognosis. The adjuvant treatment for stage I patients is unclear. The purpose of this study was to evaluate the outcomes of stage I USC treated exclusively with chemotherapy plus vaginal brachytherapy (VBT).

Material and methods

A systematic research using PubMed, Scopus, and Cochrane library was conducted to identify full articles evaluating the efficacy of VBT in patients with stage I USC. A search in ClinicalTrials.gov was performed in order to detect ongoing or recently completed trials, and in PROSPERO for searching ongoing or recently completed systematic reviews.

Results

All studies were retrospective and 364 of evaluated patients were found. The average local control was 97.5% (range, 91-100%), the disease free-survival was 88% (range, 82-94%), the overall survival was 93% (range, 72-100%), the specific cancer survival was 89.4% (range, 84.8-94%), and the G3-G4 toxicity was 0-8%.

Conclusions

These data support the concept that in adequately selected patients, VBT alone may be a suitable radiotherapy technique in women with stage I USC who underwent surgical staging and received adjuvant chemotherapy.

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Most cited references 53

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Phase III trial of doxorubicin plus cisplatin with or without paclitaxel plus filgrastim in advanced endometrial carcinoma: a Gynecologic Oncology Group Study.

Gini Fleming, Virginia L Brunetto, David Cella … (2004)

To determine whether the addition of paclitaxel to doxorubicin plus cisplatin improves overall survival (OS) in women with advanced or recurrent endometrial carcinoma. Secondary comparisons included progression-free survival (PFS), response rate (RR), and toxicities. Eligible, consenting patients received doxorubicin 60 mg/m(2) and cisplatin 50 mg/m(2) (AP), or doxorubicin 45 mg/m(2) and cisplatin 50 mg/m(2) (day 1), followed by paclitaxel 160 mg/m(2) (day 2) with filgrastim support (TAP). The initial doxorubicin dose in the AP arm was reduced to 45 mg/m(2) in patients with prior pelvic radiotherapy and those older than 65 years. Both regimens were repeated every 3 weeks to a maximum of seven cycles. Patients completed a neurotoxicity questionnaire before each cycle. Two hundred seventy-three women (10 ineligible) were registered. Objective response (57% v 34%; P <.01), PFS (median, 8.3 v 5.3 months; P <.01), and OS (median, 15.3 v 12.3 months; P =.037) were improved with TAP. Treatment was hematologically well tolerated, with only 2% of patients receiving AP, and 3% of patients receiving TAP experiencing neutropenic fever. Neurologic toxicity was worse for those receiving TAP, with 12% grade 3, and 27% grade 2 peripheral neuropathy, compared with 1% and 4%, respectively, in those receiving AP. Patient-reported neurotoxicity was significantly higher in the TAP arm following two cycles of therapy. TAP significantly improves RR, PFS, and OS compared with AP. Evaluation of this regimen in the high-risk adjuvant setting is warranted, but close attention should be paid to the increased risk of peripheral neuropathy.

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Phase III trial of doxorubicin with or without cisplatin in advanced endometrial carcinoma: a gynecologic oncology group study.

J Tate Thigpen, Mark Brady, Howard Homesley … (2004)

Doxorubicin and cisplatin have activity in endometrial carcinoma and at initiation of this study ranked as the most active agents. This trial of stage III, IV, or recurrent disease evaluated whether combining these agents increases response rate (RR) and prolongs progression-free survival (PFS) and overall survival (OS) over doxorubicin alone. Of 299 patients registered, 281 (94%) were eligible. Regimens were doxorubicin 60 mg/m(2) intravenously or doxorubicin 60 mg/m(2) plus cisplatin 50 mg/m(2) every 3 weeks until disease progression, unacceptable toxicity, or a total of 500 mg/m(2) doxorubicin. There were 12 (8%) complete (CR) and 26 (17%) partial responses (PR) among 150 patients receiving doxorubicin versus 25 (19%) CRs and 30 (23%) PRs among patients receiving the combination. The overall response rate was higher among patients receiving the combination (42%) compared with patients receiving doxorubicin (25%; P =.004). Median PFS was 5.7 and 3.8 months, respectively, for the combination and single agent. The PFS hazard ratio was 0.736 (95% CI, 0.577 to 0.939; P =.014). Median OS was 9.0 and 9.2 months, respectively, for the combination and single agent. Overall death rates were similar in the two groups (hazard ratio, 0.928; 95% CI, 0.727 to 1.185). Nausea, vomiting, and hematologic toxicities were common. The combination produced more grade 3 to 4 leukopenia (62% v 40%), thrombocytopenia (14% v 2%), anemia (22% v 4%), and nausea/vomiting (13% v 3%). Adding cisplatin to doxorubicin in advanced endometrial carcinoma improves RR and PFS with a negligible impact on OS and produces increased toxicity. These results have served as a building block for subsequent phase III trials in patients with disseminated and high-risk limited endometrial carcinoma.

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Management of women with uterine papillary serous cancer: a Society of Gynecologic Oncology (SGO) review.

Alexander B. Olawaiye, Amanda Fader, Paola Gehrig … (2009)

Uterine papillary serous carcinoma (UPSC) is a clinically and pathologically distinct subtype of endometrial cancer. Although less common than its endometrioid carcinoma (EEC) counterpart, UPSC accounts for a disproportionate number of endometrial cancer related deaths. To date, limited prospective trials exist from which evidence-based management can be developed. This review summarizes the available literature concerning UPSC in an effort to provide the clinician with information pertinent to its management. MEDLINE was searched for all research articles published in English between January 1, 1966 and May 1, 2009 in which the studied population included women diagnosed with UPSC. Although preference was given to prospective studies, studies were not limited by design or by numbers of subjects given the paucity of available reports. UPSC is morphologically and genetically different from EEC. Women often present with postmenopausal vaginal bleeding, but may also present with abnormal cervical cytology, ascites, or a pelvic mass. In some cases, the diagnosis may be made with endometrial biopsy, while in other cases it is not made until the time of definitive surgery. Metastatic disease is common and best identified via comprehensive surgical staging. Local and distant recurrences occur frequently, with extra-pelvic relapses reported most commonly. Optimal cytoreduction and adjuvant platinum/taxane-based chemotherapy appear to improve survival, while adjuvant radiotherapy may contribute to loco-regional disease control. Women diagnosed with UPSC should undergo comprehensive surgical staging and an attempt at optimal cytoreduction. Platinum/taxane-based adjuvant chemotherapy should be considered in the treatment of both early- and advanced-stage patients. Careful long-term surveillance is indicated as many of these women will recur. Prospective clinical trials of women with UPSC are necessary in order to delineate the optimal therapy for women with newly diagnosed and recurrent disease.

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Author and article information

Journal

Journal ID (nlm-ta): J Contemp Brachytherapy

Journal ID (iso-abbrev): J Contemp Brachytherapy

Journal ID (publisher-id): JCB

Title: Journal of Contemporary Brachytherapy

Publisher: Termedia Publishing House

ISSN (Print): 1689-832X

ISSN (Electronic): 2081-2841

Publication date (Electronic): 28 February 2020

Publication date (Print): February 2020

Volume: 12

Issue: 1

Pages: 61-66

Affiliations

[1 ]Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia – Gemelli ART (Advanced Radiation Therapy), Interventional Oncology Center (IOC), Roma, Italy,

[2 ]Department of Radiological, Oncological and Anatomo Pathological Sciences, Azienda Ospedaliero Universitaria Policlinico Umberto I, “Sapienza” University, Rome, Italy,

[3 ]Radiotherapy Unit, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy,

[4 ]Radiotherapy Unit, S. Spirito Hospital, Pescara, Italy,

[5 ]Radiotherapy Unit, Department of Oncology, San Luca Hospital, Lucca, Italy,

[6 ]Radiotherapy Unit, Presidio Ospedaliero San Filippo Neri, Roma, Italy,

[7 ]Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy,

[8 ]Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy,

[9 ]Department of Oncology-Radiotherapy, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy,

[10 ]Division of Radiation Oncology, ASST-Lecco, Ospedale A.Manzoni, Lecco, Italy,

[11 ]Presidente Fondazione Area Radiologica, Roma, Italy,

[12 ]UOC Radioterapia Oncologica, Azienda Ospedaliera “Brotzu”, Cagliari, Italy,

[13 ]Radiotherapy Unit, Dipartimento di Scienze Biomediche, Sperimentali e Cliniche Mario Serio, University of Florence, Firenze, Italy,

[14 ]Department of Medicine and Surgery and Translational Medicine, Gynecology Unit, Sant’ Andrea University Hospital, “Sapienza” University, Rome, Italy,

[15 ]Department of Medicine and Surgery and Translational Medicine, Radiotherapy Oncology, Sant’ Andrea Hospital, “Sapienza” University, Rome, Italy

Author notes

Address for correspondence: Lisa Vicenzi, MD, PhD Radiotherapy Unit, Azienda Ospedaliero Universitaria Ospedali Riuniti, via Conca 71 60126, Ancona, Italy, phone: +39 071 5964842, fax: +39 071 5964838, e-mail: lisavicenzi@ 123456gmail.com

Article

Publisher ID: 39754

DOI: 10.5114/jcb.2020.92698

PMC ID: 7073340

PubMed ID: 32190072

SO-VID: 7b4c7754-421e-4607-a96d-fc55be55c9ad

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0). License ( http://creativecommons.org/licenses/by-nc-sa/4.0/)

The role of vaginal brachytherapy in stage I endometrial serous cancer: a systematic review

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Abstract

Purpose

Material and methods

Results

Conclusions

Related collections

Karger: Oncology

Most cited references 53

Phase III trial of doxorubicin plus cisplatin with or without paclitaxel plus filgrastim in advanced endometrial carcinoma: a Gynecologic Oncology Group Study.

Phase III trial of doxorubicin with or without cisplatin in advanced endometrial carcinoma: a gynecologic oncology group study.

Management of women with uterine papillary serous cancer: a Society of Gynecologic Oncology (SGO) review.

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