Comparison of Survival Benefits of Combined Chemotherapy and Radiotherapy Versus Chemotherapy Alone for Uterine Serous Carcinoma: A Meta-analysis

Lin, Yanying; Zhou, Jingyi; Cheng, Yuan; Zhao, Lijun; Yang, Yuan; Wang, Jianliu

doi:10.1097/igc.0000000000000856

Cited by 12 publications

(12 citation statements)

References 19 publications

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“…Additionally, a meta-analysis comparing the effect of CT alone verses combined CT and RT on OS in women with USC showed that combined CT and RT reduced the risk of death compared with CT alone, and further analysis found a benefit for combined therapy for both early stage and advanced disease. 20 Similarly, 2 retrospective studies of women with USC found a survival benefit for combined therapy with CT and RT for patients with advanced-stage disease 19 and for women with all stages of USC. 25 Limited prospective evidence supports this approach, as a phase II trial of “sandwich” adjuvant pelvic RT and paclitaxel/carboplatin CT for patients with USC showed that this treatment is safe and efficacious.…”

Section: Discussionmentioning

confidence: 99%

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Combined Adjuvant Chemotherapy and Radiation Therapy Improves Disease-Free Survival for Uterine Serous Cancer

Arden

Marvin

Hong

et al. 2020

Advances in Radiation Oncology

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Purpose Uterine serous carcinoma (USC) is a rare but aggressive endometrial cancer histology. We reviewed outcomes for patients with USC to identify the best adjuvant treatment strategy. Methods and Materials We retrospectively identified 162 patients with The International Federation of Gynecology and Obstetrics (FIGO) stage I-IVA USC treated at our institution. Baseline characteristics, treatment details, clinical outcomes, and toxicity data were recorded. Results Median follow-up was 3.4 years (0.3-26 years). A variety of adjuvant therapy strategies were employed: 14% no adjuvant therapy, 28% radiation alone, 15% chemotherapy alone, and 43% combined chemotherapy and radiation. Distant metastasis was the most common type of recurrence (37% at 5 years). For patients with stage I-IVA disease, there were no significant differences in outcomes by treatment type. For patients with stage I-II disease (70% of the cohort), disease-free survival was significantly higher after chemotherapy (alone or with radiation therapy, P = .005) and after combined chemotherapy and radiation compared with all other treatments ( P = .025). Toxicity outcomes were favorable, with minimal grade 3 and no grade 4 or 5 events. Conclusions Patients with USC experience high rates of recurrence and mortality. Distant metastasis is the most common pattern of failure for all stages. For patients with early-stage disease, combined chemotherapy and radiation improves 5-year disease-free survival compared with either single adjuvant treatment alone or no adjuvant treatment. The relatively large group of patients with USC included in this study may account for our ability to detect this improvement whereas clinical trials have failed to do so, possibly owing to the relatively small percentages of patients with USC enrolled.

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Section: Discussionmentioning

confidence: 99%

“… 15 Evidence regarding the role of RT in this disease is conflicting, with some studies failing to show a benefit whereas others have demonstrated improved outcomes with the addition of RT. 9 , 14 , 16 , 17 , 18 , 19 , 20 …”

Section: Introductionmentioning

confidence: 99%

Combined Adjuvant Chemotherapy and Radiation Therapy Improves Disease-Free Survival for Uterine Serous Cancer

Arden

Marvin

Hong

et al. 2020

Advances in Radiation Oncology

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“…While a recent study showed that adjuvant chemotherapy (chemo) with or without radiotherapy (RT) is associated with improved survival [ 18 ], several studies show that both chemo and RT are associated with improved survival outcomes compared to adjuvant chemo alone or RT alone in women with USC [ 19 - 21 ]. A large meta-analysis suggested a survival benefit to combined chemo and RT (CRT) for patients with early USC [ 22 ]. All of these adjuvant strategies, including observation, are valid approaches for early-stage USC according to the most recent National Comprehensive Cancer Network Uterine Neoplasms guidelines (version 1.2021).…”

Section: Introductionmentioning

confidence: 99%

The Impact of Adjuvant Management Strategies on Outcomes in Women With Early Stage Uterine Serous Carcinoma

Cook¹,

Khalil²,

Burmeister³

et al. 2021

Cureus

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Objective To determine the impact of different adjuvant strategies on outcomes in women with early-stage uterine serous carcinoma (USC). Methods Our retrospective database for women with endometrial carcinoma was queried for women with 2009 International Federation of Gynecology and Obstetrics (FIGO) stages I-II USC who underwent surgical staging between January 1991 and April 2019 followed by adjuvant management (observation, radiation therapy (RT), chemotherapy (CT), or combined modality treatment (CRT)). Chi-square tests were performed to compare differences in outcome by type of adjuvant management. Recurrence-free survival (RFS), disease-specific survival (DSS), and overall survival (OS) were assessed by Kaplan-Meier and log-rank tests. Univariate and multivariate analyses (MVA) were performed to identify statistically significant predictors of survival endpoints. Results We identified 171 women who met our inclusion criteria. The median follow-up time was 70.5 months. Seventy-five percent of the study cohort was FIGO stage IA, 13% were stage IB, and 12% were stage II. All women underwent pelvic lymph node dissection with a median number of dissected lymph nodes of 14. Omentectomy was performed in 64% of patients. Adjuvant RT was utilized in 56% of women (65 patients received vaginal brachytherapy alone, 10 patients received pelvic RT, and 21 patients received a combination of both). The most commonly used chemotherapy regimen was carboplatin and paclitaxel with a median number of cycles of six. A total of 44% of the cohort received CRT, 12% received RT alone, 19% received chemo alone, and 25% were observed. Five-year RFS was 73% for those who received CRT, 84% for those who received RT alone, 68% for those who received CT alone, and 55% for those who were observed ( p =0.13). Five-year DSS was 81%, 94%, 71%, and 60%, respectively ( p =0.02). Five-year OS was 76%, 70%, 60%, and 56%, respectively ( p =0.11). On MVA of OS and DSS, a higher percentage of myometrial invasion, the presence of lower uterine segment involvement, positive peritoneal cytology, and receipt of chemotherapy alone/observation were independent predictors of worse outcomes. The sole independent predictor of worse RFS on MVA was the presence of positive peritoneal cytology. Conclusion In this cohort of women with early-stage USC who underwent surgical staging, adjuvant radiation treatment with or without chemotherapy was associated with improved survival endpoints and trended toward improved recurrence rates.

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“…La prise en charge adjuvante des carcinomes séreux et à cellules claires comprend une chimiothérapie, une radiothérapie externe pelvienne suivies d’une curiethérapie. Une curiethérapie vaginale seule ou en association à une chimiothérapie peut être réalisée pour les stades IA sans emboles vasculaires complètement stadifiés [8] , [9] , [10] , [11] , [12] . La prise en charge adjuvante des carcinosarcomes et des carcinomes indifférenciés comprend une chimiothérapie systémique suivie d’une radiothérapie externe pelvienne et d’une curiethérapie [13] , [14] , [15] .…”

Section: Introductionunclassified

Évaluation de l’application des recommandations des cancers de l’endomètre de type 2 : étude rétrospective multicentrique

et al. 2020

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Introduction Les carcinomes de l’endomètre de type 2 sont des cancers peu fréquents et de mauvais pronostique. Il existe très peu d’étude analysant leur prise en charge. L’objectif de l’étude était d’étudier la prise en charge des carcinomes de type 2 dans nos centres en évaluant l’application des recommandations. Matériel et méthode Il s’agit d’une étude multicentrique rétrospective enregistrant les cancers de l’endomètre de type 2 pris en charge de janvier 2009 à décembre 2019. Les analyses ont été adaptées aux dernières recommandations françaises appliquées par rapport à l’année de prise en charge. Résultats Soixante-quatorze carcinomes de type 2 ont été analysés dans dix centres: 34 carcinosarcomes (45,9 %), 29 carcinomes séreux (39,2 %), neuf carcinomes à cellules claires (12,2 %) et deux carcinomes indifférenciés (2,7 %). Lors de la prise en charge initiale, les recommandations étaient appliquées dans 45,9 % des cas. Le principal motif de non-application des recommandations était la non-réalisation d’une stadification ganglionnaire chirurgicale pour 20 patientes (57,1 %). Lors de la prise en charge adjuvante, les recommandations étaient appliquées dans 37,8 % des cas. Le principal motif de non-application des recommandations était la non-réalisation d’une restadification ganglionnaire chirurgicale ou radiologique pour 25 patientes (67,6 %). Discussion L’applicabilité des recommandations pour la prise en charge des carcinomes de type 2 reste difficile en raison de l’âge élevé et des comorbidités des patientes notamment pour la réalisation d’une stadification chirurgicale ganglionnaire pelvienne et lombo-aortique. L’utilisation de nouvelles techniques de stadification permettrait de mieux sélectionner les indications de curages ganglionnaires.

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Comparison of Survival Benefits of Combined Chemotherapy and Radiotherapy Versus Chemotherapy Alone for Uterine Serous Carcinoma: A Meta-analysis

Cited by 12 publications

References 19 publications

Combined Adjuvant Chemotherapy and Radiation Therapy Improves Disease-Free Survival for Uterine Serous Cancer

Combined Adjuvant Chemotherapy and Radiation Therapy Improves Disease-Free Survival for Uterine Serous Cancer

The Impact of Adjuvant Management Strategies on Outcomes in Women With Early Stage Uterine Serous Carcinoma

Évaluation de l’application des recommandations des cancers de l’endomètre de type 2 : étude rétrospective multicentrique

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