Complete remission of uterine endometrial cancer with multiple lung metastases treated by paclitaxel and carboplatin

Abstract

Endometrial cancer is believed to have a better prognosis than cervical cancer. However, this is not necessarily true for cases beyond International Federation of Gynecology and Obstetrics (FIGO) stage III, and advanced endometrial cancer with distant metastases in particular has a poor prognosis. Moreover, there is no established therapy for advanced endometrial cancer. Recently, we treated two patients with endometrial cancer with multiple lung metastases (FIGO stage IVb). Both patients had massive uncontrollable genital bleeding and eventually progressed to anemia. The imminent severe bleeding was considered to be a major reason for exacerbation of their general condition. Therefore, hysterectomy was performed as a counter-measure to improve their general condition. In their postoperative course, the two patients successfully underwent T-J chemotherapy [paclitaxel: 210 m/m2 over 3h; carboplatin: area under the curve (AUC) 5]. Six courses of the regimen were given every 3-4 weeks. Multiple lung shadows in chest X-P and computed tomography (CT) were reduced in number and size after two courses of T-J chemotherapy. The multiple lung metastases either disappeared or just remained as scars after six courses. There has been no evidence of recurrence for 28 months in one patient and 7 months in the other patient.

Complete remission of an endometrial carcinoma with bilateral multiple pulmonary and extrapelvic metastases treated by surgery and chemotherapy consisting of paclitaxel and carboplatin

“…At the time of the preparation of manuscript, both patients had no evidence of disease and the durations of complete responses were 28 and 7 months, respectively. However, there were no additional extrapelvic metastases other than pulmonary in these two patients (7) . On the other hand, in endometrial carcinoma, metastases confined to the lungs are generally associated with a better prognosis and have a high response rate to progestins (3) .…”

“…Recently, the combination of paclitaxel with a platinum analogue has been found to be an active chemotherapeutic regimen with a response rate of 56–78% in advanced or recurrent endometrial carcinoma (4–6) . Furthermore, Niwa et al (7) successfully treated two patients with bilateral multiple pulmonary metastases with surgery followed by chemotherapy consisting of paclitaxel and carboplatin. At the time of the preparation of manuscript, both patients had no evidence of disease and the durations of complete responses were 28 and 7 months, respectively.…”

Clinical outcome of metastatic uterine leiomyosarcoma and carcinosarcoma in a single institute

“…also reported that current chemotherapy drugs are minimally effective for uterine LMS 13 . These observations definitely differ from observations in endometrial cancer, in which combination chemotherapy appears to be the optimal treatment modality in pulmonary metastasis after primary surgery for hysterectomy 14–16 …”

“…13 These observations definitely differ from observations in endometrial cancer, in which combination chemotherapy appears to be the optimal treatment modality in pulmonary metastasis after primary surgery for hysterectomy. [14][15][16] Uterine LMS and CS are more prone to metastasize to distant organs than endometrial cancer. In the present series, two cases in FIGO stage I showed metastasis to the lung 7-12 months after hysterectomy.…”

Hematogenous metastases in patients with Stage I or II endometrial carcinoma

“…Data from the literature and our own observations indicate that resection of pulmonary metastases combined with chemo-and/or hormonotherapy is a cornerstone treatment for patients with HM to the lung from EC, especially those with solitary HM [4,8,23,41]. Niwa et al [41] and Gücer et al [23] successfully treated patients with bilateral multiple pulmonary metastases with surgery followed by chemotherapy consisting of paclitaxel and carboplatin.…”