Neoadjuvant Chemotherapy Versus Primary Cytoreductive Surgery for Stage IV Uterine Serous Carcinoma

Abstract

Objective This study compares surgical and survival outcomes of women with stage IV uterine serous carcinoma (USC) treated with neoadjuvant chemotherapy (NAC) and interval cytoreduction to women treated with primary cytoreductive surgery (PCS) followed by adjuvant chemotherapy. Methods This retrospective dual cohort study included women diagnosed with stage IV USC at a single academic institution. Kruskal-Wallis and Fisher’s exact tests were used to compare demographics and surgical outcomes. Progression-free (PFS) and overall survival (OS) was estimated by using Kaplan-Meier methods. Comparison between study groups was tested by log-rank statistics. Results Ten women with stage IV USC who received NAC and 34 who underwent PCS met inclusion criteria. NAC patients had a lower mean BMI and were more often African American. Compared to PCS, the NAC cohort had shorter mean operative times (137±66 minutes versus 203±80 minutes, P=0.025) and were discharged from the hospital earlier (median length of stay 3 vs. 5 days, P=0.002). Rates of debulking to no gross residual disease (70% NAC v. 32.3% PCS) or <1cm of disease (30% NAC v. 50% PCS) did not differ (p=0.10). Median follow-up time was 17.5 months. There was no difference in median PFS (10.4 v. 12 months, p=0.29) or OS (17.3 v. 20.7 months, p=0.23) for NAC and PCS cohorts. Conclusions Women receiving NAC for Stage IV USC had shorter surgeries and hospital stays than those receiving PCS. There was no difference in PFS or OS, although our sample size was small. NAC may be an appropriate therapy for select patients with advanced stage USC.

Analysis of the outcome of patients with stage IV uterine serous carcinoma mimicking ovarian cancer

“…Reported results in the treatment of uterine serous carcinoma are similar to those of ovarian cancer series, but with lower progression-free survival and overall survival rates. [21][22][23][24] In our series, overall survival was lower in the neoadjuvant chemotherapy group than the primary surgery group (20 months versus 27 months). This difference was statistically nonsignificant and is likely to be due to differences in demographics and patient selection, rather than treatment-related effects alone.…”

“…Reported safety and effectiveness outcomes of neoadjuvant chemotherapy are comparable to those of primary cytoreductive surgery. [18][19][20][21][22][23][24] This study analysed outcomes for women with stage IV uterine serous carcinoma treated at the Queensland Centre for Gynaecological cancer, Queensland, Australia.…”

Current recommendations and recent progress in endometrial cancer

“…Several studies have demonstrated the utility of this approach, often in patients with serous histology because the pattern of disease spread is similar to that of ovarian cancer, in which the use of neoadjuvant chemotherapy is well described. In some cohorts, neoadjuvant chemotherapy has resulted in decreased operative time and hospital stay without worsening OS …”

“…In some cohorts, neoadjuvant chemotherapy has resulted in decreased operative time and hospital stay without worsening OS. 83,84 Adjuvant Therapy…”

Survival outcome of women with stage IV uterine carcinosarcoma who received neoadjuvant chemotherapy followed by surgery

“…Neoadjuvant chemotherapy is an alternative treatment approach for patients who are not suitable for primary surgical treatment. The role of neoadjuvant chemotherapy has been studied in various types of gynecologic malignancy including ovarian and high‐grade endometrial cancers; however, the effectiveness of neoadjuvant chemotherapy in UCS has not been studied likely due to the rarity of disease. Given that a substantial number of women with stage IV UCS are potentially poor candidates for primary surgical treatment, examining the utility of neoadjuvant chemotherapy prior to surgical treatment is of clinical value in the management of this disease.…”