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Adjuvant treatment of high-risk endometrial cancers

Authors
Gini Fleming, MD
Paul A DiSilvestro, MD
Section Editors
Barbara Goff, MD
Don S Dizon, MD, FACP
Deputy Editor
Sadhna R Vora, MD

INTRODUCTION

Adenocarcinomas of the endometrium are the most common gynecologic malignancy in developed countries and the second most common in developing countries. Among the different histologic types of adenocarcinomas, grade 1 and 2 endometrioid uterine cancers have a favorable prognosis and typically present at an early stage. Other histologic types of uterine adenocarcinoma (eg, serous, clear cell) are associated with a poorer prognosis.

The American Joint Committee on Cancer (AJCC) and International Federation of Gynecology and Obstetrics (FIGO) combined staging system is used to designate cancer stage (table 1). In addition to stage, other pathologic factors are used to assign risk for recurrent or persistent disease into low, intermediate, and high risk.

Women with high-risk endometrial cancer have a poor prognosis following surgery alone. Therefore, adjuvant treatment is often administered, although the effect of any therapy following surgery on overall survival is unclear. This review will focus on treatment of high-risk endometrial cancer.

An overview of endometrial cancer, including clinical features and an approach to diagnosis, the approach to adjuvant treatment, and treatment of both low- and intermediate-risk endometrial cancer are discussed separately.

(See "Overview of endometrial carcinoma".)

                      
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Literature review current through: Nov 2017. | This topic last updated: Nov 15, 2017.
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References
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  1. Cancer Genome Atlas Research Network, Kandoth C, Schultz N, et al. Integrated genomic characterization of endometrial carcinoma. Nature 2013; 497:67.
  2. Kosary C. Cancer of the Corpus Uteri. In SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988-2001, Patient and Tumor Characteristics. NCI, SEER Program, National Cancer Institute; Bethesda, MD 2007.
  3. Creutzberg CL, van Putten WL, Wárlám-Rodenhuis CC, et al. Outcome of high-risk stage IC, grade 3, compared with stage I endometrial carcinoma patients: the Postoperative Radiation Therapy in Endometrial Carcinoma Trial. J Clin Oncol 2004; 22:1234.
  4. Liang LW, Perez AR, Cangemi NA, et al. An Assessment of Prognostic Factors, Adjuvant Treatment, and Outcomes of Stage IA Polyp-Limited Versus Endometrium-Limited Type II Endometrial Carcinoma. Int J Gynecol Cancer 2016; 26:497.
  5. Fader AN, Starks D, Gehrig PA, et al. An updated clinicopathologic study of early-stage uterine papillary serous carcinoma (UPSC). Gynecol Oncol 2009; 115:244.
  6. Fader AN, Nagel C, Axtell AE, et al. Stage II uterine papillary serous carcinoma: Carboplatin/paclitaxel chemotherapy improves recurrence and survival outcomes. Gynecol Oncol 2009; 112:558.
  7. Bernardini MQ, Gien LT, Lau S, et al. Treatment related outcomes in high-risk endometrial carcinoma: Canadian high risk endometrial cancer consortium (CHREC). Gynecol Oncol 2016; 141:148.
  8. De Boer SM, Powell ME, Mileshkin LR, et al. Final results of the international randomized PORTEC-3 trial of adjuvant chemotherapy and radiation therapy (RT) versus RT alone for women with high-risk endometrial cancer. J Clin Oncol 2017; 35S: ASCO # 5502.
  9. de Boer SM, Powell ME, Mileshkin L, et al. Toxicity and quality of life after adjuvant chemoradiotherapy versus radiotherapy alone for women with high-risk endometrial cancer (PORTEC-3): an open-label, multicentre, randomised, phase 3 trial. Lancet Oncol 2016; 17:1114.
  10. McMeekin DS, Filiaci VL, Aghajanian C, et al. Randomized phase III trial of pelvic radiation therapy (PXRT) versus vaginal cuff brachytherapy followed by paclitaxel/ carboplatin chemotherapy (VCB/C) in patients with high risk (HR), early stage endometrial cancer (EC): a Gynecologic Oncology Group trial. Gynec Oncol 2014; 134:438.
  11. Randall M, Filiaci V, McMeekin D, et al. A Phase III Trial of Pelvic Radiation Therapy versus Vaginal Cuff Brachytherapy followed by Paclitaxel/Carboplatin Chemotherapy in Patients with High-risk, Early Stage Endometrial Cancer: A Gynecology Oncology Group Study (abstract). Int J Radiat Oncol Biol Phys 2017. Article in press.
  12. Galaal K, Al Moundhri M, Bryant A, et al. Adjuvant chemotherapy for advanced endometrial cancer. Cochrane Database Syst Rev 2014; :CD010681.
  13. Matei D, Filiaci VL, Randall M, Steinhoff M. A randomized phase III trial of cisplatin and tumor volume directed irradiation followed by carboplatin and paclitaxel vs. carboplatin and paclitaxel for optimally debulked, advanced endometrial carcinoma. J Clin Oncol 2017; 35S: abstract #5505.
  14. Patsavas K, Woessner J, Gielda B, et al. Optimal surgical debulking in uterine papillary serous carcinoma affects survival. Gynecol Oncol 2011; 121:581.
  15. Rauh-Hain JA, Growdon WB, Schorge JO, et al. Prognostic determinants in patients with stage IIIC and IV uterine papillary serous carcinoma. Gynecol Oncol 2010; 119:299.
  16. Shih KK, Yun E, Gardner GJ, et al. Surgical cytoreduction in stage IV endometrioid endometrial carcinoma. Gynecol Oncol 2011; 122:608.
  17. Bristow RE, Zerbe MJ, Rosenshein NB, et al. Stage IVB endometrial carcinoma: the role of cytoreductive surgery and determinants of survival. Gynecol Oncol 2000; 78:85.
  18. Miller DS, Filiaci G, Mannel R, et al. Randomized Phase III Noninferiority Trial of First Line Chemotherapy for Metastatic or Recurrent Endometrial Carcinoma: A Gynecologic Oncology Group Study. LBA2. Presented at the 2012 Society of Gynecologic Oncology Annual Meeting, Austin, TX.
  19. Griggs JJ, Mangu PB, Anderson H, et al. Appropriate chemotherapy dosing for obese adult patients with cancer: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol 2012; 30:1553.