TY - JOUR
T1 - Surgical management and adjuvant therapy for patients with uterine clear cell carcinoma
T2 - A multi-institutional review
AU - Thomas, M.
AU - Mariani, A.
AU - Wright, J. D.
AU - Madarek, E. O.S.
AU - Powell, M. A.
AU - Mutch, D. G.
AU - Podratz, K. C.
AU - Dowdy, S. C.
PY - 2008/2
Y1 - 2008/2
N2 - Objective: To assess the role of surgical staging, adjuvant therapy, and cytoreduction in uterine clear cell carcinoma (UCCC). Methods: A retrospective review was conducted at 2 major gynecologic cancer centers of all primary UCCC between 1982 and 2004. Results: UCCC was confirmed in 99 patients. The 5-year overall survival (OS) was 79%, 77%, 47%, and 21% for stages I-IV respectively. 69 patients had no gross evidence of extra-uterine disease, but 36 (52%) were upstaged at surgery. For those 22 patients with stages I and II disease who had a systematic lymphadenectomy (LND) (> 20 lymph nodes), no lymphatic (LF), peritoneal (PF), or hematological (HF) failures were noted. Radiation (RT) improved PFS (67 vs. 36%, p = 0.02), and reduced pelvic sidewall recurrences (18 vs. 53%, p = 0.04) and vaginal failures (VF) (7 vs. 35%, p = 0.04) for 45 patients at risk for LF (positive nodes or suboptimal LND). 39 patients with stages IIIC and IV disease were separately analyzed. Patients with no visible residual disease after cytoreduction had a significant improvement in median PFS (17 vs. 7months, p < 0.001), and OS (40 vs. 18months, p = 0.02) compared to patients with any residual disease after surgery. Conclusion: Comprehensive surgical staging with a systematic LND is essential to accurately define early stage UCCC. Vaginal brachytherapy may be adequate adjuvant therapy for stages I and II UCCC confirmed by systematic LND. Patients at risk for LF appear to benefit from pelvic RT. An effort at cytoreduction to no visible residual disease should be made in advanced UCCC when feasible.
AB - Objective: To assess the role of surgical staging, adjuvant therapy, and cytoreduction in uterine clear cell carcinoma (UCCC). Methods: A retrospective review was conducted at 2 major gynecologic cancer centers of all primary UCCC between 1982 and 2004. Results: UCCC was confirmed in 99 patients. The 5-year overall survival (OS) was 79%, 77%, 47%, and 21% for stages I-IV respectively. 69 patients had no gross evidence of extra-uterine disease, but 36 (52%) were upstaged at surgery. For those 22 patients with stages I and II disease who had a systematic lymphadenectomy (LND) (> 20 lymph nodes), no lymphatic (LF), peritoneal (PF), or hematological (HF) failures were noted. Radiation (RT) improved PFS (67 vs. 36%, p = 0.02), and reduced pelvic sidewall recurrences (18 vs. 53%, p = 0.04) and vaginal failures (VF) (7 vs. 35%, p = 0.04) for 45 patients at risk for LF (positive nodes or suboptimal LND). 39 patients with stages IIIC and IV disease were separately analyzed. Patients with no visible residual disease after cytoreduction had a significant improvement in median PFS (17 vs. 7months, p < 0.001), and OS (40 vs. 18months, p = 0.02) compared to patients with any residual disease after surgery. Conclusion: Comprehensive surgical staging with a systematic LND is essential to accurately define early stage UCCC. Vaginal brachytherapy may be adequate adjuvant therapy for stages I and II UCCC confirmed by systematic LND. Patients at risk for LF appear to benefit from pelvic RT. An effort at cytoreduction to no visible residual disease should be made in advanced UCCC when feasible.
KW - Cytoreduction
KW - Radiation therapy
KW - Systematic lymphadenectomy
KW - Uterine clear cell carcinoma
UR - http://www.scopus.com/inward/record.url?scp=38649111337&partnerID=8YFLogxK
U2 - 10.1016/j.ygyno.2007.11.008
DO - 10.1016/j.ygyno.2007.11.008
M3 - Article
C2 - 18096208
AN - SCOPUS:38649111337
SN - 0090-8258
VL - 108
SP - 293
EP - 297
JO - Gynecologic oncology
JF - Gynecologic oncology
IS - 2
ER -