Objective. To determine the efficacy of adjuvant platinum-based chemotherapy in Stage I uterine papillary serous carcinoma (UPSC). Methods. A retrospective multi-institu-tional investigation was performed to identify ...Objective. To determine the efficacy of adjuvant platinum-based chemotherapy in Stage I uterine papillary serous carcinoma (UPSC). Methods. A retrospective multi-institu-tional investigation was performed to identify surgically staged patients with Stage I UPSC who were (1) treated after surgery with 3-6 courses of platinum-based chemotherapy without radiation from 1990-2003, and (2) followed for a minimum of 12 months, or until recurrence. Results. Six patients (IA-2, IB-3, IC-1) were treated with carboplatin (AUC 6) or cisplatin (50 mg/m2) alone. One patient recurred to the vagina, was treated with chemo-radiation, and is alive and well at 122 months. One patient recurred to the lung, liver, and brain, and died of disease at 24 months. The remaining 4 patients are alive with no evidence of disease 15-124 months (mean 62 months) after treatment. Two patients (IB-1, IC-1) were treated with cisplatin (50 mg/m2) and cyclophosphamide (1000 mg/m2), and both are alive and well with no evidence of disease 75 and 168 months after treatment. Twenty-one patients (IA-5, IB-13, IC-3) were treated with a combination of carboplatin (AUC 6)-and paclitaxel (135 mg/m2-175 mg/m2). One patient recurred to the vagina after 3 cycles of carboplatin/paclitaxel, and was treated with chemo-radiation. She is now without evidence of disease 10 months after treatment. At present, all 21 patients with Stage I UPSC treated following surgical staging with carboplatin/ paclitaxel chemotherapy are alive and well with no evidence of disease 10-138 months (mean 41 months) after treatment. Conclusion. Combination carboplatin/paclitaxel chemotherapy following surgery is effective in the treatment of Stage I UPSC.展开更多
Uterine papillary serous carcinoma(UPSC) was established as a distinct type of endometrial carcinoma by Lauchlan in 1981 and Hendrickson et al in 1982, and ac- counted for 1 % - 10% of endometrial cancers. The occurre...Uterine papillary serous carcinoma(UPSC) was established as a distinct type of endometrial carcinoma by Lauchlan in 1981 and Hendrickson et al in 1982, and ac- counted for 1 % - 10% of endometrial cancers. The occurrencer of papillary patterns of en- dometrial adenocarcinoma had been reportedly recognized since 1900, while until the late 1970s several authors have had described a variant of papillary endometrial cancer. UPSC is a morphologically unique variant of endometrial carcinoma that is pathologically defined by the presence of high nuclear grade, distinct papillary architechtural changes, psammoma bodies, and extensive lymph - vascular space invasion. CA125 is often mentioned a useful tumor marker either for diagnosis before starting treatment or in monitoring recurrence. The optimal treatment of UPSC is controversial and appears to be dependent upon the stage of the disease. Primary surgery comprised of TAH/BSO and complete staging is the mainstay of treatment. The patients with recurrent UPSC in many studies were treated with various combinations of surgery , radiation therapy, and chemotherapy. The molecular basis for the gneeral poor response of UPSC to adjuvant chemotherapy and radiotherapy is not well under- stood. UPSC tumors are more often aneuploid and contain overexpressed mutant p53 protein as compared to endometrioid adenocarcinoma. Unlike patients with adenocarcinoma of the endometrium, women with UPSC were less likely to be obese, hypertensive, or diabetic.展开更多
Uterine papillary serous carcinoma (UPSC) is an aggressive form of endometrial cancer characterized by a high recurrence rate and a poor prognosis. Prior studies evaluating treatment of UPSC have been limited by small...Uterine papillary serous carcinoma (UPSC) is an aggressive form of endometrial cancer characterized by a high recurrence rate and a poor prognosis. Prior studies evaluating treatment of UPSC have been limited by small numbers of patients and inclusion of partially staged patients. The purpose of this study was to evaluate the efficacy of adjuvant platinumbased chemotherapy and vaginal cuff radiation in a large cohort of surgical stage I UPSC patients. Methods. We retrospectively reviewed 74 stage I patients with UPSC who underwent complete surgical staging at our institution between 1987 and 2004. Results. Stage IA patients were divided into two groups: patients with no cancer in the hysterectomy specimen (defined as no residual uterine disease) and patients with cancer in the hysterectomy specimen (defined as residual uterine disease). Stage IA patients with no residual uterine disease had no recurrences, regardless of adjuvant therapy (n = 12). Stage IA patients with residual uterine disease who were treated with platinum-based chemotherapy had no recurrences (n = 7). However, 6 of 14 (43% ) stage IA patients with residual uterine disease who did not receive chemotherapy recurred. The 15 patients with stage IB UPSC who received platinum-based chemotherapy had no recurrences but 10 of the 13 (77% ) stage IB patients who did not receive chemotherapy recurred. One of the 7 patients with stage IC UPSC who received platinum-based chemotherapy recurred and 4 of the 5 (80% ) stage IC patients who did not receive chemotherapy recurred. Overall platinum-based chemotherapy was associated with improved disease-free survival (P < 0.01) and improved overall survival (P < 0.05) in patients with stage I UPSC. None of the 43 patients who received radiation to the vaginal cuff recurred locally, but 6 of the 31 (19% ) patients who were not treated with vaginal radiation recurred at the cuff. Conclusions. Platinum-based chemotherapy improves the disease-free and overall survival of patients with stage I UPSC and vaginal cuff radiation provides local control. Stage IA UPSC patients with no residual uterine disease can be observed but concomitant platinum-based chemotherapy and vaginal cuff radiation (referred to as chemoradiation) should be offered to all other stage I UPSC patients.展开更多
文摘Objective. To determine the efficacy of adjuvant platinum-based chemotherapy in Stage I uterine papillary serous carcinoma (UPSC). Methods. A retrospective multi-institu-tional investigation was performed to identify surgically staged patients with Stage I UPSC who were (1) treated after surgery with 3-6 courses of platinum-based chemotherapy without radiation from 1990-2003, and (2) followed for a minimum of 12 months, or until recurrence. Results. Six patients (IA-2, IB-3, IC-1) were treated with carboplatin (AUC 6) or cisplatin (50 mg/m2) alone. One patient recurred to the vagina, was treated with chemo-radiation, and is alive and well at 122 months. One patient recurred to the lung, liver, and brain, and died of disease at 24 months. The remaining 4 patients are alive with no evidence of disease 15-124 months (mean 62 months) after treatment. Two patients (IB-1, IC-1) were treated with cisplatin (50 mg/m2) and cyclophosphamide (1000 mg/m2), and both are alive and well with no evidence of disease 75 and 168 months after treatment. Twenty-one patients (IA-5, IB-13, IC-3) were treated with a combination of carboplatin (AUC 6)-and paclitaxel (135 mg/m2-175 mg/m2). One patient recurred to the vagina after 3 cycles of carboplatin/paclitaxel, and was treated with chemo-radiation. She is now without evidence of disease 10 months after treatment. At present, all 21 patients with Stage I UPSC treated following surgical staging with carboplatin/ paclitaxel chemotherapy are alive and well with no evidence of disease 10-138 months (mean 41 months) after treatment. Conclusion. Combination carboplatin/paclitaxel chemotherapy following surgery is effective in the treatment of Stage I UPSC.
文摘Uterine papillary serous carcinoma(UPSC) was established as a distinct type of endometrial carcinoma by Lauchlan in 1981 and Hendrickson et al in 1982, and ac- counted for 1 % - 10% of endometrial cancers. The occurrencer of papillary patterns of en- dometrial adenocarcinoma had been reportedly recognized since 1900, while until the late 1970s several authors have had described a variant of papillary endometrial cancer. UPSC is a morphologically unique variant of endometrial carcinoma that is pathologically defined by the presence of high nuclear grade, distinct papillary architechtural changes, psammoma bodies, and extensive lymph - vascular space invasion. CA125 is often mentioned a useful tumor marker either for diagnosis before starting treatment or in monitoring recurrence. The optimal treatment of UPSC is controversial and appears to be dependent upon the stage of the disease. Primary surgery comprised of TAH/BSO and complete staging is the mainstay of treatment. The patients with recurrent UPSC in many studies were treated with various combinations of surgery , radiation therapy, and chemotherapy. The molecular basis for the gneeral poor response of UPSC to adjuvant chemotherapy and radiotherapy is not well under- stood. UPSC tumors are more often aneuploid and contain overexpressed mutant p53 protein as compared to endometrioid adenocarcinoma. Unlike patients with adenocarcinoma of the endometrium, women with UPSC were less likely to be obese, hypertensive, or diabetic.
文摘Uterine papillary serous carcinoma (UPSC) is an aggressive form of endometrial cancer characterized by a high recurrence rate and a poor prognosis. Prior studies evaluating treatment of UPSC have been limited by small numbers of patients and inclusion of partially staged patients. The purpose of this study was to evaluate the efficacy of adjuvant platinumbased chemotherapy and vaginal cuff radiation in a large cohort of surgical stage I UPSC patients. Methods. We retrospectively reviewed 74 stage I patients with UPSC who underwent complete surgical staging at our institution between 1987 and 2004. Results. Stage IA patients were divided into two groups: patients with no cancer in the hysterectomy specimen (defined as no residual uterine disease) and patients with cancer in the hysterectomy specimen (defined as residual uterine disease). Stage IA patients with no residual uterine disease had no recurrences, regardless of adjuvant therapy (n = 12). Stage IA patients with residual uterine disease who were treated with platinum-based chemotherapy had no recurrences (n = 7). However, 6 of 14 (43% ) stage IA patients with residual uterine disease who did not receive chemotherapy recurred. The 15 patients with stage IB UPSC who received platinum-based chemotherapy had no recurrences but 10 of the 13 (77% ) stage IB patients who did not receive chemotherapy recurred. One of the 7 patients with stage IC UPSC who received platinum-based chemotherapy recurred and 4 of the 5 (80% ) stage IC patients who did not receive chemotherapy recurred. Overall platinum-based chemotherapy was associated with improved disease-free survival (P < 0.01) and improved overall survival (P < 0.05) in patients with stage I UPSC. None of the 43 patients who received radiation to the vaginal cuff recurred locally, but 6 of the 31 (19% ) patients who were not treated with vaginal radiation recurred at the cuff. Conclusions. Platinum-based chemotherapy improves the disease-free and overall survival of patients with stage I UPSC and vaginal cuff radiation provides local control. Stage IA UPSC patients with no residual uterine disease can be observed but concomitant platinum-based chemotherapy and vaginal cuff radiation (referred to as chemoradiation) should be offered to all other stage I UPSC patients.
