Impact of chemotherapy and radiotherapy on management of early stage clear cell and papillary serous carcinoma of the uterus

Julian C. Hong, Jonathan Foote, Gloria Broadwater, Stephanie Gaillard, Laura J. Havrilesky, Junzo P. Chino

Research output: Contribution to journalArticle

Abstract

Objective: The aim of the study was to assess interaction of lymph node dissection (LND), adjuvant chemotherapy (CT), and radiotherapy (RT) in stage I uterine papillary serous carcinoma (UPSC) and uterine clear cell carcinoma (UCC). Methods/Materials: The National Cancer Data Base was queried for women diagnosed with International Federation of Gynecology and Obstetrics stage I UPSC and UCC from 1998 to 2012. Overall survival (OS) was estimated for combinations of RTand CT by the Kaplan-Meier method stratified by histology and LND. Multivariate Cox proportional hazard models were generated. Results: Uterine papillary serous carcinoma: 5432 women with UPSC were identified. Uterine papillary serous carcinoma had the highest 5-year OS with CT + RTwith (83%) or without LND (76%). On multivariate analyses, CT [hazard ratio (HR), 0.77; P = 0.01] and vaginal cuff brachytherapy (HR, 0.68; P = 0.003) with LND were independently associated with OS. Without LND, vaginal cuff brachytherapy (HR, 0.53; P = 0.03), but not CT (HR, 1.21; P = 0.92), was associated with OS. Uterine clear cell carcinoma: 2516 women with UCC were identified. Uterine clear cell carcinoma with and without LND had comparable 5-year OS for all combinations of CT and RT on univariate and multivariate analyses. Conclusions: In stage I papillary serous uterine cancer, brachytherapy and CT were associated with increased survival; however, the benefit of chemotherapywas limited to those with surgical staging. In contrast, no adjuvant therapy was associated with survival in stage I uterine clear cell carcinoma, and further investigation to identify more effective therapies is warranted.

Original languageEnglish (US)
Pages (from-to)720-729
Number of pages10
JournalInternational Journal of Gynecological Cancer
Volume27
Issue number4
DOIs
StatePublished - Jan 1 2017
Externally publishedYes

Keywords

  • Chemotherapy
  • National Cancer Data Base (NCDB)
  • Radiation therapy
  • Uterine clear cell carcinoma
  • Uterine papillary serous carcinoma

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

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