Surgical management and adjuvant therapy for patients with uterine clear cell carcinoma

A multi-institutional review

M. Thomas, A. Mariani, J. D. Wright, E. O S Madarek, M. A. Powell, D. G. Mutch, K. C. Podratz, Sean Christopher Dowdy

Research output: Contribution to journalArticle

63 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)293-297
Number of pages5
JournalGynecologic Oncology
Volume108
Issue number2
DOIs
StatePublished - Feb 2008

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Carcinoma
Therapeutics
Uterine Diseases
Radiation
Survival
Brachytherapy
Lymph Node Excision
Lymph Nodes
Recurrence
Neoplasms

Keywords

  • Cytoreduction
  • Radiation therapy
  • Systematic lymphadenectomy
  • Uterine clear cell carcinoma

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

Cite this

Surgical management and adjuvant therapy for patients with uterine clear cell carcinoma : A multi-institutional review. / Thomas, M.; Mariani, A.; Wright, J. D.; Madarek, E. O S; Powell, M. A.; Mutch, D. G.; Podratz, K. C.; Dowdy, Sean Christopher.

In: Gynecologic Oncology, Vol. 108, No. 2, 02.2008, p. 293-297.

Research output: Contribution to journalArticle

Thomas, M. ; Mariani, A. ; Wright, J. D. ; Madarek, E. O S ; Powell, M. A. ; Mutch, D. G. ; Podratz, K. C. ; Dowdy, Sean Christopher. / Surgical management and adjuvant therapy for patients with uterine clear cell carcinoma : A multi-institutional review. In: Gynecologic Oncology. 2008 ; Vol. 108, No. 2. pp. 293-297.
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abstract = "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.",
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AU - Dowdy, Sean Christopher

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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.

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