TY - JOUR
T1 - Uterine serous carcinoma
T2 - Reassessing effectiveness of platinum-based adjuvant therapy
AU - Tortorella, Lucia
AU - Langstraat, Carrie L.
AU - Weaver, Amy L.
AU - McGree, Michaela E.
AU - Bakkum-Gamez, Jamie N.
AU - Dowdy, Sean C.
AU - Cliby, William A.
AU - Keeney, Gary L.
AU - Sherman, Mark E.
AU - Weroha, Saravut J.
AU - Mariani, Andrea
AU - Podratz, Karl C.
N1 - Publisher Copyright:
© 2018
PY - 2018/5
Y1 - 2018/5
N2 - Objective: Two randomized trials failed to demonstrate efficacy of platinum-based chemotherapy (PbCT) for uterine serous carcinoma (USC). Our objective was to reassess the value of PbCT for patients with microscopic residuum (R0). Methods: Progression-free survival (PFS) after surgery was analyzed for 409 patients and correlated with adjuvant therapies: vaginal brachytherapy (VBRT), external beam radiotherapy (EBRT), PbCT, or combinations. Results: The estimated 5-year PFS for stage I (n = 209) USC was 65.1% for observation only; 90.7%, VBRT only; and 91.1%, PbCT ± VBRT (85% received VBRT); VBRT significantly (P =.004) impacted PFS, but the added value of PbCT remains uncertain. Of 58 stage IIIC, PbCT-treated patients (±EBRT), 5-year PFS was 33.9%; most failures had a vascular disseminated component. Median PFS for 72 stage IV, PbCT-treated patients was 18.6 months for R0; 8.0, R1 ≤ 1 cm residual disease; and 4.6, R2 > 1 cm (P =.008). The progression rate (PR) during 1 to 2 year follow-up for R0 was similar to PR during 0–1 year follow-up for R1 (P =.31), suggesting recurrences in patients with R0 disease before 2 years are likely platinum resistant. PRs during follow-up were nearly identical for R0 ≥ 2 years and R1 ≥ 1 year (P =.95), presumably showing limited numbers of platinum-sensitive tumors. Conclusions: A comparison of PR for patients treated with PbCT for stage IV R0 and R1 disease suggested that a 1-year lag interval precedes clinical recognition of PbCT refractory/resistant R0 disease. Most patients treated with PbCT who had microscopic residuum had recurrences within 2 years (across stages), emphasizing the need for more effective therapy.
AB - Objective: Two randomized trials failed to demonstrate efficacy of platinum-based chemotherapy (PbCT) for uterine serous carcinoma (USC). Our objective was to reassess the value of PbCT for patients with microscopic residuum (R0). Methods: Progression-free survival (PFS) after surgery was analyzed for 409 patients and correlated with adjuvant therapies: vaginal brachytherapy (VBRT), external beam radiotherapy (EBRT), PbCT, or combinations. Results: The estimated 5-year PFS for stage I (n = 209) USC was 65.1% for observation only; 90.7%, VBRT only; and 91.1%, PbCT ± VBRT (85% received VBRT); VBRT significantly (P =.004) impacted PFS, but the added value of PbCT remains uncertain. Of 58 stage IIIC, PbCT-treated patients (±EBRT), 5-year PFS was 33.9%; most failures had a vascular disseminated component. Median PFS for 72 stage IV, PbCT-treated patients was 18.6 months for R0; 8.0, R1 ≤ 1 cm residual disease; and 4.6, R2 > 1 cm (P =.008). The progression rate (PR) during 1 to 2 year follow-up for R0 was similar to PR during 0–1 year follow-up for R1 (P =.31), suggesting recurrences in patients with R0 disease before 2 years are likely platinum resistant. PRs during follow-up were nearly identical for R0 ≥ 2 years and R1 ≥ 1 year (P =.95), presumably showing limited numbers of platinum-sensitive tumors. Conclusions: A comparison of PR for patients treated with PbCT for stage IV R0 and R1 disease suggested that a 1-year lag interval precedes clinical recognition of PbCT refractory/resistant R0 disease. Most patients treated with PbCT who had microscopic residuum had recurrences within 2 years (across stages), emphasizing the need for more effective therapy.
KW - Platinum-based chemotherapy
KW - Therapeutic efficacy
KW - Uterine serous carcinoma
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U2 - 10.1016/j.ygyno.2018.02.022
DO - 10.1016/j.ygyno.2018.02.022
M3 - Article
C2 - 29550183
AN - SCOPUS:85043520811
SN - 0090-8258
VL - 149
SP - 291
EP - 296
JO - Gynecologic oncology
JF - Gynecologic oncology
IS - 2
ER -