Abstract
Despite the fact that endometrial cancer is predominantly a disease that occurs in elderly women, little is known about best practices for therapy when endometrial cancer develops in the “oldest old” patients greater than the age of 80 or in patients with age-associated comorbidities. Treatment of endometrial cancer in these populations is a challenge as surgery is indicated in the vast majority of cases, and there are no validated screening tools to assess a patient’s fitness for endometrial cancer surgery. Patients with endometrial cancer not uncommonly require adjuvant therapy in the form of hormones, radiation, chemotherapy, or a combination thereof, but little information exists regarding best practices in an elderly patient and outcomes. This chapter aims to summarize the challenges and options surrounding the care of elderly patients who present with endometrial cancer.
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References
US Census Bureau. US interim projections by age, sex, race and Hispanic origin. http://www.census.gov/inc/www/usinterim,inj/. Internet release date: 18 Mar 2004.
Yancik R, Ries LA. Cancer in older persons: an international issue in an aging world. Semin Oncol. 2004;31:128–36.
Yancik R. Population aging and cancer: a cross-national concern. Cancer J. 2005;11:437–41.
Wright JD, Lewin SN, Barrera-Medil NI, Sun X, et al. Endometrial cancer in the oldest old: tumor characteristics, patterns of care and outcome. Gynecol Oncol. 2011;122:69–74.
American Cancer Society. Facts and figures 2011. Atlanta: ACS; 2011.
Jemal A, Siegel R, Ward E, Murry T, et al. Cancer statistics. CA Cancer J Clin. 2006;56: 106–30.
Balducci L, Extermann M. Management of cancer in the older person: a practical approach. Oncologist. 2000;5(3):224–37.
Moore KN, Lanneau GS, Smith C, Lanneau M, Walker JL, et al. Pathologic findings and outcomes for octogenarians presenting with uterine malignancy. Gynecol Oncol. 2008;106:572–8.
PACE. Shall we operate. Crit Rev Oncol Hematol. 2008;65:156–63.
Kristjansson SR, Neshakken A, Jordhoy MS, et al. Comprehensive geriatric assessment can predict complications in elderly patients after elective surgery for colorectal cancer: a prospective observational cohort study. Crit Rev Oncol Hematol. 2009;76(3):208–17.
Robinson TN, Wallace JI, Wu DS, Wiktor A, Pointer CF, et al. Accumulated frailty characteristics predict post op discharge institutionalization in the geriatric patient. J Am Coll Surg. 2011;213:37–44.
American College of Obstetricians and Gynecologists. ACOG practice bulletin. Management of endometrial cancer. Obstet Gynecol. 2005;65:1258–69.
Montz FJ, Bristow RE, Bovicelli A, Tomacruz R, Kurman RJ. Intrauterine progesterone treatment of early endometrial cancer. Am J Obstet Gynecol. 2002;186:651–7.
Gotlieb WH, Beiner ME, Shalmon B, Korach Y, Segal Y, et al. Outcome of fertility sparing treatment with progestins in young patients with endometrial cancer. Obstet Gynecol. 2003;102:718–25.
Imai M, Jobo T, Sato R, Kawaguchi M, Kuramoto H. Medroxyprogesterone acetate therapy for patients with adenocarcinoma of the endometrium who wish to preserve the uterus – usefulness and limitations. Eur J Gynaecol Oncol. 2001;22:217–20.
Kaku T, Yoshikawa H, Tsuda H, Sakamoto A, Fukunaga M, et al. Conservative therapy for adenocarcinoma and atypical endometrial hyperplasia of the endometrium in young women: central pathologic review and treatment outcome. Cancer Lett. 2001;167:39–48.
Rose PG, Baker S, Kern M, Fitgerald TJ, et al. Primary radiation therapy for endometrial carcinoma: a case controlled study. Int J Radiat Oncol Biol Phys. 1993;27(3):585–90.
Varia M, Rosenman J, Halle J, Walton L, et al. Primary radiation therapy for medically inoperable patients with endometrial carcinoma – stages I–II. Int J Radiat Oncol Biol Phys. 1987;13(1):11–5.
Lehoczky O, Bosze P, Ungar L, Tottossy B. Stage I endometrial carcinoma: treatment of non-operable patients with intracavitary radiation alone. Gynecol Oncol. 1991;43(3):211–6.
Grigsby PW, Kuske RR, Perez CA, Walz BJ, et al. Medically inoperable stage I adenocarcinoma of the endometrium treated with radiotherapy alone. Int J Radiat Oncol Biol Phys. 1987;13(4):483–8.
Coon D, Beriwal S, Heron DE, Kelley JL, Edwards RP, et al. High dose rate rotte “Y” applicator brachytherapy for definitive treatment of medically inoperable endometrial cancer: 10-year results. Int J Radiat Oncol Biol Phys. 2008;71(3):777–83.
Sasini T, Massi G, Amunni G, Carriero C, et al. Vaginal hysterectomy and abdominal hysterectomy for treatment of endometrial cancer in the elderly. Gynecol Oncol. 2005;96(2):362–7.
Kilgore LC, Partridge EE, Alvarez RD, et al. Adenocarcinoma of the endometrium: survival comparisons of patients with and without pelvic node sampling. Gynecol Oncol. 1995;56:29–33.
Cragun JM, Havrilesky LJ, Calingaert B, et al. Retrospective analysis of selective lymphadenectomy in apparent early-stage endometrial cancer. J Clin Oncol. 2005;23:3668–75.
Benedetti Panici P, Basile S, Maneschi F, Alberto Lissoni A, Signorelli M, et al. Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst. 2008;100(23):1707–16.
ASTEC Study Group, Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet. 2009;373(9658):125–36.
Creutzberg CL, van Putten WL, Koper PC, Lybeert ML, Jobsen JJ, Warlam-Rodenhuis CC, et al. Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC Study Group. Post Operative Radiation Therapy in Endometrial Carcinoma. Lancet. 2000;355(9213):1404–11.
Keys HM, Roberts JA, Brunetto VL, Zaino RJ, Spirtos NM, Bloss JD, et al. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2004;92(3):744–51.
Nout RA, Smit VTHBM, Putter H, Jurgenliemk-Schulz IM, Jobsen JJ, Lutgens LCHW, et al. Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): an open-label, non-inferiority, randomised trial. Lancet. 2010;375(9717):816–23.
Fleming ND, Lentz SE, Cass I, Li AJ, Karlan BY, Walsh CS. Is older age a poor prognostic factor in stage I and II endometrioid endometrial adenocarcinoma? Gynecol Oncol. 2011;120:189–92.
Alektiar KM, Venkatraman E, Abu-Rustum N, Barakat R. Is endometrial carcinoma intrinsically more aggressive in elderly patients? Cancer. 2003;98:2368–77.
Moscarini M, Ricciardi E, Quarto A, Maniglio P, Caserta D. Vaginal treatment of endometrial cancer: role in the elderly. World J Surg Oncol. 2011;9:74.
Siento G, Uccella S, Ghezzi F, Cromi A, Zefiro F, et al. Surgical and survival outcomes in older women with endometrial cancer treated by laparoscopy. Menopause. 2010;17(3):539–44.
Lachance JA, Everett EN, Greer B, Mandel L, Swisher E, et al. The effect of age on clinical/pathologic features, surgical morbidity and outcome of patients with endometrial cancer. Gynecol Oncol. 2006;101:470–5.
Okuma K, Yamashita H, Kawana K, Nakagawa S, Oda K, et al. Advanced age is a significant determinant of poor prognosis in patients treated with surgery plus post operative radiotherapy for endometrial cancer. J Obstet Gynaecol Res. 2010;36(4):757–63.
Jolly S, Vargas CE, Kumar T, et al. The impact of age on long term outcome in patients with endometrial cancer treated with post-operative radiation. Gynecol Oncol. 2006;103:87–93.
Pignon T, Horiot JC, Bolla M, et al. Age is not a limiting factor for radical radiotherapy in pelvic malignancies. Radiother Oncol. 1997;42:107–20.
Creasman W. Revised FIGO staging for carcinoma of the endometrium. Int J Gynaecol Obstet. 2009;105(2):109.
Randall ME, Filiaci VL, Muss H, Spirtos NM, Mannel RS, et al. Randomized phase III trial of whole-abdominal irradiation versus doxorubicin and cisplatin chemotherapy in advanced endometrial carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol. 2006;24(1):36–44.
Homesley HD, Filiaci V, Gibbons SK, Long HJ, Cella D, et al. A randomized phase III trial in advanced endometrial carcinoma of surgery and volume directed radiation followed by cisplatin and doxorubicin with or without paclitaxel: a Gynecologic Oncology Group study. Gynecol Oncol. 2009;112(3):543–52.
Thigpen JT, Brady MF, Homesley HD, et al. Phase III trial of doxorubicin with or without cisplatin in advanced endometrial carcinoma: a Gynecologic Oncology Group study. J Clin Oncol. 2004;22(19):3902–8.
Fleming GF, Filiaci VL, Bentley RC, et al. Phase III randomized trial of doxorubicin + cisplatin versus doxorubicin + 24-h paclitaxel + filgrastim in endometrial carcinoma: a Gynecologic Oncology Group study. Ann Oncol. 2004;15(8):1173–8.
Fleming GF, Brunetto VL, Cella D, et al. Phase III trial of doxorubicin plus cisplatin with or without paclitaxel plus filgrastim in advanced endometrial carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol. 2004;22(11):2159–66.
Fleming GF, Filiaci VL, Bentley RC, Herzog T, Sorosky J, et al. Phase III randomized trial of doxorubicin + cisplatin versus doxorubicin + 24-h paclitaxel + filgrastim in endometrial carcinoma: a Gynecologic Oncology Group study. Ann Oncol. 2004;15(8):1173–8.
Goff BA, Goodman A, Muntz HG, Fuller Jr AF, Nikrui N, Rice LW. Surgical stage IV endometrial carcinoma: a study of 47 cases. Gynecol Oncol. 1994;52(2):237–40.
Chi DS, Welshinger M, Venkatraman ES, Barakat RR. The role of surgical cytoreduction in stage IV endometrial carcinoma. Gynecol Oncol. 1997;67(1):56–60.
Bristow RE, Zerbe MJ, Rosenshein NB, Grumbine FC, Montz FJ. Stage IVB endometrial carcinoma: the role of cytoreductive surgery and determinants of survival. Gynecol Oncol. 2000;78(2):85–91.
Ayhan A, Taskiran C, Celik C, Yuce K, Kucukali T. The influence of cytoreductive surgery on survival and morbidity in stage IVB endometrial cancer. Int J Gynecol Cancer. 2002;12(5): 448–53.
Lambrou NC, Gomez-Marin O, Mirhashemi R, Beach H, Salom E, Almeida-Parra Z, et al. Optimal surgical cytoreduction in patients with stage III and stage IV endometrial carcinoma: a study of morbidity and survival. Gynecol Oncol. 2004;93(3):653–8.
Landrum LM, Moore KN, Myers TKN, Lanneau GS, McMeekin DS, et al. Stage IVB endometrial cancer: does applying an ovarian cancer treatment paradigm result in similar outcomes? A case control analysis. Gynecol Oncol. 2009;112:337–41.
Alphs HH, Zahurak ML, Bristow RE, Diaz-Montes TP. Predictors of surgical outcome and survival among elderly women diagnosed with ovarian and primary peritoneal cancer. Gynecol Oncol. 2006;103:1048–53.
Diaz-Montes TP, Zahurak ML, Giuntoli II RL, et al. Surgical care of elderly women with ovarian cancer: a population-based perspective. Gynecol Oncol. 2005;99:352–7.
Hightower RD, Nguyen HN, Averette HE, Hoskins W, Harrison T, Steren A. National survey of ovarian carcinoma. IV: patterns of care and related survival for older patients. Cancer. 1994;73:377–83.
Cloven NG, Manetta A, Berman ML, Kohler MF, DiSaia PJ. Management of ovarian cancer in patients older than 80 years of age. Gynecol Oncol. 1999;73:137–9.
Wright JD, Herzog TJ, Powell MA. Morbidity of cytoreductive surgery in the elderly. Am J Obstet Gynecol. 2004;190:1398–400.
Moore KN, Reid MS, Fong DN, Myers TK, Landrum LM, et al. Ovarian cancer in the octogenarian: does the paradigm of aggressive cytoreductive surgery and chemotherapy still apply? Gynecol Oncol. 2008;110(2):133–9.
Wright JD, Lewin SN, Deutsch I, Burke WM, Sun X, et al. Defining the limits of radical cytoreductive surgery for ovarian cancer. Gynecol Oncol. 2011;123:467–73.
Lentz SS, Brady MF, Major FJ, Reid GC, Soper JT. Hig dose megesterol acetate in advanced or recurrent endometrial carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol. 1996;14(2):257–361.
Piver MS, Barlow JJ, Lurain JR, Blumenson LE. Medroxyprogesterone acetate (Depo-Provera) vs. hydroxyprogesterone caproate (Delalutin) in women with metastatic endometrial adenocarcinoma. Cancer. 1980;45(2):268–72.
Podratz KC, O’Brien PC, Malkasian GD, Decker DG, Jefferies JA, et al. Effects of progestational agents in treatment of endometrial carcinoma. Obstet Gynecol. 1985;66(1):106–10.
Thigpen JT, Brady MF, Alvarez RD, Adelson MD, Hoesley HD, et al. Oral medroxyprogesterone acetate in the treatment of advanced or recurrent endometrial carcinoma: a dose response study by the Gynecologic Oncology Group. J Clin Oncol. 1999;17(6):1736–44.
Crespo C, Gonzalez-Martin A, Lastra E, Garcia-Lopez J, Moyano A. Metastatic endometrial cancer in lung and liver: complete and prolonged response to hormonal therapy with progestins. Gynecol Oncol. 1999;72(2):250–5.
Fader AN, Drake RD, O’Malley DM, et al. Platinum/taxane-based chemotherapy with or without radiation therapy favorably impacts survival outcomes in stage I uterine papillary serous carcinoma. Cancer. 2009;115:2119–27.
Fader AN, Nagel C, Axtell AE, et al. Stage II uterine papillary serous carcinoma: carboplatin/paclitaxel chemotherapy improves recurrence and survival outcomes. Gynecol Oncol. 2009;112:558–62.
Fader AN, Starks D, Gehrig PA, et al. An updated clinicopathologic study of early-stage uterine papillary serous carcinoma (UPSC). Gynecol Oncol. 2009;115:244–8.
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Moore, K.N. (2013). Treatment of Endometrial Cancer in the Geriatric Patient. In: Lichtman, S., Audisio, R. (eds) Management of Gynecological Cancers in Older Women. Springer, London. https://doi.org/10.1007/978-1-4471-4605-6_15
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DOI: https://doi.org/10.1007/978-1-4471-4605-6_15
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