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Treatment for Advanced and Recurrent Carcinoma: Combined Modalities

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Uterine Cancer

Abstract

The use of chemotherapy has provided new opportunities for exploring the combination of local and systemic modalities in the treatment of both early and advanced stages of endometrial carcinoma. The following circumstances are discussed: (1) radiation therapy for locally recurrent endometrial cancer; (2) surgery for stage IV and recurrent endometrial cancer; and (3) advanced stage endometrial cancer consolidating with postoperative and post-chemotherapy radiation therapy. Integration of hormones is also discussed.

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References

  1. Tarone RE, Chu KC. Age-period-cohort analyses of breast, ovarian, endometrial and cervical cancer mortality rates for Caucasian women in the USA. J Epidemiol Biostat. 2000;5:221–31.

    CAS  PubMed  Google Scholar 

  2. Morgan JD, Reddy S, Sarin P, et al. Isolated vaginal recurrences of endometrial carcinoma. Radiology. 1993;189:609–13.

    Article  Google Scholar 

  3. Hoekstra CJ, Koper PC, van Putten WL. Recurrent endometrial adenocarcinoma after surgery alone: prognostic factors and treatment. Radiother Oncol. 1998;27:164–6.

    Article  Google Scholar 

  4. Creutzberg CL, van Putten WL, Koper PC, et al. Surgery and postoperative radiotherapy versus surgery alone for patients with stage 1 endometrial carcinoma: multicenter randomised trial. PORTEC study group. Post Operative Radiation Therapy in Endometrial Carcinoma. Lancet. 2000;355:1404–11.

    Article  CAS  Google Scholar 

  5. Creutzberg CL, van Putten WL, Koper PC, et al. Survival after relapse in patients with endometrial cancer: results from a randomized trial small star, filled. Gynecol Oncol. 2003;89:201–9.

    Article  Google Scholar 

  6. Kuten A, Grigsby PW, Perez CA, et al. Results of radiotherapy in recurrent endometrial carcinoma: a retrospective analysis of 51 patients. Int J Radiat Oncol Biol Phys. 1989;17:29–34.

    Article  CAS  Google Scholar 

  7. Curran WJ, Whittington R, Peters AJ, Fanning J. Vaginal recurrences of endometrial carcinoma: the prognostic value of staging by a primary vaginal carcinoma system. Int J Radiat Oncol Biol Phys. 1988;15:803–8.

    Article  Google Scholar 

  8. Pai HH, Souhami L, Clark BG, Roman T. Isolated vaginal recurrences in endometrial carcinoma: treatment results using high-dose-rate intracavitary brachytherapy and external beam radiotherapy. Gynecol Oncol. 1997;66:300–7.

    Article  CAS  Google Scholar 

  9. Jhingran A, Burke TW, Eifel PJ. Definitive radiotherapy for patients with isolated vaginal recurrence of endometrial carcinoma after hysterectomy. Int J Radiat Oncol Biol Phys. 2003;56:1366–72.

    Article  Google Scholar 

  10. Jereczek-Fossa B, Badzio A, Jassem J. Recurrent endometrial cancer after surgery alone: results of salvage radiotherapy. Int J Radiat Oncol Biol Phys. 2000;48:405–13.

    Article  CAS  Google Scholar 

  11. Wylie J, Irwin C, Pintilie M, et al. Results of radical radiotherapy for recurrent endometrial cancer. Gynecol Oncol. 2000;77:66–72.

    Article  CAS  Google Scholar 

  12. Monk BJ, Tewari KS, Puthawala AA, et al. Treatment of recurrent gynecologic malignancies with iodine-125 permanent interstitial irradiation. Int J Radiat Oncol Biol Phys. 2002;52:806–15.

    Article  Google Scholar 

  13. Nag S, Yacoub S, Copeland LS, Fowler JM. Interstitial brachytherapy for salvage treatment of vaginal recurrences in previously unirradiated endometrial cancer patients. Int J Radiat Oncol Biol Phys. 2002;54:1153–9.

    Article  Google Scholar 

  14. Tewari K, Cappuccini F, Brewster WR, et al. Interstitial brachytherapy for vaginal recurrences of endometrial carcinoma. Gynecol Oncol. 1999;74:416–22.

    Article  CAS  Google Scholar 

  15. Bristow RE, Zerbe MJ, Rosenshein NB, et al. Stage IVB endometrial carcinoma: the role of cytoreductive surgery and determinants of survival. Gynecol Oncol. 2000;2:85–91.

    Article  Google Scholar 

  16. Chi DS, Welshinger M, Venkatraman ES, et al. The role of surgical cytoreduction in Stage IV endometrial cancer. Gynecol Oncol. 1997;1:56–60.

    Article  Google Scholar 

  17. Goff BA, Goodman A, Muntz HG, Fuller AF, Nikrui N, Rice L. Surgical stage IV endometrial carcinoma: a study of 47 cases. Gynecol Oncol. 1994;52:237–40.

    Article  CAS  Google Scholar 

  18. Morley GW, Hopkins MP, Lindenauer SM, et al. Pelvic exenteration, University of Michigan: 100 patients at 5 years. Obstet Gynecol. 1989;74:934–43.

    CAS  PubMed  Google Scholar 

  19. Barakat RR, Goldman NA, Patel DA, et al. Pelvic exenteration for recurrent endometrial cancer. Gynecol Oncol. 1999;75:99–102.

    Article  CAS  Google Scholar 

  20. Dowdy SC, Mariani A, Cliby WA, Haddock MG, Petersen IA, Sim FH, Podratz KC. Radical pelvic resection and intraoperative radiation therapy for recurrent endometrial cancer: technique and analysis of outcomes. Gynecol Oncol. 2006;101:280–6.

    Article  Google Scholar 

  21. Scarabelli C, Campagnutta E, Giorda G, DePiero G, Sopracordevole F, Quaranta M, DeMarco L. Maximal cytoreductive surgery as a reasonable therapeutic alternative for recurrent endometrial carcinoma. Gynecol Oncol. 1998;70:90–3.

    Article  CAS  Google Scholar 

  22. Campagnutta E, Giorda G, Depiero G, Sopracoreveole F, Visentin MC, Martella L, Scarabelli C. Surgical treatment of recurrent endometrial carcinoma. Cancer. 2004;100(1):89–96.

    Article  Google Scholar 

  23. Awtrey CS, Sadungog MG, Leitao MM, Alektiar KM, Aghajanian C, Hummer AJ, Barakat RR, Chi DS. Surgical resection of recurrent endometrial carcinoma. Gynecol Oncol. 2006;102(3):480–8.

    Article  Google Scholar 

  24. Bristow RE, Santillan A, Zahurak ML, Gardner GJ, Giuntoli 2nd RL, Armstrong DK. Salvage cytoreductive surgery for recurrent endometrial cancer. Gynecol Oncol. 2006;103(1):281–7.

    Article  Google Scholar 

  25. Potish RA, Twiggs LB, Adcock LL, Prem KA. Role of whole abdominal radiation therapy in the management of endometrial cancer: prognostic importance of factors indicating peritoneal metastases. Gynecol Oncol. 1985;21:80–6.

    Article  CAS  Google Scholar 

  26. Soper JT, Creasman WT, Clarke-Pearson DL, Sullivan DC, et al. Intraperitoneal chromic phosphate P 32 suspension therapy of malignant peritoneal cytology in endometrial carcinoma. Am J Obstet Gynecol. 1985;153:191–6.

    Article  CAS  Google Scholar 

  27. Wethington SL, Barrena Medel NI, Wright JD, Herzog TJ. Prognostic significance and treatment implications of positive peritoneal cytology in endometrial adenocarcinoma: unraveling a mystery. Gynecol Oncol. 2009;115(1):18–25.

    Article  Google Scholar 

  28. Havrilesky LJ, Secord AA, O’Malley DM, Broadwater G, Bae-Jump V, Cohn DE, Gehrig PA. Multicenter analysis of recurrence and survival in stage IIIA endometrial cancer. Gynecol Oncol. 2009;114(2):279–83.

    Article  Google Scholar 

  29. Creasman WT, Disaia PJ, Blessing J, et al. Prognostic significance of peritoneal cytology in patients with endometrial cancer and preliminary data concerning therapy with intraperitoneal radiopharmaceuticals. Am J Obstet Gynecol. 1981;141:921–9.

    Article  CAS  Google Scholar 

  30. Yazigi R, Piver MS, Blumenson L. Malignant peritoneal cytology as prognostic indicator in stage I endometrial cancer. Gynecol Oncol. 1983;62:359–62.

    CAS  Google Scholar 

  31. Potish RA, Twigs LB, Adcock LL, et al. Paraaortic lymph node radiotherapy in cancer of the uterine corpus. Obstet Gynecol. 1985;65:251–6.

    CAS  PubMed  Google Scholar 

  32. Feuer GA, Calanog A. Endometrial carcinoma: treatment of positive paraaortic nodes. Gynecol Oncol. 1987;27:104–9.

    Article  CAS  Google Scholar 

  33. Rose PG, Bundy BN, Watkins EB, Thigpen JT, Deppe G, Maiman MA, Clarke-Pearson DL, Insalaco S. Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med. 1999;340(15):1144–53.

    Article  CAS  Google Scholar 

  34. Peters WA, Liu PY, Barrett RJ, Stock RJ, Monk BJ, Berek JS, Souhami L, Grigsby P, Gordon W, Alberts DS. Concurrent chemotherapy and pelvic radiation therapy compared to pelvic radiation therapy alone as adjuvant therapy after radical surgery in high risk early stage cancer of the cervix. J Clin Oncol. 2000;18(8):1606–13.

    Article  CAS  Google Scholar 

  35. Pickel H, Lahousen M, Petru E, Stettner H, Hackl A, Kapp K, Winter R. Consolidation radiotherapy after carboplatin-based chemotherapy in radically operated advanced ovarian cancer. Gynecol Oncol. 1999;72(2):215–9.

    Article  CAS  Google Scholar 

  36. Duska LR, Berkowitz R, Matulonis U, Muto M, Goodman A, Mcintyre JF, Klein A, Atkinson T, Seiden MV, Campos S. A pilot trial of TAC (paclitaxel, doxorubicin, and carboplatin) chemotherapy with Filgrastim (r-met HuG-CSF) support followed by radiotherapy in patients with “high risk” endometrial cancer. Gynecol Oncol. 2005;96:198–203.

    Article  CAS  Google Scholar 

  37. Soper JT, Reisinger SA, Ashbury R, Jones E, Clarke-Pearson DL. Feasibility study of concurrent weekly cisplatin and whole abdominopelvic irradiation followed by doxorubicin/cisplatin chemotherapy for advanced stage endometrial carcinoma: a Gynecologic Oncology Group trial. Gynecol Oncol. 2004;95:95–100.

    Article  CAS  Google Scholar 

  38. Bruzzone M, Miglietta L, Frazone P, Gadducci A, Boccardo F. Combined treatment with chemotherapy and radiotherapy in high-risk FIGO stage III-IV endometrial cancer patients. Gynecol Oncol. 2004;93(2):345–52.

    Article  CAS  Google Scholar 

  39. Frigerio L, Mangili G, Aletti M, Carnelli M, Garavaglia E, Beatrice S, Ferrari A. Concomitant radiotherapy and paclitaxel for high-risk endometrial cancer: first feasibility study. Gynecol Oncol. 2001;81:53–7.

    Article  CAS  Google Scholar 

  40. Greven K, Winter K, Underhill K, Fontenesci J, Cooper J, Burke T. Preliminary analysis of RTOG 9708: adjuvant postoperative radiotherapy combined with cisplatin/paclitaxel chemotherapy after surgery for patients with high-risk endometrial cancer. Int J Radiat Oncol Biol Phys. 2004;59(1):168–73.

    Article  Google Scholar 

  41. Wilkinson-Ryan I, Binder PS, Pourabolghassem S, Al-Hammadi N, Fuh K, Hagemann A, THaker P, Scharz J, Grigsby P, Mutch D, Powell M. Concomitant chemotherapy and radiation for the treatment of advanced stage endometrial cancer. Gynecol Oncol. 2014;134(1):24–8.

    Article  CAS  Google Scholar 

  42. Randall ME, Filiaci VL, Muss H, Spirtos NM, Mannel RS, Fowler J, Thigpen JT, Benda JA. 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;24:34–44.

    Article  Google Scholar 

  43. Fleming GF. Major progress for a less common cancer. J Clin Oncol. 2006;24:6–8.

    Article  Google Scholar 

  44. Homesley HD, Filiaci V, Gibbons SK, 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;112:543–52.

    Article  CAS  Google Scholar 

  45. Aghajanian C, Sill MW, Darcy KM, Greer B, McMeekin DS, Rose PG, Rotmensch J, Barnes MN, Hanjani P, Leslie KK. Phase II trial of bevacizumab in recurrent or persistent endometrial cancer: a Gynecologic Oncology Group study. J Clin Oncol. 2011;29(16):2259–65.

    Article  CAS  Google Scholar 

  46. Viswanathan AN, Lee H, Berkowitz R, Berlin S, Campos S, Feltmate C, Horowitz N, Muto M, Sadow CA, Matulonis U. A prospective feasibility study of radiation and concurrent bevacizumab for recurrent endometrial cancer. Gynecol Oncol. 2014;132(1):55–60.

    Article  CAS  Google Scholar 

  47. Kelley RM, Baker WH. Progestational agents in the treatment of carcinoma of the endometrium. N Engl J Med. 1961;264:216–22.

    Article  CAS  Google Scholar 

  48. Piver MS, Barlow JJ, Luain JR, et al. Medroxyprogesterone acetate versus hydroxyprogesterone caproate in women with metastatic endometrial adenocarcinoma. Am J Clin Oncol. 1980;45:268–72.

    CAS  Google Scholar 

  49. Bonte J. Medroxyprogesterone in the management of primary and recurrent endometrial adenocarcinoma. Acta Obstet Gynecol Scand Suppl. 1972;19:21–4.

    Article  CAS  Google Scholar 

  50. Reifenstein EC. The treatment of advanced endometrial cancer with hydroxyprogesterone caproate. Gynecol Oncol. 1974;2:337–414.

    Article  Google Scholar 

  51. Geisler HE. The use of megestrol acetate in the treatment of advanced malignant lesions of the endometrium. Gynecol Oncol. 1979;1:340–6.

    Article  Google Scholar 

  52. Thigpen JT, Brady MF, Alvarez RD, 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;17:1736–44.

    Article  CAS  Google Scholar 

  53. Quinn MA, Cauchi M, Fortune D. Endometrial carcinoma: steroid receptors and response to medroxyprogesterone acetate. Gynecol Oncol. 1985;21:314–9.

    Article  CAS  Google Scholar 

  54. Thigpen JT, Blessing J, Disaia P. Oral medroxyprogesterone acetate in advanced or recurrent endometrial carcinoma: results of therapy and correlation with estrogen and progesterone receptor levels. In: Iacobelli S, editor. Endocrinology and malignancy: basic and clinical issues, The Proceedings of the First International Congress on Cancer and Hormones. Rome: CRC Press, Parthenon Publishers; 1986. p. 446–7.

    Google Scholar 

  55. Barakat RR, Grigsby PW, Sabbatini P, et al. Corpus epithelial tumors. In: Hoskins WJ, Perez CA, Young RC, editors. Principles and practices of gynecologic oncology. 2nd ed. Philadelphia, PA: Lippincott-Raven; 1997. p. 880–4.

    Google Scholar 

  56. Mortel R, Levy C, Wolff JP, et al. Female sex steroid receptors in postmenopausal endometrial carcinoma and biochemical response to an antiestrogen. Cancer Res. 1981;41:1140–7.

    CAS  PubMed  Google Scholar 

  57. Carlson JA, Allegra JC, Day TG, et al. Tamoxifen and endometrial carcinoma: alterations in estrogen and progesterone receptors in untreated patients and combination hormonal therapy in advanced neoplasia. Am J Obstet Gynecol. 1984;149:149–53.

    Article  Google Scholar 

  58. Thigpen JT, Brady MF, Homesley HD. Tamoxifen in the treatment of advanced or recurrent endometrial carcinoma. A Gynecologic Oncology Group study. J Clin Oncol. 2001;19:364–7.

    Article  CAS  Google Scholar 

  59. Moore TD, Phillips PH, Nerenstone SR, et al. Systemic treatment of advanced and recurrent endometrial carcinoma: current status and future directions. J Clin Oncol. 1991;9:1071–7.

    Article  CAS  Google Scholar 

  60. Pandya KJ, Yeap BY, Davis TE. Phase II study of megestrol and mestrol and tamoxifen in advanced endometrial carcinoma: an Eastern Cooperative Oncology Group (ECOG) study. Am J Clin Oncol. 2001;24:43–6.

    Article  CAS  Google Scholar 

  61. Fiorca JV, Brunetto VL, Hanjani P, et al. A phase II study of recurrent and advanced endometrial carcinoma treated with alternating courses of megestrol acetate (Megace) and tamoxifen citrate (Nolvadex). Gynecol Oncol. 2004;92(1):10–4.

    Article  Google Scholar 

  62. Whitney CW, Brunetto VL, Zaine RJ, et al. Phase II study of medroxyprogesterone acetate plus tamoxifen in advanced endometrial carcinoma: a Gynecologic Oncology study. Gynecol Oncol. 2004;92:4–9.

    Article  CAS  Google Scholar 

  63. Horton J, Elson P, Gordon P, et al. Combination chemotherapy for advanced endometrial cancer. An evaluation of three regimens. Cancer. 1982;49:2441–5.

    Article  CAS  Google Scholar 

  64. Piver MS, Lele SB, Patsner B, et al. Melphalan, 5-fluorouracil, and medroxyprogesterone acetate in metastatic endometrial carcinoma. Obstet Gynecol. 1986;67:261–7.

    Article  CAS  Google Scholar 

  65. Cohen CJ, Bruckner HW, Deppe G, et al. Multidrug treatment of advanced and recurrent endometrial carcinoma: a Gynecologic Oncology Group study. Obstet Gynecol. 1984;63:719–26.

    CAS  PubMed  Google Scholar 

  66. Ayoub J, Audet-Lapointe P, Methot Y, et al. Efficacy of sequential cyclical hormonal therapy in endometrial cancer and its correlation with steroid hormone receptor status. Gynecol Oncol. 1988;31:327–37.

    Article  CAS  Google Scholar 

  67. Cornelison TL, Baker TR, Piver MS, et al. Cisplatin, adriamycin, etoposide, megestrol acetate versus melphalan, 5-fluorouracil, medroxyprogesterone acetate in the treatment of endometrial carcinoma. Gynecol Oncol. 1995;59:243–8.

    Article  CAS  Google Scholar 

  68. Bafaloukos D, Aravantinos G, Samonis G, et al. Carboplatin, methotrexate and 5-fluorouracil in combination with medroxyprogesterone acetate (JMF-M) in the treatment of advanced or recurrent endometrial carcinoma: a Hellenic cooperative oncology group study. Oncology. 1999;56:198–201.

    Article  CAS  Google Scholar 

  69. Bevis KS, Kilgore LC, Alvarez RD, Straughn Jr JM, Leath 3rd CA. Combination therapy with paclitaxel, carboplatin, and megestrol acetate for the management of advanced stage or recurrent carcinoma of the endometrium: a phase II study. J Reprod Med. 2014;59(3-4):113–20.

    CAS  PubMed  Google Scholar 

  70. Rose PG, Brunetto VL, VanLe L, Bell J, Walker JL, Lee RB. A phase II trial of anastrozole in advanced recurrent or persistent endometrial carcinoma: a Gynecologic Oncology Group Study. Gynecol Oncol. 2000;78(2):212–6.

    Article  CAS  Google Scholar 

  71. Gallion HH, Brunetto VL, Cibull M, et al. Randomized phase III trial of standard timed doxorubicin plus cisplatin versus circadian timed doxorubicin plus cisplatin in stage III and IV or recurrent endometrial carcinoma: a Gynecologic Oncology Group study. J Clin Oncol. 2003;21:3808–13.

    Article  CAS  Google Scholar 

  72. Ma BB, Oza A, Eisenhauer E, Stanimir G, Carey M, Chapman W, Latta E, Sidu K, Powers J, Walsh W, Fyles A. The activity of letrozole in patients with advanced or recurrent endometrial cancer and correlation with biological markers- a study of the National Cancer Institute of Canada Clinical Trials Group. Int J Gynecol Cancer. 2004;14(4):650–8.

    Article  CAS  Google Scholar 

  73. Slomovitz BM, Jiang Y, Yates MS, Soliman PT, Johnston T, Nowakowski M, et al. A phase II study of everolimus and letrozole in patients with recurrent endometrial carcinoma. J Clin Oncol. 2015;33:930.

    Article  CAS  Google Scholar 

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Correspondence to Marcela G. del Carmen M.D., M.P.H. .

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del Carmen, M.G., Horowitz, N.S. (2015). Treatment for Advanced and Recurrent Carcinoma: Combined Modalities. In: Muggia, F., Santin, A.D., Oliva, E. (eds) Uterine Cancer. Current Clinical Oncology. Springer, Cham. https://doi.org/10.1007/7631_2015_10

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  • DOI: https://doi.org/10.1007/7631_2015_10

  • Publisher Name: Springer, Cham

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