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
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.
Morgan JD, Reddy S, Sarin P, et al. Isolated vaginal recurrences of endometrial carcinoma. Radiology. 1993;189:609–13.
Hoekstra CJ, Koper PC, van Putten WL. Recurrent endometrial adenocarcinoma after surgery alone: prognostic factors and treatment. Radiother Oncol. 1998;27:164–6.
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.
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.
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.
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.
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.
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.
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.
Wylie J, Irwin C, Pintilie M, et al. Results of radical radiotherapy for recurrent endometrial cancer. Gynecol Oncol. 2000;77:66–72.
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.
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.
Tewari K, Cappuccini F, Brewster WR, et al. Interstitial brachytherapy for vaginal recurrences of endometrial carcinoma. Gynecol Oncol. 1999;74:416–22.
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.
Chi DS, Welshinger M, Venkatraman ES, et al. The role of surgical cytoreduction in Stage IV endometrial cancer. Gynecol Oncol. 1997;1:56–60.
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.
Morley GW, Hopkins MP, Lindenauer SM, et al. Pelvic exenteration, University of Michigan: 100 patients at 5 years. Obstet Gynecol. 1989;74:934–43.
Barakat RR, Goldman NA, Patel DA, et al. Pelvic exenteration for recurrent endometrial cancer. Gynecol Oncol. 1999;75:99–102.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Yazigi R, Piver MS, Blumenson L. Malignant peritoneal cytology as prognostic indicator in stage I endometrial cancer. Gynecol Oncol. 1983;62:359–62.
Potish RA, Twigs LB, Adcock LL, et al. Paraaortic lymph node radiotherapy in cancer of the uterine corpus. Obstet Gynecol. 1985;65:251–6.
Feuer GA, Calanog A. Endometrial carcinoma: treatment of positive paraaortic nodes. Gynecol Oncol. 1987;27:104–9.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Fleming GF. Major progress for a less common cancer. J Clin Oncol. 2006;24:6–8.
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.
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.
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.
Kelley RM, Baker WH. Progestational agents in the treatment of carcinoma of the endometrium. N Engl J Med. 1961;264:216–22.
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.
Bonte J. Medroxyprogesterone in the management of primary and recurrent endometrial adenocarcinoma. Acta Obstet Gynecol Scand Suppl. 1972;19:21–4.
Reifenstein EC. The treatment of advanced endometrial cancer with hydroxyprogesterone caproate. Gynecol Oncol. 1974;2:337–414.
Geisler HE. The use of megestrol acetate in the treatment of advanced malignant lesions of the endometrium. Gynecol Oncol. 1979;1:340–6.
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.
Quinn MA, Cauchi M, Fortune D. Endometrial carcinoma: steroid receptors and response to medroxyprogesterone acetate. Gynecol Oncol. 1985;21:314–9.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Horton J, Elson P, Gordon P, et al. Combination chemotherapy for advanced endometrial cancer. An evaluation of three regimens. Cancer. 1982;49:2441–5.
Piver MS, Lele SB, Patsner B, et al. Melphalan, 5-fluorouracil, and medroxyprogesterone acetate in metastatic endometrial carcinoma. Obstet Gynecol. 1986;67:261–7.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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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
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