Five-year outcomes of adjuvant carboplatin/paclitaxel chemotherapy and intravaginal radiation for stage I–II papillary serous endometrial cancer

Abstract

ObjectiveThe purpose of this study is to report our single-institution experience with concurrent adjuvant intravaginal radiation (IVRT) and carboplatin/paclitaxel chemotherapy for early stage uterine papillary serous carcinoma (UPSC). MethodsFrom 10/2000 to 12/2009, 41 women with stage I–II UPSC underwent surgery followed by IVRT (median dose of 21Gy in 3 fractions) and concurrent carboplatin (AUC=5–6) and paclitaxel (175mg/m2) for six planned cycles. IVRT was administered on non-chemotherapy weeks. The Kaplan–Meier method was used to estimate survival, and the log-rank test was used for comparisons. ResultsMedian patient age was 67years (51–80years). Surgery included hysterectomy, bilateral salpingo-oophorectomy, peritoneal washings, omental biopsy, and pelvic and paraaortic lymph node sampling. FIGO 2009 stage was IA in 73%, IB in 10%, and II in 17%. Histology was pure serous in 71% of cases. Thirty-five patients (85%) completed all planned treatment. With a median follow-up time of 58months, the 5-year disease-free (DFS) and overall survival (OS) rates were 85% (95%CI, 73–96%) and 90% (95%CI, 80–100%). The 5-year pelvic, para-aortic, and distant recurrence rates were 9%, 5%, and 10%, respectively. There were no vaginal recurrences. Of the 4 pelvic recurrences, 2 were isolated and were successfully salvaged. Patients with stage II disease had lower DFS (71% vs. 88%; p=0.017) and OS (71% vs. 93%; p=0.001) than patients with stage I disease. ConclusionsConcurrent adjuvant carboplatin/paclitaxel chemotherapy and IVRT provide excellent outcomes for early stage UPSC. Whether this regimen is superior to pelvic radiation will require confirmation from the ongoing randomized trial.