Neoadjuvant chemotherapy followed by surgery for advanced-stage endometrial cancer.

N.M De Lange,L.J.M Van Der Putten,I Vandenput,J.S Kwon,J.M.A Pijnenborg,D Mirchandani,N.P.M Ezendam,F Amant

doi:10.3747/co.26.4655

Abstract

Data showing the value of neoadjuvant chemotherapy (nact) followed by interval debulking surgery (ids) in the management of advanced-stage serous endometrial carcinoma (eca) are limited; the aim of the present study was to expand the knowledge about that treatment strategy in patients with advanced eca, including endometrioid eca. Data were collected retrospectively from all patients with advanced-stage eca treated with nact between 2005 and 2014 at 3 oncology referral centres. Primary outcomes were the radiologic response to nact and achievement of optimal or complete ids. Secondary outcomes were recurrence rate and progression-free and overall survival. Of 102 eca cases included, a complete radiologic response was achieved in only 4 cases, with a partial response being achieved in 72% (64% of endometrioid cases, 80% of serous cases). Complete ids was achieved in 62% of the endometrioid cases and in 56% of the serous eca cases, with optimal ids achieved in 31% and 28% of those cases respectively. Survival rates were calculated for all patients with complete and optimal ids; recurrence was observed in 56% and 67% of the cases respectively, and progression-free survival was 18 months and 13 months respectively. Median survival duration was 24 months for endometrioid eca and 28 months for serous eca. For patients with advanced eca who are not suitable for primary debulking, nact followed by ids can be considered regardless of histologic subtype. The treatment options for this group of patients are limited and have to be explored.

Highlights

Endometrial carcinoma is the most common gynaecologic malignancy in developed countries, with a lifetime risk of 2.88% for white and 1.69% for African American women[1,2]
For patients with advanced eca who are not suitable for primary debulking, nact followed by ids can be considered regardless of histologic subtype
NEOADJUVANT CHEMOTHERAPY FOR ADVANCED-STAGE ENDOMETRIAL CANCER, de Lange et al Another study compared surgical outcomes and survival for Fédération Internationale de Gynécologie et d’Obstétrique stage iv serous eca treated with either nact followed by ids or by complete debulking followed by adjuvant chemotherapy[8]

Summary

Introduction

Endometrial carcinoma (eca) is the most common gynaecologic malignancy in developed countries, with a lifetime risk of 2.88% for white and 1.69% for African American women[1,2]. The primary treatment for these carcinomas is surgical[3]. Some patients are unfit for primary surgical treatment because of either comorbidities or advanced disease. A prospective study demonstrated that neoadjuvant chemotherapy (nact) followed by interval debulking surgery (ids) is an effective alternative treatment strategy for patients with advanced serous eca[4], which, like ovarian cancer, usually spreads intraperitoneally[5,6]. Data showing the value of neoadjuvant chemotherapy (nact) followed by interval debulking surgery (ids) in the management of advanced-stage serous endometrial carcinoma (eca) are limited; the aim of the present study was to expand the knowledge about that treatment strategy in patients with advanced eca, including endometrioid eca

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Discussion

Conclusion