Surgical management and adjuvant therapy for patients with uterine clear cell carcinoma: A multi-institutional review

Abstract

Objective To assess the role of surgical staging, adjuvant therapy, and cytoreduction in uterine clear cell carcinoma (UCCC). Methods A retrospective review was conducted at 2 major gynecologic cancer centers of all primary UCCC between 1982 and 2004. Results UCCC was confirmed in 99 patients. The 5-year overall survival (OS) was 79%, 77%, 47%, and 21% for stages I–IV respectively. 69 patients had no gross evidence of extra-uterine disease, but 36 (52%) were upstaged at surgery. For those 22 patients with stages I and II disease who had a systematic lymphadenectomy (LND) (> 20 lymph nodes), no lymphatic (LF), peritoneal (PF), or hematological (HF) failures were noted. Radiation (RT) improved PFS (67 vs. 36%, p = 0.02), and reduced pelvic sidewall recurrences (18 vs. 53%, p = 0.04) and vaginal failures (VF) (7 vs. 35%, p = 0.04) for 45 patients at risk for LF (positive nodes or suboptimal LND). 39 patients with stages IIIC and IV disease were separately analyzed. Patients with no visible residual disease after cytoreduction had a significant improvement in median PFS (17 vs. 7months, p < 0.001), and OS (40 vs. 18months, p = 0.02) compared to patients with any residual disease after surgery. Conclusion Comprehensive surgical staging with a systematic LND is essential to accurately define early stage UCCC. Vaginal brachytherapy may be adequate adjuvant therapy for stages I and II UCCC confirmed by systematic LND. Patients at risk for LF appear to benefit from pelvic RT. An effort at cytoreduction to no visible residual disease should be made in advanced UCCC when feasible.