Uterine Papillary Serous Carcinoma: Comparisons of Outcomes in Surgical Stage I Patients With and Without Adjuvant Therapy

Abstract

A review of medical records between 1987 and 2000 at the authors' institutions identified 60 patients who had undergone hysterectomy for treatment of stage I uterine papillary serous carcinoma. The outcomes of those who had and who had not received adjuvant therapy were compared. All patients underwent total hysterectomy with bilateral salpingo-oophorectomy, pelvic/para-aortic lymphadenectomy, and peritoneal cytology. Twenty patients had received adjuvant therapy. Baseline demographic and clinical characteristics were similar for both arms of the study. Adjuvant radiation therapy was administered to 12 patients (3 stage IA, 6 stage IBC, and 3 stage IC), including 4 who received brachytherapy alone, 3 who were given whole abdominal radiation therapy, and 5 who had brachytherapy plus whole pelvic radiation. After a mean follow up of 40 months, 2 patients in this group had recurred, 1 in the chest (stage IC) and 1 in the upper abdomen (stage IA). Despite additional treatment with chemotherapy, both of these women died. Seven (33%) of the 20 adjuvant therapy patients (2 stage IA, 3 stage IB, and 2 stage IC) received chemotherapy, including platinum-based agents with cyclophosphamide, doxorubicin, or paclitaxel. There were no recurrences in this group after a mean 32 months of follow up. The final patient in the adjuvant therapy group was treated with both whole abdominal radiation and chemotherapy. She was alive and well 57 months after treatment. Among the 40 patients who had no adjuvant therapy, 13 were diagnosed with stage IA disease, 17 with stage IBC disease, and 10 with stage IC. In a mean follow-up period of 24 months, 7 (17%) had a recurrence of disease (mean time to recurrence 17 months). All 7 recurrences were outside the pelvis, although 4 appeared initially to be confined to the vaginal cuff. These 4 received brachytherapy and whole pelvic radiation, and the other 3 were treated with chemotherapy. Six of the 7 have died and 1 is alive with disease. The average disease-free intervals for women in the adjuvant therapy and the observation groups were 41 and 31 months, respectively. The mean overall survival was 40 and 39 months, respectively. The 5-year disease-free survival rates for the adjuvant therapy group and the observation group were 60% and 66%, respectively (P = 0.08), and the mean overall survival rate for both groups were 59 and 66%, respectively.