Journal Article

Neoadjuvant chemotherapy followed by interval debulking surgery in patients with serous endometrial cancer with transperitoneal spread (stage IV): a new preferred treatment?

Moerman, Ph, Van Calster, B, Berteloot, P, Capoen, A, Vergote, I, Vandenput, I, Neven, P, Amant, F, Leunen, K

2009

Overview

Background: To investigate the value of neoadjuvant chemotherapy (NACT), followed by interval debulking surgery (IDS), in endometrial cancer with transperitoneal spread (stage IV). Methods: Patients with endometrial cancer with transperitoneal spread, as determined by laparoscopy (±pleural effusion), were treated with NACT. Efficacy was determined according to the Response Evaluation Criteria in Solid Tumors, residual tumour at IDS and histopathological assessment of tumour regression. Results: A total of 30 patients (median age: 65 years; range:44–81 years) received 3–4 cycles of NACT (83% paclitaxel/carboplatin). Histopathological subtypes were as follows: serous (90%), clear cell (3%) and endometrioid (6%) carcinoma. Response according to RECIST was as follows: 2 (7%) complete remission, 20 (67%) partial remission, 6 (20%) stable disease and 2 (7%) progressive disease (PD). Patients with PD were not operated upon. A total of 24 patients (80%) had optimal cytoreduction ( R ⩽1 cm), of whom 22 (92%) were without residual tumour. Four patients were considered inoperable and were excluded from further analysis. The median progression-free survival and overall survival times were 13 and 23 months, respectively. Histopathological features of chemoresponse in both uterus and omentum were related to a better PFS ( P =0.017, hazard ratio (HR) =0.785) and overall survival ( P =0.014, HR=0.707). In particular, the absence of tumour infiltration and necrosis were associated with prognosis. Conclusion: The use of NACT resulted in a high rate (80%) of optimal IDS for the treatment of endometrial cancer with transperitoneal spread.

• Publisher: Nature Publishing Group UK,Nature Publishing Group
• Subject: Adenocarcinoma, Clear Cell - drug therapy / Adenocarcinoma, Clear Cell - pathology / Adenocarcinoma, Clear Cell - surgery / Adult / Aged / Aged, 80 and over / Antineoplastic Combined Chemotherapy Protocols - adverse effects / Antineoplastic Combined Chemotherapy Protocols - therapeutic use / Ascites / Biological and medical sciences / Biomedical and Life Sciences / Biomedicine / Cancer Research / Cancer therapies / Carboplatin - administration & dosage / Carboplatin - adverse effects / Carcinoma, Endometrioid - drug therapy / Carcinoma, Endometrioid - pathology / Carcinoma, Endometrioid - surgery / Chemotherapy / Chemotherapy, Adjuvant / Clinical Study / Cystadenocarcinoma, Serous - drug therapy / Cystadenocarcinoma, Serous - pathology / Cystadenocarcinoma, Serous - surgery / Disease-Free Survival / Drug Resistance / Endometrial cancer / Endometrial Neoplasms - drug therapy / Endometrial Neoplasms - pathology / Endometrial Neoplasms - surgery / Epidemiology / Female / Female genital diseases / Gynecology. Andrology. Obstetrics / Humans / Laparoscopy / Medical prognosis / Medical research / Medical sciences / Metastasis / Middle Aged / Molecular Medicine / Neoadjuvant Therapy / Neoplasm Staging / Oncology / Ovarian cancer / Paclitaxel - administration & dosage / Paclitaxel - adverse effects / Pleural effusion / Prospective Studies / Remission (Medicine) / Surgery / Tumors / Uterus