The importance of chemotherapy and radiation in uterine papillary serous carcinoma

Abstract: Purpose: To identify prognostic and predictive factors of overall survival (OS), relapse-free survival (RFS) and toxicity for patients with uterine papillary serous carcinoma (UPSC). Materials and methods: Patient, tumor, treatment and relapse characteristics of 135 women with Stages I–IVA UPSC treated between 1980 and 2006 at Dana–Farber/Brigham and Women''s Cancer Center (DF/BWCC) were analyzed using Cox regression models to determine prognostic and predictive factors for OS, RFS and toxicity. Results: Mean follow-up was 5.5years (range, 0.01–25.2). Median 5-year OS was 52%, and RFS was 42% for all patients. On Cox regression analysis, increasing age, stage, and myometrial invasion were prognostic factors associated with shorter OS and RFS. A paclitaxel–platinum chemotherapy regimen was significantly associated with longer OS (hazard ratio [HR]=0.34, 95% confidence interval [CI] 0.15–0.74, p=0.007) and RFS (HR=0.45, 95% CI 0.22–0.92, p=0.03). RFS was improved for patients treated with RT (HR=0.44, 95% CI 0.25–0.77, p=0.004). The 5-year grade 3+ toxicity rate was 3.5% for those who received RT and was 2.9% for those who did not (p=NS). Conclusion: Uterine papillary serous cancer can be an aggressive tumor type with a poor prognosis. RFS was improved by radiation and chemotherapy with few grade 3 or higher complications. Using radiation and paclitaxel–platinum chemotherapy should be attempted whenever feasible for patients with UPSC who do not have distant metastases at diagnosis. [Copyright &y& Elsevier]