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Management of Women with Uterine Papillary Serous Cancer: a Society of Gynecologic Oncology (SGO) Review☆

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Management of Women with Uterine Papillary Serous Cancer: a Society of Gynecologic Oncology (SGO) Review☆ Gynecologic Oncology 115 (2009) 142–153 Contents lists available at ScienceDirect Gynecologic Oncology journal homepage: www.elsevier.com/locate/ygyno Review Management of women with uterine papillary serous cancer: A Society of Gynecologic Oncology (SGO) review☆ David M. Boruta II a,⁎, Paola A. Gehrig b, Amanda Nickles Fader c, Alexander B. Olawaiye d a Department of Obstetrics, Gynecology and Reproductive Biology, Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, MA 02114, USA b Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA c Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA d Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Gynecologic Oncology, University of Pittsburgh Medical Center, Magee-Women's Hospital, Pittsburgh, PA 15213, USA article info abstract Article history: Objective. Uterine papillary serous carcinoma (UPSC) is a clinically and pathologically distinct subtype of Received 7 May 2009 endometrial cancer. Although less common than its endometrioid carcinoma (EEC) counterpart, UPSC Available online 9 July 2009 accounts for a disproportionate number of endometrial cancer related deaths. To date, limited prospective trials exist from which evidence-based management can be developed. This review summarizes the Keywords: available literature concerning UPSC in an effort to provide the clinician with information pertinent to its Uterine papillary serous carcinoma management. Endometrial cancer Staging Methods. MEDLINE was searched for all research articles published in English between January 1, 1966 Radiotherapy and May 1, 2009 in which the studied population included women diagnosed with UPSC. Although Chemotherapy preference was given to prospective studies, studies were not limited by design or by numbers of subjects given the paucity of available reports. Results. UPSC is morphologically and genetically different from EEC. Women often present with postmenopausal vaginal bleeding, but may also present with abnormal cervical cytology, ascites, or a pelvic mass. In some cases, the diagnosis may be made with endometrial biopsy, while in other cases it is not made until the time of definitive surgery. Metastatic disease is common and best identified via comprehensive surgical staging. Local and distant recurrences occur frequently, with extra-pelvic relapses reported most commonly. Optimal cytoreduction and adjuvant platinum/taxane-based chemotherapy appear to improve survival, while adjuvant radiotherapy may contribute to loco-regional disease control. Conclusions. Women diagnosed with UPSC should undergo comprehensive surgical staging and an attempt at optimal cytoreduction. Platinum/taxane-based adjuvant chemotherapy should be considered in the treatment of both early- and advanced-stage patients. Careful long-term surveillance is indicated as many of these women will recur. Prospective clinical trials of women with UPSC are necessary in order to delineate the optimal therapy for women with newly diagnosed and recurrent disease. © 2009 Elsevier Inc. All rights reserved. Contents Introduction ................................................................ 143 Questions................................................................ 143 Choice of topic and rationale....................................................... 143 Methods .................................................................. 143 Literature search strategy ........................................................ 143 Results ................................................................... 143 Epidemiology .............................................................. 143 Molecular biology and pathogenesis ................................................... 144 ☆ The Society of Gynecologic Oncologists Clinical Practice Committee is providing this evidence-based medicine summary of current clinical science to SGO members to help facilitate treatment planning. ⁎ Corresponding author. Massachusetts General Hospital, Vincent Obstetrics and Gynecology Service, Gillette Center for Gynecologic Oncology, Yawkey Center, Suite 9E, 55 Fruit street, Boston, MA 02114, USA. Fax: +1 617 724 6898. E-mail address: [email protected] (D.M. Boruta). 0090-8258/$ – see front matter © 2009 Elsevier Inc. All rights reserved. doi:10.1016/j.ygyno.2009.06.011 D.M. Boruta II et al. / Gynecologic Oncology 115 (2009) 142–153 143 Diagnosis ............................................................... 145 Management .............................................................. 145 Surgery ................................................................ 145 Adjuvant therapy ............................................................ 146 Risk and pattern of recurrence of UPSC ................................................ 146 Early-stage disease ........................................................... 146 Radiotherapy ............................................................ 146 Chemotherapy ........................................................... 147 Advanced-stage and recurrent disease .................................................. 148 Radiotherapy ............................................................ 148 Chemotherapy ........................................................... 148 Chemotherapy vs. radiotherapy ................................................... 149 Tumor markers and surveillance..................................................... 149 Future research............................................................. 149 Summary and recommendations ...................................................... 150 Questions ............................................................... 150 Target population............................................................ 150 Key evidence .............................................................. 150 Recommendations ........................................................... 150 Conflict of interest statement ........................................................ 150 Acknowledgments ............................................................. 150 References ................................................................. 150 Introduction an initial set of topics and prepared drafts of guidelines for review by the CPC. Final drafts were discussed with the SGO Council and other Questions appropriate SGO committees before publication. 1. What distinguishes uterine papillary serous carcinoma (UPSC) from Literature search strategy endometrioid (EEC) and other endometrial histologic subtypes? 2. Based on available evidence, what is the best approach to the A MEDLINE search of English literature published between January management of women with UPSC? 1966 and June 2009 was performed. All publications with the keywords “uterine neoplasm” or “endometrial neoplasm” were Choice of topic and rationale combined and then searched for the keyword “serous” in order to develop a comprehensive list of literature related to UPSC. Additional Endometrial cancer remains the most common gynecologic publications were identified by survey of reference lists within malignancy in women in the United States. In 2008, an estimated identified publications. 40,100 new cases of endometrial cancer will be diagnosed and 7470 While developing this review, especially the portion devoted to deaths will occur. The incidence of endometrial cancer is approxi- management, the merit of creating inclusion and exclusion criteria mately the same as the incidence of all other female genital tract based upon subject numbers within each study was considered. malignances combined [1]. While the incidence and mortality rates Ultimately, the lack of data in the form of large trials was felt to prohibit from several other cancers have plateaued or decreased in the last exclusion of publications reporting small pools of UPSC patients. Thus, decade, rates for endometrial cancer continue to rise [1]. Although the all peer reviewed original report publications containing the appro- reasons for this are likely multifactorial, findings from a recent SEER priate subjects were considered. In the studies that include different database study of more than 45,000 women with endometrial cancer histologic types of endometrial cancer, we extracted subsection suggest that the increase in mortality may be related to an increased analysis specific to the papillary serous subtype whenever such were rate of advanced-stage cancers and high-risk histologies including available. However, as many of the grade 3 endometrial cancers are of UPSC [2]. mixed histologies, we included those in which the papillary serous Although UPSC represents approximately 10% of all endometrial component was driving the clinical behavior of the tumor. cancer diagnoses, it accounts for up to 39% of endometrial cancer related deaths [2–4]. This disproportion makes clear the need for Results improved management. Unfortunately, prospective randomized study of UPSC has been hampered by its relative rarity. Evidence-based Epidemiology management is thus difficult to develop and expert consensus has been slow to evolve. Lauchlan and Hendrickson et al. first established UPSC as a distinct On this note, the Society for Gynecologic Oncologists (SGO) subtype of endometrial cancer describing it as histologically similar to working through the Clinical Practice Committee
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