Chemotherapy in the adjuvant and advanced-recurrent settings

Sandro Pignata, Carmela Pisano, Sabrina Chiara Cecere, Francesca Esposito, Davide Leopardo, Giovanni Salvatore Bruni, Gaetano Facchini

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Endometrial cancer is a highly curable malignancy when it presents as uterine-confined disease, but the prognosis for metastatic or recurrent endometrial cancer is poor. For those patients which are diagnosed at an early stage, surgery alone may be adequate for cure and clinical outcome is often favorable, with approximately 90% of cases surviving at 5 years. However, after primary diagnosis and treatment, roughly 30-40% of patients with stage III and IV are expected to recur within the following 5 years. Adjuvant treatment for endometrial cancer is not yet clearly defined. FIGO Stage I-III endometrial cancer patients, usually undergo surgery and some of them are offered adjuvant treatment based on risk assessment. Grade, age, stage are considered all independent risk factor for recurrence. Radiotherapy (RT) has been considered the adjuvant therapy of choice for decades, being able to reduce local recurrence rate and improving progression free survival, but without any impact on overall survival. In the last two decades, a shift toward the use of more systemic chemotherapy (CT) in addition or instead of radiation has occurred, although few prospective studies have been performed in this field. On the other end the median survival of women with recurrent or metastatic endometrial cancer is only approximately 12 months. Hormonal therapy, most commonly with progestins, benefits a small group of patients. Cytotoxic chemotherapy is indicated as frontline treatment for the majority of women with metastatic or recurrent disease. Combination chemotherapy typically produces quite high response rates, although combination regimens have not always improved survival historically. Recently, a GOG randomized trial compared doxorubicin plus cisplatin to the triplet of doxorubicin, cisplatin and paclitaxel and it was found that the addition of paclitaxel significantly improved response rate, progression-free survival, and overall survival although at the price of significant toxicity.

Original languageEnglish
Title of host publicationEndometrial Cancer: Prevention, Diagnosis and Treatment
PublisherNova Science Publishers, Inc.
Pages197-206
Number of pages10
ISBN (Print)9781622577408
Publication statusPublished - Feb 2013

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

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    Pignata, S., Pisano, C., Cecere, S. C., Esposito, F., Leopardo, D., Bruni, G. S., & Facchini, G. (2013). Chemotherapy in the adjuvant and advanced-recurrent settings. In Endometrial Cancer: Prevention, Diagnosis and Treatment (pp. 197-206). Nova Science Publishers, Inc..