Neoadjuvant chemotherapy followed by interval debulking surgery in patients with serous endometrial cancer with transperitoneal spread (stage IV): a new preferred treatment?
Vandenput I et al. - In a study to investigate the value of neoadjuvant chemotherapy (NACT), followed by interval debulking surgery (IDS), in endometrial cancer with transperitoneal spread (stage IV), it was found that use of NACT resulted in a high rate (80%) of optimal IDS for treatment of endometrial cancer with transperitoneal spread. Methods- Pts 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 (RECIST), residual tumour at IDS and histopathological assessment of tumour regression.
Results- 30 pts (median age: 65 yrs) 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).
- Pts with PD were not operated upon.
- 24 pts (80%) had optimal cytoreduction (R 1 cm), of whom 22 (92%) were without residual tumour.
- 4 pts were considered inoperable and were excluded from further analysis.
- Median progression-free survival (PFS) and overall survival (OS) times were 13 and 23 mos, respectively.
- Histopathological features of chemoresponse in both uterus and omentum were related to better PFS and OS.
- Absence of tumour infiltration and necrosis were associated with prognosis.
[more...]
|
|
|
