Vandenput I, Van Calster B, Capoen A, Leunen K, Berteloot P, Neven P, Moerman P, Vergote I, Amant F
Neoadjuvant chemotherapy followed by interval debulking surgery in patients with serous endometrial cancer with transperitoneal spread (stage IV): a new preferred treatment? [JOURNAL ARTICLE]
Br J Cancer 2009 Jun 30.
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.British Journal of Cancer advance online publication, 30 June 2009; doi:10.1038/sj.bjc.6605157 www.bjcancer.com.
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