Large retrospective analysis out of Stanford supports use of standard chemo/brachytherapy for USPC a

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This recap includes posts that were lost during CSN's data outage from 10/29/18 to 1/30/19.

zsazsa1

Jan 05, 2019 - 12:06 am

I cannot get at the entire article.  Is anyone associated with a university that might have a medical library tha would have access to the entire article?  Here's the link, and below it the text.  There is information about stage III that would only be in the full text.

https://www.ncbi.nlm.nih.gov/pubmed/30551884

The interesting thing is that it's large, over 1700 patients.  And they're older, since they're all on Medicare, because the info was taken from the SEER-Medicare files (Cancer registry of people on Medicare).  Essentially, what was found for stage I - II UPSC was that the chance of having died of cancer by 4 yrs after surgery if you had NO treatment was 25%.  If you had one treatment (brachytherapy or chemo), your chance of having died of cancer by 4 yrs was 15%.  And if you had both brachytherapy and chemo, the chance of death from cancer by 4 yrs after surgery was 9%.  Stage III survival was helped by chemo.  But the specifics are not in the abstract - we would need to get at the full text.

I would say that this is encouraging and pretty strong evidence that our oncologists' recommendation of chemo and brachytherapy is the way to go for stage I-II.  I'm finding that the chemo is not so bad.  I can definitely live through it.  And hopefully, in my case, where the washings were negative, the visual inspection was negative, and only isolated cells were found in one sentinal node, I really was a stage I.  My CA-125 however was more consistent with a III.

For those who are considering whether the chemo and brachy are worth it, this should be useful information.  I'd really like to see the entire article, but for those who are of Medicare age who have this cancer, the evidence is strong that the treatment helps.  And one could assume that for younger patients, it would probably also help.

Gynecol Oncol. 2018 Dec 12. pii: S0090-8258(18)31472-0. doi: 10.1016/j.ygyno.2018.12.007. [Epub ahead of print]

National patterns of care and cancer-specific outcomes of adjuvant treatment in patients with serous and clear cell endometrial carcinoma.

Xiang M1, English DP2, Kidd EA3.

Author information

1 Department of Radiation Oncology, Stanford University, Stanford, CA, United States of America.

2 Department of Gynecology, Division of Gynecologic Oncology, Stanford University, Stanford, CA, United States of America.

3 Department of Radiation Oncology, Stanford University, Stanford, CA, United States of America. Electronic address: ekidd@stanford.edu.

Abstract

OBJECTIVES:

To investigate outcomes of adjuvant therapy for serous and clear cell endometrial carcinoma, as prior studies are limited by sample size and/or patient heterogeneity. National guidelines permit substantial variations in treatment, suggesting the need for additional data.

METHODS:

Patients with FIGO stages I-III serous or clear cell uterine carcinoma who underwent at least total hysterectomy were identified in SEER-Medicare. Adjuvant external beam radiation, brachytherapy, and chemotherapy were determined using SEER fields and Medicare claims. The primary outcome was death from endometrial cancer (cancer-specific mortality [CSM]) evaluated using Gray's test (univariable analysis, UVA) and Fine-Gray regression (multivariable analysis, MVA).

RESULTS:

A total of 1789 patients (1437 serous, 352 clear cell) were identified. In stages I-II patients (n = 1188), brachytherapy was significant for survival in UVA (P = 0.03) and MVA (P = 0.02). Additionally, in the subset with serous histology (n = 947), chemotherapy was also significant in UVA (P = 0.002) and approached significance in MVA (P = 0.05). The 4-year CSM for stages I-II serous cancers was 25% without brachytherapy or chemotherapy, 15% with one, and 9% with both (P ≤ 0.05 for all pairwise comparisons). In stage III patients (n = 601), chemotherapy was significant in UVA (P = 0.002) and MVA (P = 0.006). Most (81%) patients underwent lymph node dissection, which predicted lower CSM in stage III (P = 0.001) but not stages I-II patients.

CONCLUSIONS:

Our results suggest brachytherapy benefits stages I-II serous/clear cell cancers, chemotherapy benefits stage III serous/clear cell cancers, and both chemotherapy and brachytherapy benefit stages I-II serous cancers.

Copyright © 2018. Published by Elsevier Inc.

KEYWORDS:

Brachytherapy; Chemotherapy; Clear cell carcinoma; Endometrial cancer; External beam radiation; Serous carcinoma

PMID:  30551884

DOI: 10.1016/j.ygyno.2018.12.007

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Barbara531

Jan 09, 2019 - 4:22 am

Thanks I am stage 3C1 USPC Serous

Thank you for passing on this new study. I was diagnosed at 68 so this is encouraging.

I was not able to finish the sandwich chemo due to neuropathy. I did 3 chemos of Paclitaxel (Taxol)Carboplatin (Paraplatin) then 25 ext radiations and 3 internals finishing up May 1, 2018.

July 3 Pet scan NED 12/17/2018 pet scan showed 2 small lymph nodes hot spots. Doing another Pet scan 1/15/2019 to see if growing as could be cancer or inflammation. My CA 125 has been normal before surgery and ever since.

If cancer may have to go back for more radiation if it is outside of the original field as received the maximum to the pelvic area and perhaps go back to chemo. If so I will try icing my feet and hands this time. Have you finished your treatment? Best wishes you remain NED.

 

Abbycat2

Jan 09, 2019 - 8:19 am

I posted this UPSC research study in Oct, 2014 re: treatment

Prognostic factors and treatment-related outcomes in patients with uterine serous cancer (USC).

Presented Sunday, June 3, 2012

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Abstract

 

Authors:

Maria deLeon, Lingeng Lu, Pei Hui, Alessandro Santin, Thomas J. Rutherford, Dan Arin-Silasi, Masoud Azodi, Elena Ratner, Peter E. Schwartz; Yale University, New Haven, CT; Yale School of Medicine, New Haven, CT; Yale University School of Medicine, New Haven, CT

Abstract Disclosures

Background:USC an uncommon (10%) but aggressive form of uterine cancer, causes 50% of uterine cancer deaths. The purpose of this study is to report a large single-institution experience with USC investigating the effects of clinicopathological parameters and treatment on overall (OS) and disease-free survival (DFS). Methods:Records from our institution were reviewed from 1987-2009. All 334 USC patients (pts) identified were surgically staged. Postoperative treatments used were: (1) observation (OBS, n=33); (2) platinum-based chemotherapy (PCH, n=78); (3) whole pelvis radiation therapy (WPRT, n=16); (4) PCH and vaginal apex brachytherapy (PCHR, n=165); (5) vaginal apex brachytherapy (VAB, n=35). The cancer stages were 121 pts IA (36.2%), 36 IB (10.8%), 27 II (8.1%), 39 IIIA (11.7%), 2 IIIB (0.6%), 32 IIIC1 (9.6%), 9 IIIC2 (2.7%), 28 IVA (8.4%) and 40 IVB (12%). Results:The 5-year OS for stage IA/IB, II, IIIA/IIIB, IIIC1/IIIC2, IVA/IVB were 82%, 70%, 64%, 36%, and 9%, respectively. The 5-year DFS for stage IA/IB, II, IIIA/IIIB, IIIC1/IIIC2, IVA/IVB were 82%, 68%, 56%, 24%, 6%, respectively. Advanced stage was associated with significantly shorter OS and DFS (p <0.01). The 5-year OS for stage IA/IB disease was 94% for pts who received PCHR, 90% for OBS, 75% for PCH, 65% for VAB and 0% for WPRT. The 5-year DFS for PCHR, OBS, PCH, VAB and WPRT for Stage IA/IB were 89%, 82%, 86%, 72% and 0% respectively. For stage II-IVB pts, the 5-year OS was 51% for PCHR, 0% for OBS, 23% for PCH and 20% for WPRT. The 5-year DFS for stage II-IVB with PCHR, OBS, PCH and WPRT were 42%, 0%, 17% and 13% respectively. Older age pts had worse survival, (p<0.01). Race and BMI did not impact survival. Incomplete surgical debulking (p<0.01), depth of myometrial invasion >50% (p<0.01) and lymph node metastasis (p<0.01) were all associated with worse prognosis. Conclusions:PCHR overall exhibited better OS and DFS regardless of disease stage. Age, incomplete surgical debulking, depth of myometrial invasion and lymph node involvement were independent prognostic factors in USC patients in this study.

 

zsazsa1

Jan 09, 2019 - 9:26 am

Icing seems to be helping to prevent neuropathy

I keep my hands and feet directly in cold water with a little bit of ice in the water throughout my infusion.  i've occasionally had slight twinges of neuropathy in the few days after chemo, but it's quickly resolved, and hasn't interfered with chemo at all (I recently had round 4/6).  I keep a heating pad on my torso during treatment, which helps to keep me warm.  It's not pleasant, but I feel that it is worth it to avoid neuropathy.

I'm waiting for the vaginal cuff to heal before having brachytherapy.  I am wondering about whether whole pelvic irradiation would be a good idea or not.  My surgeon and oncologist are against it, because they feel that the morbidity is too high, saying that my colon will never work again after both chemo and radiation.  I just cannot make the decision yet, as the cuff isn't yet healed.

Barbara, could they use Cyberknife on the 2 nodes?