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15-10-2014 | Uterine cancer | Article

Surgical and systemic management of endometrial cancer: an international survey

Journal: Archives of Gynecology and Obstetrics

Authors: Christina Fotopoulou, Robert Kraetschell, Sean Dowdy, Keiichi Fujiwara, Nobuo Yaegashi, Domenica Larusso, Antonio Casado, Sven Mahner, Thomas J. Herzog, Sean Kehoe, Ignace Vergote, David Scott Miller, Christian Marth, Shingo Fujii, Jalid Sehouli

Publisher: Springer Berlin Heidelberg

Abstract

Purpose

To ascertain the spectrum of clinical management of endometrial carcinoma (EC) the largest international survey was conducted to evaluate and identify differences worldwide.

Methods

After validation of a 15-item questionnaire regarding surgical and adjuvant treatment of EC in Germany, an English-adapted questionnaire was put online and posted to all the major gynecological cancer Societies worldwide for further distribution commencing in 2010 and continued for 26 months.

Results

A total of 618 Institutions around the world participated: Central Europe (CE), Southern Europe (SE), Northern Europe (NE), Asia and USA/Canada/UK. Both a therapeutic and staging value was attributed to systematic pelvic and paraaortic lymph node dissection (LND) in CE (74.6 %) and in Asia (67.2 %), as opposed to USA/UK where LND was mainly for staging purposes (53.5 %; p < 0.001). LND was performed up to the renal veins in CE in 86.8 %, in Asia in 80.8 %, in USA/UK in 51.2 % and in SE in 45.1 % (p < 0.001) of cases. In advanced disease, centers from Asia were treated most with adjuvant chemotherapy alone (93.6 %), as opposed to centers in SE, CE and UK/USA that employed combination chemo-radiotherapy in 90.9 % (p < 0.001) of cases. Paclitaxel/carboplatin was mostly used followed by doxorubicin/cisplatin (75 vs. 23.3 %; p < 0.001). In total, 94 % of all participants supported the concept of treating EC patients within appropriate clinical trials.

Conclusions

There is broad range in both the surgical and adjuvant treatment of EC across different countries. Large-scale multicenter prospective trials are warranted to establish consistent, evidence-based guidelines to optimize treatment worldwide.

Colombo N, Preti E, Landoni F, Carinelli S, Colombo A, Marini C, Sessa C, ESMO Guidelines Working Group (2013) Endometrial cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol Suppl 6:vi33–vi38. doi:10.1093/annonc/mdt353

ACOG practice bulletin, clinical management guidelines for obstetrician-gynecologists, number 65, August 2005: management of endometrial cancer. American College of Obstetricians and Gynecologists (2005). Obstet Gynecol 106(2):413-25

Mariani A, Dowdy SC, Cliby WA, Gostout BS, Jones MB, Wilson TO et al (2008) Prospective assessment of lymphatic dissemination in endometrial cancer: a paradigm shift in surgical staging. Gynecol Oncol 109(1):11–18CrossRefPubMedCentralPubMed

Walsh CS, Karlan BY (2008) Lymphadenectomy’s role in early endometrial cancer: prognostic or therapeutic? J Natl Cancer Inst 100(23):1660–1661CrossRefPubMed

Fotopoulou C, Savvatis K, Kraetschell R et al (2010) Systematic pelvic and aortic lymphadenectomy in intermediate and high-risk endometrial cancer: lymph-node mapping and identification of predictive factors for lymph-node status. Eur J Obstet Gynecol Reprod Biol 149(2):199–203CrossRefPubMed

Mariani A, Webb MJ, Keeney GL, Podratz KC (2001) Routes of lymphatic spread: a study of 112 consecutive patients with endometrial cancer. Gynecol Oncol 81(1):100–104CrossRefPubMed

Marnitz S, Köhler C (2012) Current therapy of patients with endometrial carcinoma. A critical review. Strahlenther Onkol 188(1):12–20CrossRefPubMed

Creutzberg CL, Nout RA (2011) The role of radiotherapy in endometrial cancer: current evidence and trends. Curr Oncol Rep 13(6):472–478CrossRefPubMedCentralPubMed

Kong A, Johnson N, Kitchener HC, Lawrie TA (2012) Adjuvant radiotherapy for stage I endometrial cancer: an updated Cochrane systematic review and meta-analysis. J Natl Cancer Inst 104(21):1625–1634CrossRefPubMed

10.

Kitchener HC, Trimble EL (2009) Endometrial Cancer Working Group of the Gynecologic Cancer Intergroup. Endometrial cancer state of the science meeting. IJGC 19(1):134–140

11.

Bakkum-Gamez JN, Gonzalez-Bosquet J, Laack NN, Mariani A, Dowdy SC (2008) Current issues in the management of endometrial cancer. Mayo Clin Proc 83(1):97–112CrossRefPubMed

12.

ASTEC study group, Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK (2009) Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet 373(9658):125–136CrossRef

13.

Benedetti Panici P, Basile S, Maneschi F, Alberto Lissoni A, Signorelli M, Scambia G et al (2008) Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst 100(23):1707–1716CrossRefPubMed

14.

Todo Y, Kato H, Kaneuchi M, Watari H, Takeda M, Sakuragi N (2010) Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis. Lancet 375(9721):1165–1172CrossRefPubMed

15.

Hirahatake K, Hareyama H, Sakuragi N, Nishiya M, Makinoda S, Fujimoto S (1997) A clinical and pathologic study on paraaortic lymph node metastasis in endometrial carcinoma. J Surg Oncol 65:82–87CrossRefPubMed

16.

Mariani A, Dowdy SC, Podratz KC (2009) New surgical staging of endometrial cancer: 20 years later. IJGC 105(2):110–111

17.

Bakkum-Gamez JN, Mariani A, Dowdy SC, Weaver AL, McGree ME, Cliby WA et al (2011) The impact of surgical guidelines and periodic quality assessment on the staging of endometrial cancer. Gynecol Oncol 123(1):58–64CrossRefPubMed

18.

Creutzberg CL, van Putten WL, Koper PC, Lybeert ML, Jobsen JJ, Wárlám-Rodenhuis CC et al (2000) Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC Study Group. Post operative radiation therapy in Endometrial Carcinoma. Lancet 355(9213):1404–1411CrossRefPubMed

19.

Creutzberg CL, van Putten WL, Koper PC et al (2003) PORTEC Study Group. Survival after relapse in patients with endometrial cancer: results from a randomized trial. Gynecol Oncol 89(2):201–209CrossRefPubMed

20.

Creutzberg CL, van Putten WL, Koper PC, Lybeert ML, Jobsen JJ, Wárlám-Rodenhuis CC et al (2004) Postoperative Radiation Therapy in Endometrial Carcinoma Trial. Outcome of high-risk stage IC, grade 3, compared with stage I endometrial carcinoma patients: the postoperative radiation therapy in Endometrial Carcinoma trial. JCO 22(7):1234–1241CrossRef

21.

Nout RA, Putter H, Jürgenliemk-Schulz IM et al (2009) Quality of life after pelvic radiotherapy or vaginal brachytherapy for endometrial cancer: first results of the randomized PORTEC-2 trial. JCO 27(21):3547–3556CrossRef

22.

Nout RA, Putter H, Jürgenliemk-Schulz IM, Jobsen JJ, Lutgens LC, van der Steen-Banasik EM et al (2010) PORTEC Study Group. Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): an open-label, non-inferiority, randomised trial. Lancet 375(9717):816–823CrossRefPubMed

23.

Nout RA, van de Poll-Franse LV, Lybeert ML, Wárlám-Rodenhuis CC, Jobsen JJ, Mens JW et al (2011) Long-term outcome and quality of life of patients with endometrial carcinoma treated with or without pelvic radiotherapy in the post operative radiation therapy in endometrial carcinoma 1 (PORTEC-1) trial. JCO 29(13):1692–1700CrossRef

24.

Nugent EK, Bishop EA, Mathews CA, Moxley KM, Tenney M, Mannel RS et al (2012) Do uterine risk factors or lymph node metastasis more significantly affect recurrence in patients with endometrioid adenocarcinoma? Gynecol Oncol 125(1):94–98CrossRefPubMed

25.

Nout RA, Putter H, Jürgenliemk-Schulz IM et al (2012) Five-year quality of life of endometrial cancer patients treated in the randomised post operative radiation therapy in endometrial cancer (PORTEC-2) trial and comparison with norm data. Eur J Cancer 48(11):1638–1648CrossRefPubMed

26.

Aalders J, Abeler V, Kolstad P, Onsrud M (1980) Postoperative external irradiation and prognostic parameters in stage I endometrial carcinoma: clinical and histopathologic study of 540 patients. Obstet Gynecol 56(4):419–427PubMed

27.

Kristina Lindemann, Mathias Onsrud, Gunnar Kristensen, Claes Trope (2012) Survival after radiation therapy for early-stage endometrial carcinoma: The Oslo study revisited after up to 43 years of follow-up. JCO 30, suppl; abstr 5008

28.

Kiess AP, Damast S, Makker V, Kollmeier MA, Gardner GJ, Aghajanian C et al (2012) Five-year outcomes of adjuvant carboplatin/paclitaxel chemotherapy and intravaginal radiation for stage I-II papillary serous endometrial cancer. Gynecol Oncol 127(2):321–325CrossRefPubMed

29.

Duska LR, Berkowitz R, Matulonis U, Muto M, Goodman A, McIntyre JF et al (2005) A pilot trial of TAC (paclitaxel, doxorubicin, and carboplatin) chemotherapy with filgastrim (r-metHuG-CSF) support followed by radiotherapy in patients with “high-risk” endometrial cancer. Gynecol Oncol 96(1):198–203CrossRefPubMed

30.

Sehouli J, Lichtenegger W (2004) Management des Endometriumkarzinoms: standards und neue Trends. Der Gynäkologe 37(3):245–256CrossRef

31.

Creasman WT, Mutch DE, Herzog TJ (2010) ASTEC lymphadenectomy and radiation therapy studies: are conclusions valid? Gynecol Oncol 116(3):293–294CrossRefPubMed

32.

Wright JD, Barrena Medel NI, Sehouli J, Fujiwara K, Herzog TJ (2012) Contemporary management of endometrial cancer. Lancet 379(9823):1352–1360CrossRefPubMed