22. Endometrial Carcinoma(Corpus Carcinoma).
22.1 General considerations
FIGO staging |
|
Surgical staging |
IA Tumor limited to endometrium
IB Invasion to less than one-half the myometrium
IC Invasion to more than one-half the myometrium____________
IIA Endocervical glandular involvement only
IIB Cervical stromal invasion______________________________
IIIA Tumor invades serosa and/or adnexa,and/or positive peritoneal
cytology
IIIB Vaginal metastases
IIIC Metastases to pelvic and/or para-aortic lymph nodes________
IVA Tumor invasion of bladder and/or bowel mucosa
IVB Distal metastases including intra-abdominal and/or inguinal
lymph nodes_______________________________________
Histopathology____________________________________________
G1 ≤ 5% of a nonsquamous or nonmorular solid growth pattern
G2 6-50% of a nonsquamous or nonmorular solid growth pattern
G3 >50% of a nonsquamous or nonmorular solid growth pattern __
Surgery is the mainstay of initial therapy and most cases diagnosed in stage I can be surgically cured. Postoperative irradiation is used for
optimal locoregional control in those patients with deep myometrial
or parametrial invasion, cervical extension or pelvic lymph node
involvement . Systemic adjuvant therapy to date has failed to improve
results. The prognosis for metastatic or recurrent disease remains poor.
Patients with local recurrence can sometimes be salvaged with
radiation(or concomitant radiochemotherapy) .In case of more
widespread disease, hormone therapy can be of benefit when tumors
express functional estrogen and progesterone receptors, while
cytotoxic chemotherapy can result in (mostly short lived) responses in
the others.
Literature: for review e.g.
CHEN et al, Oncology 13(1999): 1665-1670(discussion 1675-
1678 and 1681-1682)
ELIT and HIRTE, Expert Opin.Investig. Drugs 9(2000):2831-
2853
EMONS and HEYL ,J.Cancer Res.Clin.Oncol.126(2000): 619-
623(hormonal treatment)
FLEMING,Curr.Oncol. Rep.1(1999):47-53
22.2 Hormone therapy
22.2.1 Progestins
|
Medroxyprogesterone acetate 200-400mg/d p.o. |
Continued until unacceptable toxicity or progression of disease occurs. Higher dosages offer no benefit!
136 Endometrial Carcinoma(Corpus Carcinoma)
Literature:
EMONS and HEYL,J. Cancer Res.Clin.Oncol.126 (2000):619-623 (review)
THIGPEN et al,J.Clin.Oncol.17 (1999):1736-1744(dose-response study by the Gynecologic Oncology Group[GOG] comparing 200 mg/d with1000 mg/d)
|
Megestrol acetate 160mg/d p.o. |
Continued until unacceptable toxicity or progression of disease occurs.
Higher dosages are not recommended.
Literature:
EMONS and HEYL, J. Cancer Res.Clin. Oncol.126(2000):619-623 (review)
LENTZ et al,J.Clin.Oncol. 14(1996):347-361(GOG study of 800mg/d showing no advantage over lower-dose progestins)
22.2.2 Anti-estrogens
As alternative treatment option for women with risk factors for a progestin therapy(e.g. obesity, hypertension, diabetes, risk for thrombolic events). Activity is only modest, however,and no responses were seen in second-line after progestins.
|
Tamoxifen 20-40mg/d p.o. |
Literature:
EMONS and HEYL,J. Cancer Res.Clin.Oncol.126(2000):619-623 (review)
THIGPEN et al, J.Clin. Oncol.19(2001):364-367(GOG study with 20 mg b.i.d.)
The combination of a progestin and tamoxifen may offer no clinical advantage over progestine alone.
Literature:
PANDYA et al, Am.J.Clin. Oncol. 24(2001)43-46 (randomized
Study E9882 of the Eastern Cooperative Oncology Group).
22.3 Chemotherapy
22.3.1 Monotherapy
Platinum compounds (cisplatin, carboplatin),anthracyclines (doxorubicin, epirubicin), and 5-fluorouracil are considered to be the most active agents. More recently efficacy has also been demonstrated for paclitaxel and ifosfamide.
Literature:
LISSONI et al, Ann.Oncol.7(1996):861-863(paclitaxel)
PAWINSKI et al, Eur.J Obstet.Gynec. Repord. Biol.86(1999):
179-183(randomized phase II study of the EORTC Gynecological
Cancer Cooperative Group comparing ifosfamide and cyclophos-
phamide)
22.3.2 Combination chemotherapy
22.3.2.1 Doxorubicin+ cisplatin
|
Doxorubicin 60mg/mē i.v. d1 |
|
Cisplatin 50-60mg/mē i.v. d1 |
To be repeated every 3 weeks
Literature:
DEPPE et al, Eur,J.Gynaecol. Oncol.15(1994):263-266
THIGPEN et al, Proc. Am.Soc.Clin. Oncol.12(1993):261
22.3.2.2 Paclitaxel + carboplatin
|
Paclitaxel 175mg/mē i.v.(3 h inf) d1 followed by |
|
Carboplatin AUC 5-7 i.v.(30 min inf) d1 |
To be repeated every 4 weeks(up to 6 cycles) as outpatient treatment
Literature:
HOSKINS et,al,J.Clin.Oncol.19(2001):4048-4053
22.3.2.3 Paclitaxel + cisplatin + doxorubicin
|
Doxorubicin 45mg/mē i.v. d1 |
|
Paclitaxel 160mg/mē i.v.(3 h inf) d1 |
|
Cisplatin 60mg/mē i.v.(1 h inf) d1 |
To be repeated every 3 weeks with G-CSF support
Literature:
FLEMING et al,J. Clin.Oncol.19(2001):1021-1029 (recommended doses from a phase I trial of the GOG).