Patterns Of First Recurrence After Adjuvant Radiotherapy In Papillary Serous And Clear Cell Carcinoma Of The Uterus

Papillary serous (PS) and clear cell (CC) carcinomas of the uterus comprise 15% or less of all endometrial cancers, and are known to confer a higher risk of local and distant relapse in comparison to endometrioid histology. This study reports the therapeutic details, patterns of failure, and outcomes in patients with PS and CC uterine cancer who had RT as a component of their care at a single institution. Following surgery, 67 patients with PS or CC carcinoma of the uterus received external beam RT (EBRT) and/or vaginal cuff brachytherapy (VCB) between September 1998 and January 2010. Patient and pathologic characteristics, treatment regimens, patterns of failure, and rates of relapse and salvage were retrospectively reviewed. First sites of recurrence were classified as pelvic/vaginal, abdomen or distant. Those with multiple sites of first recurrence were censored separately for each site. Time to first recurrence was estimated using Kaplan-Meier analysis, with comparisons made using log-rank statistic. Median follow-up was 2.1 years (range, 0.2-7.9) and median age was 63 (range, 26-94). Distribution by stage was: IA 16%, IB 10%, IC 9%, IIA 3%, IIB 9%, IIIA 19%, IIIB 3%, IIIC 27%, IVA 0%, and IVB 3%. Radiation treatment was pelvic EBRT and VCB in 58%, pelvic EBRT alone in 21%, and VCB alone in 21%. Of those who received pelvic EBRT, 17% received concurrent chemotherapy and 13% (n = 7) also received whole abdominal irradiation (WAI). Pre-operative and adjuvant chemotherapy was administered to 7% and 44% of patients, respectively. For the entire cohort (n = 67) actuarial five-year relapse-free survival was 49.6% and overall survival was 59.2%. Among patients who received pelvic EBRT (n = 48), actuarial patterns of first relapse were analyzed. For stage I/II and III/IV patients, 2-year rates of relapse were 5.0% and 9.6% (p = 0.540) in the pelvis, 5.3% and 39.3% (p = 0.019) in the abdomen, and 5.9% and 27.5% (0.042) distantly, respectively. Of those who recurred, we documented salvage treatment in 43% and successful salvage in 7%. PS and CC carcinomas of the uterus are aggressive histologies associated with poor relapse-free survival rates. Among patients who received pelvic EBRT, observed pelvic relapse rates were low for both stage I/II and III/IV patients. As reported elsewhere, rates of abdominal and distant relapse were high for patients with stage III/IV disease. High pelvic control and low salvage rates in these patients receiving pelvic EBRT, however, suggest that the addition of pelvic EBRT to systemic chemotherapy deserves consideration.