Uterine Cancer pp 237-249 | Cite as

Treatment for Advanced and Recurrent Carcinoma: Combined Modalities

  • Marcela G. del CarmenEmail author
  • Neil S. Horowitz
Part of the Current Clinical Oncology book series (CCO)


The contribution of chemotherapy has provided new opportunities for exploring the combination of local and systemic modalities in both early stages of disease and advanced stages. The following circumstances are discussed: (1) radiation therapy for locally recurrent endometrial cancer; (2) surgery for stage IV and recurrent endometrial cancer; and (3) advanced stage endometrial cancer consolidating with postoperative and post-chemotherapy radiation therapy. Integration of hormones is also discussed.


Endometrial cancer Radiation Surgery in stage IV and recurrence Chemotherapy Hormones 


  1. 1.
    Tarone RE, Chu KC. Age-period-cohort analyses of breast, ovarian, endometrial and cervical cancer mortality rates for Caucasian women in the USA. J Epidemiol Biostat 2000;5:221–231.PubMedGoogle Scholar
  2. 2.
    Morgan JD, Reddy S, Sarin P, et al Isolated vaginal recurrences of endometrial carcinoma. Radiology 1993;189:609–613.PubMedGoogle Scholar
  3. 3.
    Hoekstra CJ, Koper PC, van Putten WL. Recurrent endometrial adenocarcinoma after surgery alone: prognostic factors and treatment. Radiother Oncol 1998;27:164–166.CrossRefGoogle Scholar
  4. 4.
    Creutzberg CL, van Putten WL, Koper PC, et al Surgery and postoperative radiotherapy versus surgery alone for patients with stage 1 endometrial carcinoma: multicenter randomised trial. PORTEC study group. Post Operative Radiation Therapy in Endometrial Carcinoma. Lancet 2000;355:1404–1411.PubMedCrossRefGoogle Scholar
  5. 5.
    Creutzberg CL, van Putten WL, Koper PC, et al Survival after relapse in patients with endometrial cancer: results from a randomized trial small star, filled. Gynecol Oncol 2003;89:201–209.PubMedCrossRefGoogle Scholar
  6. 6.
    Kuten A, Grigsby PW, Perez CA, et al Results of radiotherapy in recurrent endometrial carcinoma: a retrospective analysis of 51 patients. Int J Radiat Oncol Biol Phys 1989;17:29–34.PubMedCrossRefGoogle Scholar
  7. 7.
    Curran WJ, Whittington R, Peters AJ, Fanning J. Vaginal recurrences of endometrial carcinoma: the prognostic value of staging by a primary vaginal carcinoma system. Int J Radiat Oncol Biol Phys 1988;15:803–808.PubMedCrossRefGoogle Scholar
  8. 8.
    Pai HH, Souhami L, Clark BG, Roman T. Isolated vaginal recurrences in endometrial carcinoma: treatment results using high-dose-rate intracavitary brachytherapy and external beam radiotherapy. Gynecol Oncol 1997;66:300–307.PubMedCrossRefGoogle Scholar
  9. 9.
    Jhingran A, Burke TW, Eifel PJ. Definitive radiotherapy for patients with isolated vaginal recurrence of endometrial carcinoma after hysterectomy. Int J Radiat Oncol Biol Phys 2003;56:1366–1372.PubMedCrossRefGoogle Scholar
  10. 10.
    Jereczek-Fossa B, Badzio A, Jassem J. Recurrent endometrial cancer after surgery alone: results of salvage radiotherapy. Int J Radiat Oncol Biol Phys 2000;48:405–413.PubMedCrossRefGoogle Scholar
  11. 11.
    Wylie J, Irwin C, Pintilie M, et al Results of radical radiotherapy for recurrent endometrial cancer. Gynecol Oncol 2000;77:66–72.PubMedCrossRefGoogle Scholar
  12. 12.
    Monk BJ, Tewari KS, Puthawala AA, et al Treatment of recurrent gynecologic malignancies with iodine-125 permanent interstitial irradiation. Int J Radiat Biol Phys 2002;52:806–815.CrossRefGoogle Scholar
  13. 13.
    NagS, Yacoub S, Copeland LS, Fowler JM. Interstitial brachytherapy for salvage treatment of vaginal recurrences in previously unirradiated endometrial cancer patients. Int J Radiat Oncol Biol Phys 2002;54:1153–1159.PubMedCrossRefGoogle Scholar
  14. 14.
    Tewari K, Cappuccini F, Brewster WR, et al Interstitial brachytherapy for vaginal recurrences of endometrial carcinoma. Gynecol Oncol 1999;74:416–422.PubMedCrossRefGoogle Scholar
  15. 15.
    Bristow RE, Zerbe MJ, Rosenshein NB, et al Stage IVB endometrial carcinoma: the role of cytoreductive surgery and determinants of survival. Gynecol Oncol 2000;2:85–91.CrossRefGoogle Scholar
  16. 16.
    Chi DS, Welshinger M, Venkatraman ES, et al The role of surgical cytoreduction in Stage IV endometrial cancer. Gynecol Oncol 1997;1:56–60.CrossRefGoogle Scholar
  17. 17.
    Goff BA, Goodman A, Muntz HG, Fuller AF, Nikrui N, and Rice L. Surgical stage IV endometrial carcinoma: a study of 47 cases. Gynecol Oncol 1994;52:237–240.PubMedCrossRefGoogle Scholar
  18. 18.
    Morley GW, Hopkins MP, Lindenauer SM, et al Pelvic exenteration, University of Michigan: 100 patients at 5 years. Obstet Gynecol 1989;74:934–943.PubMedGoogle Scholar
  19. 19.
    Barakat RR, Goldman NA, Patel DA, et al Pelvic exenteration for recurrent endometrial cancer. Gynecol Oncol 1999;75:99–102.PubMedCrossRefGoogle Scholar
  20. 20.
    Dowdy SC, Mariani A, Cliby WA, Haddock MG, Petersen IA, Sim FH, and Podratz KC. Radical pelvic resection and intraoperative radiation therapy for recurrent endometrial cancer: technique and analysis of outcomes. Gynecol Oncol 2006;101:280–286.PubMedCrossRefGoogle Scholar
  21. 21.
    Scarabelli C, Campagnutta E, Giorda G, DePiero G, Sopracordevole F, Quaranta M, DeMarco L. Maximal cytoreductive surgery as a reasonable therapeutic alteranative for recurrent endometrial carcinoma. Gynecol Oncol 1998;70:90–93.PubMedCrossRefGoogle Scholar
  22. 22.
    Campagnutta E, Giorda G, Depiero G, Sopracoreveole F, Visentin MC, Martella L, Scarabelli C. Surgical treatment of recurrent endometrial carcinoma. Cancer 2004;100(1):89–96.PubMedCrossRefGoogle Scholar
  23. 23.
    Potish RA, Twiggs LB, Adcock LL, Prem KA. Role of whole abdominal radiation therapy in the management of endometrial cancer: prognostic importance of factors indicating peritoneal metastases. Gynecol Oncol 1985;21:80–86.PubMedCrossRefGoogle Scholar
  24. 24.
    Soper JT, Creasman WT, Clarke-Pearson DL, Sullivan DC, et al Intraperitoneal chromic phosphate P 32 suspension therapy of malignant peritoneal cytology in endometrial carcinoma. Am J Obstet Gynecol 1985;153:191–196.PubMedGoogle Scholar
  25. 25.
    Creasman WT, Disaia PJ, Blessing J, et al Prognostic significance of peritoneal cytology in patients with endometrial cancer and preliminary data concerning therapy with intreperitoneal radiopharmaceuticals. Am J Obstet Gynecol 1981;141:921–929.PubMedGoogle Scholar
  26. 26.
    Yazigi R, Piver MS, Blumenson L. Malignant peritoneal cytology as prognostic indicator in stage I endometrial cancer. Gynecol Oncol 1983;62:359–362.Google Scholar
  27. 27.
    Potish RA, Twigs LB, Adcock LL, et al Paraaortic lymph node radiotherapy in cancer of the uterine corpus. Obstet Gynecol 1985;65:251–256.PubMedGoogle Scholar
  28. 28.
    Feuer GA, Calanog A. Endometrial carcinoma: treatment of positive paraaortic nodes. Gynecol Oncol 1987;27:104–109.PubMedCrossRefGoogle Scholar
  29. 29.
    Rose PG, Bundy BN, Watkins EB, Thigpen JT, Deppe G, Maiman MA, Clarke-Pearson DL, Insalaco S. Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N Engl J Med 1999;340(15):1144–1153.PubMedCrossRefGoogle Scholar
  30. 30.
    Peters WA, Liu PY, Barrett RJ, Stock RJ, Monk BJ, Berek JS, Souhami L, Grigsby P, Gordon W, Alberts DS. Concurrent chemotherapy and pelvic radiation therapy compared to pelvic radiation therapy alone as adjuvant therapy after radical surgery in high risk early stage cancer of the cervix. J Clin Oncol 2000;18(8):1606–1613.PubMedGoogle Scholar
  31. 31.
    Pickel H, Lahousen M, Petru E, Stettner H, Hackl A, Kapp K, Winter R. Consolidation radiotherapy after carboplatin-based chemotherapy in radically operated advanced ovarian cancer. Gynecol Oncol 1999;72(2):215–219.PubMedCrossRefGoogle Scholar
  32. 32.
    Duska LR, Berkowitz R, Matulonis U, Muto M, Goodman A, Mcintyre JF, Klein A, Atkinson T, Seiden MV, Campos S. A pilot trial of TAC (paclitaxel, doxorubicin, and carboplatin) chemotherapy with filgastrim (r-met HuG-CSF) support followed by radiotherapy in patients with “high risk” endometrial cancer. Gynecol Oncol 2005;96:198–203.PubMedCrossRefGoogle Scholar
  33. 33.
    Soper JT, Reisinger SA, Ashbury R, Jones E, Clarke-Pearson DL. Feasibility study of concurrent weekly cisplatin and whole abdominopelvic irradiation followed by doxorubicin/cisplatin chemotherapy for advanced stage endometrial carcinoma: a Gynecologic Oncology Group trial. Gynecol Oncol 2004;95:95–100.PubMedCrossRefGoogle Scholar
  34. 34.
    Bruzzone M, Miglietta L, Frazone P, Gadducci A, Boccardo F. Combined treatment with chemotherapy and radiotherapy in high-risk FIGO stage III-IV endometrial cancer patients. Gynecol Oncol 2004;93(2):345–352.PubMedCrossRefGoogle Scholar
  35. 35.
    Frigerio L, Mangili G, Aletti M, Carnelli M, Garavaglia E, Beatrice S, Ferrari A. Concomitant radiotherapy and paclitaxel for high-risk endometrial cancer: first feasibility study. Gynecol Oncol 2001;81:53–57.PubMedCrossRefGoogle Scholar
  36. 36.
    Greven K, Winter K, Underhill K, Fontenesci J, Cooper J, Burke T. Preliminary analysis of RTOG 9708: Adjuvant postoperative radiotherapy combined with cisplatin/paclitaxel chemotherapy after surgery for patients with high-risk endometrial cancer. Int J Radiat Oncol Biol Phys 2004;59(1):168–173.PubMedCrossRefGoogle Scholar
  37. 37.
    Randall ME, Filiaci VL, Muss H, Spirtos NM, Mannel RS, Fowler J, Thigpen JT, Benda JA. Randomized phase III trial of whole-abdominal irradiation versus doxorubicin and cisplatin chemotherapy in advanced endometrial carcinoma: a Gynecologic Oncology Group study. J Clin Oncol 2006;24:34–44.CrossRefGoogle Scholar
  38. 38.
    Fleming GF. Major progress for a less common cancer. J Clin Oncol 2006;24:6–8.PubMedCrossRefGoogle Scholar
  39. 39.
    Kohorn E. Gestagens and endometrial carcinoma. Gynecol Oncol 1976;4:398–411.PubMedCrossRefGoogle Scholar
  40. 40.
    Kauppila A. Progestin therapy of endometrial, breast, and ovarian carcinoma. A review of clinical observations. Acta Gynecol 1989;63:441–450.CrossRefGoogle Scholar
  41. 41.
    Kelley RM, Baker WH. Progestational agents in the treatment of carcinoma of the endometrium. N Engl J Med 1961;264:216–222.PubMedCrossRefGoogle Scholar
  42. 42.
    Piver MS, Barlow JJ, Luain JR, et al Medroxyprogesterone acetate versus hydroxyprogesterone caproate in women with metastatic endometrial adenocarcinoma. Am J Clin Oncol 1980;45:268–272.Google Scholar
  43. 43.
    Bonte J. Medroxyprogesterone in the management of primary and recurrent endometrial adenocarcinoma. Acta Obstet Gynecol Scand Suppl 1972;19:21–24.PubMedCrossRefGoogle Scholar
  44. 44.
    Reifenstein EC. The treatment of advanced endometrial cancer with hydroxyprogesterone caproate. Gynecol Oncol 1974;2:337–414.CrossRefGoogle Scholar
  45. 45.
    Geisler HE. The use of megestrol acetate in the treatment of advanced malignant lesions of the endometrium. Gynecol Oncol 1979;1:340–346.CrossRefGoogle Scholar
  46. 46.
    Thigpen JT, Brady MF, Alvarez RD, et al Oral medroxyprogesterone acetate in the treatment of advanced or recurrent endometrial carcinoma: a dose-response study by the Gynecologic Oncology Group. J Clin Oncol 1999;17:1736–1744.PubMedGoogle Scholar
  47. 47.
    Quinn MA, Cauchi M, Fortune D. Endometrial carcinoma: steroid receptors and response to medroxyprogesterone acetate. Gynecol Oncol 1985;21:314–319.PubMedCrossRefGoogle Scholar
  48. 48.
    Thigpen JT, Blessing J, Disaia P. Oral medroxyprogesterone acetate in advanced or recurrent endometrial carcinoma: results of therapy and correlation with estrogen and progesterone receptor levels. In: Iacobelli S, editor. Endocrinology and Malignancy: Basic and Clinical Issues, The Proceedings of the First International Congress on Cancer and Hormones. CRC Press, Parthenon Publishers; Rome; 1986:446–447.Google Scholar
  49. 49.
    Barakat RR, Grigsby PW, Sabbatini P, et al. Corpus epithelial tumors. In: Hoskins WJ, Perez CA, Young RC, editors. Principles and Practices of Gynecologic Oncology. Second ed. Philadelphia, PA: Lippincott-Raven;1997:880–884.Google Scholar
  50. 50.
    Mortel R, Levy C, Wolff JP, et al Female sex steroid receptors in postmenopausal endometrial carcinoma and biochemical response to an antiestrogen. Cancer Res 1981;41:1140–1147.PubMedGoogle Scholar
  51. 51.
    Carlson JA, Allegra JC, Day TG, et al Tamoxifen and endometrial carcinoma: alterations in estrogen and progesterone receptors in untreated patients and combination hormonal therapy in advanced neoplasia. Am J Obstet Gynecol 1984;149:149–153.PubMedGoogle Scholar
  52. 52.
    Thigpen JT, Brady MF, Homesley HD. Tamoxifen in the treatment of advanced or recurrent endometrial carcinoma. A Gynecologic Oncology Group study. J Clin Oncol 2001;19:364–367.PubMedGoogle Scholar
  53. 53.
    Moore TD, Phillips PH, Nerenstone SR, et al Systemic treatment of advanced and recurrent endometrial carcinoma: current status and future directions. J Clin Oncol 1991;9:1071–1077.PubMedGoogle Scholar
  54. 54.
    Pandya KJ, Yeap BY, Davis TE. Phase II study of megestrol and mestrol and tamoxifen in advanced endometrial carcinoma: an Eastern Cooperative Oncology Group (ECOG) study. Am J Clin Oncol 2001;24:43–46.PubMedGoogle Scholar
  55. Fiorca JV, Brunetto VL, Hanjani P, et al. A phase II study of recurrent and advanced endometrial carcinoma treated with alternating courses of megestrol acetate (Megace) and tamoxifen citrate (Nolvadex). Proc ASCO (Abst # 1499); 2000;[abstract].Google Scholar
  56. 56.
    Whitney CW, Brunetto VL, Zaine RJ, et al Phase II study of medroxyprogesterone acetate plus tamoxifen in advanced endometrial carcinoma: a Gynecologic Oncology study. Gynecol Oncol 2004;92:4–9.PubMedCrossRefGoogle Scholar
  57. 57.
    Horton J, Elson P, Gordon P, et al Combination chemotherapy for advanced endometrial cancer. An evaluation of three regimens. Cancer 1982;49:2441–2445.PubMedCrossRefGoogle Scholar
  58. 58.
    Piver MS, Lele SB, Patsner B, et al Melphalan, 5-fluoroiracil, and medroxyprogesterone acetate in metastatic endometrial carcinoma. Obstet Gynecol 1986;67:261–267.PubMedCrossRefGoogle Scholar
  59. 59.
    Cohen CJ, Bruckner HW, Deppe G, et al Multidrug treatment of advanced and recurrent endometrial carcinoma: a Gynecologic Oncology Group study. Obstet Gynecol 1984;63:719–726.PubMedGoogle Scholar
  60. 60.
    Ayoub J, Audet-Lapointe P, Methot Y, et al Efficacy of sequential cyclical hormonal therapy in endometrial cancer and its correlation with steroid hormone receptor status. Gynecol Oncol 1988;31:327–337.PubMedCrossRefGoogle Scholar
  61. 61.
    Cornelison TL, Baker TR, Piver MS, et al Cisplatin, adriamycin, etoposide, megestrol acetate versus melphalan, 5-flurouracil, medroxyprogesterone acetate in the treatment of endometrial carcinoma. Gynecol Oncol 1995;59:243–248.PubMedCrossRefGoogle Scholar
  62. 62.
    Bafaloukos D, Aravantinos G, Samonis G, et al Carboplatin, methotrexate and 5-flurouracil in combination with medroxyprogesterone acetate (JMF-M) in the treatment of advanced or recurrent endometrial carcinoma: a Hellenic cooperative oncology group study. Oncology 1999;56:198–201.PubMedCrossRefGoogle Scholar
  63. 63.
    Gallion HH, Brunetto VL, Cibull M, et al Randomized phase III trial of standard timed doxorubicin plus cisplatin versus circadian timed doxorubicin plus cisplatin in stage III and IV or recurrent endometrial carcinoma: a Gynecologic Oncology Group study. J Clin Oncol 2003;21:3808–3813.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press, a part of Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology ServiceMassachusetts General HospitalBoston

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