Uterine Cancer pp 283-292 | Cite as

Chemotherapy for High-Risk Early-Stage Endometrial Cancer: Current Evidence

  • Seema Gulia
  • Sudeep Gupta


Endometrial cancer (EC) is the third common gynecological cancer affecting women in the Western world. By contrast, the incidence in developing countries is approximately tenfold lower [1]. The incidence in India is 2.3 per 100,000 women. Around 80 % of patients are diagnosed in early stages (FIGO stages I and II) and have good prognosis (5-year survival ~90 %). Currently patients with early-stage endometrial cancer are treated with primary surgery, which includes hysterectomy, bilateral salpingo-oophorectomy, and pelvic and para-aortic node dissection with or without omentectomy. The histopathological information obtained from the pathology specimen is used to identify patients with adverse prognostic features who may benefit from adjuvant therapy. Several factors have been associated with the risk of recurrence including older age, higher grade, histologic type (i.e., serous or clear cell type), deep myometrial invasion, lymphovascular space invasion (LVSI), involvement of the cervical stroma, and large tumor size (>2 cm) [2–4]. The indication of adjuvant chemotherapy or radiotherapy is based on the aggregate risk conferred by these factors.


Overall Survival Endometrial Cancer Myometrial Invasion Deep Myometrial Invasion Locoregional Recurrence Rate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Ferlay J, Bray F, Pisani P, Parkin DM. GLOBOCAN2002: cancer incidence, mortality and prevalence worldwide, IARC cancer base no. 5. Lyon: IARC Press; 2004, Version 2.0. please quote GLOBOCAN 2012.Google Scholar
  2. 2.
    Morrow P, Bundy BN, Kurman RJ, Creasman WT, Heller P, Homesley HD, et al. Relationship between surgical–pathological risk factors and outcome in clinical stage I and II carcinoma of the endometrium: a Gynecologic Oncology Group study. Gynecol Oncol. 1991;40:55–65.CrossRefPubMedGoogle Scholar
  3. 3.
    Edward P, Paul K, Karen GI, Colinmacneill JS, Kishor S, et al. Detection and patterns of treatment failure in 300 consecutive cases of “early” endometrial cancer after primary surgery. Gynecol Oncol. 1992;47(3):323–7.CrossRefGoogle Scholar
  4. 4.
    Oper BR, Astner ST, Heydemann-Obradovic A, et al. Ten-year data on 138 patients with endometrial carcinoma and postoperative vaginal brachytherapy alone: no need for external-beam radiotherapy in low and intermediate risk patients. Gynecol Oncol. 2007;107(3):541–8.CrossRefGoogle Scholar
  5. 5.
    Keys HM, Roberts JA, Brunetto VL, et al. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2004;92:744–51.CrossRefPubMedGoogle Scholar
  6. 6.
    Straughn JM, Huh WK, Kelly FJ, et al. Conservative management of stage I endometrial carcinoma after surgical staging. Gynecol Oncol. 2002;84(2):194–200.CrossRefPubMedGoogle Scholar
  7. 7.
    Hogberg T, Fredstorp-Lidebring M, Alm P, et al. A prospective population-based management program including primary surgery and postoperative risk assessment by means of DNA ploidy and histopathology. Adjuvant radiotherapy is not necessary for the majority of patients with FIGO stage I-II endometrial cancer. Int J Radiat Oncol Biol Phys. 2004;14(3):437–50.Google Scholar
  8. 8.
    Creutzberg CL, Van Putten WL, Koper PC. Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomized trial. PORTEC study group, post operative radiation therapy in endometrial carcinoma. Lancet. 2000;35:1404–11.CrossRefGoogle Scholar
  9. 9.
    Scholten AL, Van Putten WL, Beerman H, et al. Postoperative radiotherapy for stage 1 endometrial carcinoma: long-term outcome of the randomized PORTEC trial with central pathology review. Int J Radiat Oncol Biol Phys. 2005;6(3):834–8.CrossRefGoogle Scholar
  10. 10.
    Blake P, Swart AM, ASTEC/EN.5 Study Group. Adjuvant external beam radiotherapy in the treatment of endometrial cancer (MRC ASTEC and NCIC CTG EN.5 randomized trials): pooled trial results, systematic review, and meta-analysis. Lancet. 2009;373:137–46.CrossRefPubMedGoogle Scholar
  11. 11.
    Nout RA, Smit VT, Putter H, et al. Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): an open-label, non-inferiority, randomized trial. Lancet. 2010;375:816–23.CrossRefPubMedGoogle Scholar
  12. 12.
    Nout RA, Putter H, Jurgenliemk-Schulz IM, et al. Quality of life after pelvic radiotherapy or vaginal brachytherapy for endometrial cancer: first results of the randomized PORTEC-2 trial. J Clin Oncol. 2009;27:3547–56.CrossRefPubMedGoogle Scholar
  13. 13.
    Kong A, Johnson N, Kitchener HC, Lawrie TA. Adjuvant radiotherapy for stage I endometrial cancer: an updated cochrane systematic review and meta-analysis. J Natl Cancer Inst. 2012;104:1625–34.CrossRefPubMedGoogle Scholar
  14. 14.
    Hirai M, Hirono M, Oosaki T. Adjuvant chemotherapy in stage I uterine endometrial carcinoma. Int J Gynecol Obstet. 2002;78:37–44.CrossRefGoogle Scholar
  15. 15.
    Aoki Y, Watanabe M, Amikura T. Adjuvant chemotherapy as treatment of high- risk stage I and II endometrial cancer. Gynecol Oncol. 2004;94:333–9.CrossRefPubMedGoogle Scholar
  16. 16.
    Kodama J, Seki N, Ojima Y. Efficacy and prognostic implications of administering adjuvant chemotherapy to patients with endometrial cancer that is confined to the uterus. Eur J Obstet Gynecol Reprod Biol. 2007;131(1):76–80.CrossRefPubMedGoogle Scholar
  17. 17.
    Kuoppala T, Maenpaa J, Tomas E, et al. Surgically staged high-risk endometrial cancer: randomized study of adjuvant radiotherapy alone vs. sequential chemo-radiotherapy. Gynecol Oncol. 2008;110:190–5.CrossRefPubMedGoogle Scholar
  18. 18.
    Hogberg T, Signorelli M, de Oliveira CF, et al. Sequential adjuvant chemotherapy and radiotherapy in endometrial cancer: results from two randomized studies. Eur J Cancer. 2010;46:2422–31.PubMedCentralCrossRefPubMedGoogle Scholar
  19. 19.
    Susumu N, Sagae S, Udagawa Y, et al. Randomized phase III trial of pelvic radiotherapy versus cisplatin-based combined chemotherapy in patients with intermediate and high-risk endometrial cancer: a Japanese Gynecologic Oncology Group study. Gynecol Oncol. 2008;108:226–33.CrossRefPubMedGoogle Scholar
  20. 20.
    Maggi R, Lissoni A, Spina F, et al. Adjuvant chemotherapy vs radiotherapy in high-risk endometrial carcinoma: results of a randomized trial. Br J Cancer. 2006;95:266–71.PubMedCentralCrossRefPubMedGoogle Scholar
  21. 21.
    Park HJ, Nam EJ, Kim S, Kim YB, Kim YT. The benefit of adjuvant chemotherapy combined with postoperative radiotherapy for endometrial cancer: a meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2013;170(1):39–44.CrossRefPubMedGoogle Scholar
  22. 22.
    Creutzberg CL. Randomized phase III trial comparing concurrent chemo radiation and adjuvant chemotherapy with pelvic radiation alone in high risk and advanced stage endometrial carcinoma: PORTEC-3. 2006. Nederlands trial register,
  23. 23.
    Hamilton CA, Cheung MK, Osann K. Uterine papillary serous and clear cell carcinomas predict for poorer survival compared to grade 3 endometrioid corpus cancers. Br J Cancer. 2006;94:642–6.PubMedCentralPubMedGoogle Scholar
  24. 24.
    Sutton G, Axelord JH, Bundy BN. Adjuvant whole abdominal irradiation in clinical stages I and II papillary serous or clear cell carcinoma of the endometrium: a phase II study of the Gynecologic Oncology Group. Gynecol Oncol. 2006;100:349–54.CrossRefPubMedGoogle Scholar
  25. 25.
    Kelly M, O’Malley DM, Hui P. Improved survival in surgical stage I patients with uterine papillary serous carcinomas (UPSC) treated with adjuvant platinum-based chemotherapy. Gynecol Oncol. 2005;98:353–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Thigpen JT, Brady MF, Homesley HD. Phase III trial of doxorubicin with or without cisplatin in advanced endometrial carcinoma: a Gynecologic Oncology Group study. J Clin Oncol. 2004;22:3902–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Fleming GF, Filiaci VL, Bentley RC. Phase III randomized trial of doxorubicin + cisplatin versus doxorubicin + 24-h paclitaxel + filgrastim in endometrial carcinoma: a Gynecologic Oncology Group study. Ann Oncol. 2004;15:1173–8.CrossRefPubMedGoogle Scholar
  28. 28.
    Fleming GF, Brunetto VL, Cella D. Phase III trial of doxorubicin plus cisplatin with or without paclitaxel plus filgrastim in advanced endometrial carcinoma: a Gynecologic Oncology Group study. J Clin Oncol. 2004;22:2159–66.CrossRefPubMedGoogle Scholar
  29. 29.
    Hidaka T, Nakamura T, Shima T. Paclitaxel/carboplatin versus cyclophosphamide/adriamycin/cisplatin as postoperative adjuvant chemotherapy for advanced endometrial adenocarcinoma. J Obstet Gynaecol Res. 2006;32:330–7.CrossRefPubMedGoogle Scholar
  30. 30.
    Weber B, Mayer F, Bougnoux P. What is the best chemotherapy regimen in recurrent or advanced endometrial carcinoma? Preliminary results. Proc Am Soc Clin Oncol. 2003;22:1819.Google Scholar
  31. 31.
    Nomura H, Aoki D, Takahashi F, et al. Randomized phase II study comparing docetaxel plus cisplatin, docetaxel plus carboplatin, and paclitaxel plus carboplatin in patients with advanced or recurrent endometrial carcinoma: a Japanese Gynecologic Oncology Group study (JGOG2041). Ann Oncol. 2011;22:636–42.CrossRefPubMedGoogle Scholar
  32. 32.
    Badwe RA, D’Cruz AK, Budrukkar A. Treatment algorithms in cancers 2012. Clinical Research Secretariat, Tata Memorial Hospital (TMH). p. 45–54.Google Scholar

Copyright information

© Springer India 2015

Authors and Affiliations

  • Seema Gulia
    • 1
  • Sudeep Gupta
    • 1
  1. 1.Department of Medical OncologyTata Memorial CentreMumbaiIndia

Personalised recommendations