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논문KCI 등재

Management of inoperable endometrial cancer

Supakorn Pitakkarnkul|Saranya Chanpanitkitchot|Siriwan Tangjitgamol
대한산부인과학회 (Korean Soceity of Obstetrics and Gynecology)|2022.07|Obstetrics & Gynecology Science|제65권 제4호|pp. 303-316

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키워드

Quality of lifeRadiotherapyChemotherapyEndometrial cancer
주제분류산부인과학

초록

Some endometrial cancer (EMC) patients are not good candidates for primary surgery. The three major types of treatment for inoperable EMC are radiation therapy, chemotherapy, or their combination as neoadjuvant treatment before surgery. Radiation therapy alone (of different modes) has been used as the sole definitive therapeutic modality, particularly for early-stage disease that is limited to the uterine body and cervix with or without parametrial invasion. The most common treatment modality is neoadjuvant treatment before surgery. Postoperative adjuvant treatment is also occasionally used, depending mainly on the sites of the disease and the results of surgery. Data on neoadjuvant hormonal or radiation therapy are limited, with studies focusing on laboratory outcomes or having only a small number of patients. Most neoadjuvant treatments before surgery involved chemotherapy and fewer combined chemoradiotherapy. Surgery was generally performed, particularly in patients who had shown responses or at least stable disease to neoadjuvant treatment. Perioperative outcomes after neoadjuvant treatment were superior to those after primary surgery, whereas survival data were still inconsistent. Features that had or tended to have a favorable prognosis were younger age, early-stage disease, response to neoadjuvant treatment, low preoperative cancer antigen-125 level, and optimal surgery. Among different modalities of neoadjuvant treatment, which has become a frequent mode of treatment, neoadjuvant chemotherapy was more common than radiation therapy alone or chemoradiation.

Abstract

Some endometrial cancer (EMC) patients are not good candidates for primary surgery. The three major types of treatment for inoperable EMC are radiation therapy, chemotherapy, or their combination as neoadjuvant treatment before surgery. Radiation therapy alone (of different modes) has been used as the sole definitive therapeutic modality, particularly for early-stage disease that is limited to the uterine body and cervix with or without parametrial invasion. The most common treatment modality is neoadjuvant treatment before surgery. Postoperative adjuvant treatment is also occasionally used, depending mainly on the sites of the disease and the results of surgery. Data on neoadjuvant hormonal or radiation therapy are limited, with studies focusing on laboratory outcomes or having only a small number of patients. Most neoadjuvant treatments before surgery involved chemotherapy and fewer combined chemoradiotherapy. Surgery was generally performed, particularly in patients who had shown responses or at least stable disease to neoadjuvant treatment. Perioperative outcomes after neoadjuvant treatment were superior to those after primary surgery, whereas survival data were still inconsistent. Features that had or tended to have a favorable prognosis were younger age, early-stage disease, response to neoadjuvant treatment, low preoperative cancer antigen-125 level, and optimal surgery. Among different modalities of neoadjuvant treatment, which has become a frequent mode of treatment, neoadjuvant chemotherapy was more common than radiation therapy alone or chemoradiation.

참고문헌 (72)

  1. Creasman WT, "Carcinoma of the corpus uteri. FIGO 26th annual report on the results of treatment in gynecological cancer", Int J Gynaecol Obstet, 95(Suppl 1), pp.S105~S143 (2006)
  2. Bogani G, "Clinical utility of preoperative computed tomography in patients with endometrial cancer", Int J Gynecol Cancer, 27, pp.1685~1693 (2017)
  3. Dai S, "Impact and cost of preoperative computed tomography imaging on the management of patients diagnosed with high-grade endometrial cancer", Int J Gynaecol Obstet, 145, pp.219~224 (2019)
  4. Chao A, "18F-FDG PET in the management of endometrial cancer", Eur J Nucl Med Mol Imaging, 33, pp.36~44 (2006)
  5. Teng F, "Contrast-enhanced MRI in preoperative assessment of myometrial and cervical invasion, and lymph node metastasis : diagnostic value and error analysis in endometrial carcinoma", Acta Obstet Gynecol Scand, 94, pp.266~273 (2015)
  6. Bristow RE, "Extended surgical staging for uterine papillary serous carcinoma : survival outcome of locoregional(stage I-III)disease", Gynecol Oncol, 81, pp.279~286 (2001)
  7. Chao CK, "Medically inoperable stage I endometrial carcinoma : a few dilemmas in radiotherapeutic management", Int J Radiat Oncol Biol Phys, 34, pp.27~31 (1996)
  8. Yoo S, "Definitive radiation therapy for stage I-II endometrial cancer : an observational study of nonoperative management", Am J Clin Oncol, 40, pp.582~589 (2017)
  9. Kemmerer E, "Use of image-guided stereotactic body radiation therapy in lieu of intracavitary brachytherapy for the treatment of inoperable endometrial neoplasia", Int J Radiat Oncol Biol Phys, 85, pp.129~135 (2013)
  10. Gebhardt B, "Image-guided tandem and cylinder brachytherapy as monotherapy for definitive treatment of inoperable endometrial carcinoma", Gynecol Oncol, 147, pp.302~308 (2017)
  11. Shenfield CB, "The management of inoperable stage I endometrial cancer using intracavitary brachytherapy alone : a 20-year institutional review", Brachytherapy, 8, pp.278~283 (2009)
  12. Kupelian PA, "Treatment of endometrial carcinoma with radiation therapy alone", Int J Radiat Oncol Biol Phys, 27, pp.817~824 (1993)
  13. Fishman DA, "Radiation therapy as exclusive treatment for medically inoperable patients with stage I and II endometrioid carcinoma with endometrium", Gynecol Oncol, 61, pp.189~196 (1996)
  14. Churn M, "Primary radiotherapy for carcinoma of the endometrium using external beam radiotherapy and single line source brachytherapy", Clin Oncol(R Coll Radiol), 11, pp.255~262 (1999)
  15. Podzielinski I, "Primary radiation therapy for medically inoperable patients with clinical stage I and II endometrial carcinoma", Gynecol Oncol, 124, pp.36~41 (2012)
  16. Nguyen C, "High-doserate brachytherapy as the primary treatment of medically inoperable stage I-II endometrial carcinoma", Gynecol Oncol, 59, pp.370~375 (1995)
  17. Knocke TH, "Primary treatment of endometrial carcinoma with highdose-rate brachytherapy : results of 12 years of experience with 280 patients", Int J Radiat Oncol Biol Phys, 37, pp.359~365 (1997)
  18. Kucera H, "Treatment of endometrial carcinoma with high-dose-rate brachytherapy alone in medically inoperable stage I patients", Acta Obstet Gynecol Scand, 77, pp.1008~1012 (1998)
  19. Nguyen TV, "High-dose-rate brachytherapy for medically inoperable stage I endometrial cancer", Gynecol Oncol, 71, pp.196~203 (1998)
  20. Niazi TM, "Long-term results of high-dose-rate brachytherapy in the primary treatment of medically inoperable stage I-II endometrial carcinoma", Int J Radiat Oncol Biol Phys, 63, pp.1108~1113 (2005)
  21. Weitmann HD, "Pilot study in the treatment of endometrial carcinoma with 3D image-based high-dose-rate brachytherapy using modified Heyman packing : clinical experience and dose-volume histogram analysis", Int J Radiat Oncol Biol Phys, 62, pp.468~478 (2005)
  22. Coon D, "High-dose-rate Rotte"Y"applicator brachytherapy for definitive treatment of medically inoperable endometrial cancer : 10-year results", Int J Radiat Oncol Biol Phys, 71, pp.779~783 (2008)
  23. Inciura A, "Longterm results of high-dose-rate brachytherapy and external-beam radiotherapy in the primary treatment of endometrial cancer", J Radiat Res, 51, pp.675~681 (2010)
  24. Wegner RE, "Definitive radiation therapy for endometrial cancer in medically inoperable elderly patients", Brachytherapy, 9, pp.260~265 (2010)
  25. Gill BS, "Primary radiotherapy for nonsurgically managed stage I endometrial cancer : utilization and impact of brachytherapy", Brachytherapy, 14, pp.373~379 (2015)
  26. Acharya S, "Medically inoperable endometrial cancer in patients with a high body mass index(BMI) : patterns of failure after 3-D image-based high dose rate(HDR)brachytherapy", Radiother Oncol, 118, pp.167~172 (2016)
  27. Draghini L, "Definitive three-dimensional highdose-rate brachytherapy for inoperable endometrial cancer", J Contemp Brachytherapy, 9, pp.118~123 (2017)
  28. Gannavarapu BS, "Upfront radiotherapy with brachytherapy for medically inoperable and unresectable patients with high-risk endometrial cancer", Brachytherapy, 19, pp.139~145 (2020)
  29. Irie D, "Carbon-ion radiotherapy for inoperable endometrial carcinoma", J Radiat Res, 59, pp.309~315 (2018)
  30. Schwarz JK, "Consensus statement for brachytherapy for the treatment of medically inoperable endometrial cancer", Brachytherapy, 14, pp.587~599 (2015)
  31. Creasman WT, "Surgical pathologic spread patterns of endometrial cancer. A gynecologic oncology group study", Cancer, 60(8 Suppl), pp.2035~2041 (1987)
  32. Creasman WT, "Prognosis of papillary serous, clear cell, and grade 3 stage I carcinoma of the endometrium", Gynecol Oncol, 95, pp.593~596 (2004)
  33. Brinton LA, "Etiologic heterogeneity in endometrial cancer : evidence from a gynecologic oncology group trial", Gynecol Oncol, 129, pp.277~284 (2013)
  34. Williams AT, "Role of the pathologist in assessing response to treatment of ovarian and endometrial cancers", Histopathology, 76, pp.93~101 (2020)
  35. Davidson BA, "Tumor grade and chemotherapy response in endometrioid endometrial cancer", Gynecol Oncol Rep, 17, pp.3~6 (2016)
  36. Conway JL, "Clinical outcomes of surgically unresectable endometrial cancers", Am J Clin Oncol, 42, pp.777~782 (2019)
  37. Khouri OR, "Neoadjuvant chemotherapy in patients with advanced endometrial cancer", Cancer Chemother Pharmacol, 84, pp.281~285 (2019)
  38. Rajkumar S, "Advanced stage(IIIC", IV)endometrial cancer : role of cytoreduction and determinants of survival, 2019, pp.234, 26~31
  39. Vandenput I, "Neoadjuvant chemotherapy followed by interval debulking surgery in patients with serous endometrial cancer with transperitoneal spread(stage IV) : a new preferred treatment?", Br J Cancer, 101, pp.244~249 (2009)
  40. Mahdi H, "The impact of percent reduction in CA-125 levels on prediction of the extent of interval cytoreduction and outcome in patients with advanced-stage cancer of Müllerian origin treated with neoadjuvant chemotherapy", Int J Gynecol Cancer, 25, pp.823~829 (2015)
  41. Cancer Genome Atlas Research Network, "Integrated genomic characterization of endometrial carcinoma", Nature, 497, pp.67~73 (2013)
  42. Thigpen JT, "Oral medroxyprogesterone acetate in the treatment of advanced or recurrent endometrial carcinoma : a dose-response study by the Gynecologic Oncology Group", J Clin Oncol, 17, pp.1736~1744 (1999)
  43. Manolis Nikolopoulos, "Medically unfit women with early-stage endometrial cancer treated with the levonorgestrel intrauterine system", Obstetrics & Gynecology Science, 63(3), pp.337~345 (2020), 대한산부인과학회[DOI]
  44. Martin-Hirsch PP, "Adjuvant progestagens for endometrial cancer", Cochrane Database Syst Rev, (6), pp.CD001040~ (2011)
  45. Bershteĭn LM, "Criteria for evaluating the effectiveness of aromatase inhibitors in the neoadjuvant treatment of patients with endometrial carcinoma", Vopr Onkol, 55, pp.314~318 (2009)
  46. Thangavelu A, "Neoadjuvant treatment of endometrial cancer using anastrozole : a randomised pilot study", Gynecol Oncol, 131, pp.613~618 (2013)
  47. Bershteĭn LM, "Effectiveness of aromatase inhibitors in comparison with metformin for neoadjuvant treatment in patients with endometrial cancer", Vopr Onkol, 57, pp.737~741 (2011)
  48. Sobotkowski J, "Preoperative high-dose brachytherapy in cases of endometrial carcinoma--preliminary assessment of outcomes and safety", Med Wieku Rozwoj, 8(2 Pt 1), pp.309~316 (2004)
  49. Hoffstetter S, "Preoperative brachytherapy for clinical stage I and II endometrial carcinoma : results from a series of 780 patients with a 10-year follow-up", Cancer Radiother, 8, pp.178~187 (2004)
  50. Shukla G, "Preoperative high dose rate brachytherapy for clinical stage II endometrial carcinoma", J Contemp Brachytherapy, 3, pp.70~73 (2011)
  51. Vargo JA, "Neoadjuvant radiotherapy with or without chemotherapy followed by extrafascial hysterectomy for locally advanced endometrial cancer clinically extending to the cervix or parametria", Gynecol Oncol, 135, pp.190~195 (2014)
  52. Boisen MM, "Surgical outcomes of patients undergoing extrafascial hysterectomy after neoadjuvant radiotherapy with or without chemotherapy for locally advanced endometrial cancer clinically extending to the cervix or parametria", Int J Gynecol Cancer, 27, pp.1149~1154 (2017)
  53. Rose PG, "Secondary surgical cytoreduction for advanced ovarian carcinoma", N Engl J Med, 351, pp.2489~2497 (2004)
  54. Vergote I, "Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer", N Engl J Med, 363, pp.943~953 (2010)
  55. Despierre E, "Is there a role for neoadjuvant chemotherapy in the treatment of stage IV serous endometrial carcinoma?", Int J Gynecol Cancer, 16(Suppl 1), pp.273~277 (2006)
  56. Takami M, "A case of advanced clear cell carcinoma of the endometrium that responded remarkably to neoadjuvant chemotherapy of combination carboplatin plus weekly paclitaxel", Gan To Kagaku Ryoho, 34, pp.457~460 (2007)
  57. Eto T, "Status of treatment for the overall population of patients with stage IVb endometrial cancer, and evaluation of the role of preoperative chemotherapy : a retrospective multi-institutional study of 426patients in Japan", Gynecol Oncol, 131, pp.574~580 (2013)
  58. Wilkinson-Ryan I, "Neoadjuvant chemotherapy versus primary cytoreductive surgery for stage IV uterine serous carcinoma", Int J Gynecol Cancer, 25, pp.63~68 (2015)
  59. de Lange NM, "Neoadjuvant chemotherapy followed by surgery for advanced-stage endometrial cancer", Curr Oncol, 26, pp.e226~e232 (2019)
  60. Bogani G, "Neoadjuvant chemotherapy followed by interval debulking surgery for unresectable stage IVb serous endometrial cancer", Tumori, 105, pp.92~97 (2019)
  61. Chambers LM, "Impact of treatment modality on overall survival in women with advanced endometrial cancer : a national cancer database analysis", Gynecol Oncol, 160, pp.405~412 (2021)
  62. Marabelle A, "Efficacy of pembrolizumab in patients with noncolorectal high microsatellite instability", mismatch repair-deficient cancer : results from the phase II KEYNOTE-158 study, 2020, pp.38, 1~10
  63. Makker V, "Lenvatinib plus pembrolizumab in patients with advanced endometrial cancer", J Clin Oncol, 38, pp.2981~2992 (2020)
  64. Makker V, "A multicenter, open-label, randomized, phase 3 study to compare the efficacy and safety of lenvatinib in combination with pembrolizumab vs treatment of physician’s choice in patients with advanced endometrial cancer", Gynecol Oncol, 162(Suppl 1), pp.S4~ (2021)
  65. Marth C, "Phase 3, randomized, open-label study of pembrolizumab plus lenvatinib versus chemotherapy for first-line treatment of advanced or recurrent endometrial cancer : ENGOT-en9", LEAP-001, 2022, pp.32, 93~100
  66. Randall ME, "Phase III trial : adjuvant pelvic radiation therapy versus vaginal brachytherapy plus paclitaxel", carboplatin in high-intermediate and high-risk early stage endometrial cancer, 2019, pp.37, 1810~1818
  67. Matei D, "Adjuvant chemotherapy plus radiation for locally advanced endometrial cancer", N Engl J Med, 380, pp.2317~2326 (2019)
  68. de Boer SM, "Adjuvant chemoradiotherapy versus radiotherapy alone in women with high-risk endometrial cancer(PORTEC-3) : patterns of recurrence and post-hoc survival analysis of a randomised phase 3trial", Lancet Oncol, 20, pp.1273~1285 (2019)
  69. Kaneyasu Y, "Stage IVB uterine endometrial cancer successfully salvaged by chemoradiotherapy and surgery", Int J Clin Oncol, 8, pp.60~64 (2003)
  70. Horne Z, "Complete pathologic response following neoadjuvant chemoradiotherapy and high-dose-rate brachytherapy for locally advanced endometrial carcinoma", Cureus, 7, pp.e407~ (2015)
  71. Iheagwara UK, "Neoadjuvant chemoradiation therapy followed by extrafascial hysterectomy in locally advanced type II endometrial cancer clinically extending to cervix", Pract Radiat Oncol, 9, pp.248~256 (2019)
  72. Boothe D, "Chemoradiation versus chemotherapy or radiation alone in stage III endometrial cancer : patterns of care and impact on overall survival", Gynecol Oncol, 141, pp.421~427 (2016)

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