Combination chemotherapy regimens employing doxorubicin and cisplatin; cyclophosphamide, doxorubicin, and cisplatin; paclitaxel and cisplatin with or without doxorubicin; and carboplatin and paclitaxel resulted in response rates ranging from 38% to 76% (375– 390). Despite these fairly impressive response rates, most responses are partial, with durations of 4 to 8 months, and the median survival time is less than 12 months.
Response to chemotherapy in patients with metastatic endometrial cancer does not appear to be affected by prior or concurrent progestin therapy. Metastatic site, age, disease-free interval, histology, and tumor grade appear to have no effect on chemotherapy response. Patients with long disease-free intervals and better performance status may live longer.
Treatment Results Comprehensive survival data for endometrial cancer are provided by the FIGO (391). Survival in relation to the old clinical and surgical stage is shown in Table 35.13 and in relation to surgical stage and grade in Table 35.14. The overall 5-year survival rate was 76%. Patients who underwent surgical staging had much better 5-year survival rates than those staged clinically across all stages (respectively): stage I, 87% versus 54%; stage II, 76% versus 41%; stage III, 57% versus 23%; stage IV, 18% versus 12%. Survival in surgical stage I disease ranged from more than 90% for patients with grade 1 and 2 tumors without myometrial invasion to 63% for stage IB grade 3.
Table 35.13 Carcinoma of the Endometrium: Stage Distribution and Actuarial Survival by Stage (Surgical and Clinical)
Surgical I 3,996 70 92 87 II 70912 82 76 III 758 13 66 59 IV 231 423 18
Total 6,260 100 82 76
Adapted from Creasman WT, Odicino F, Maisonneuve P, et al. Carcinoma of the corpus uteri. FIGO Annual Report on the results of treatment in gynecological cancer. J Epidemiol Biostat 2001;6:45–86, with permission.
Table 35.14 Surgically Staged Endometrial Cancer: Actuarial 5-Year Survival Rate (%) by Histologic Grade and Stage (1988 staging criteria)
Adapted from Creasman WT, Odicino F, Maisonneuve P, et al. Carcinoma of the corpus uteri. FIGO Annual Report on the results of treatment in gynecological cancer. J Epidemiol Biostat 2001;6:45–86, with permission.
History and physical examination remain the most effective methods of follow-up in patients treated for endometrial cancer (392–394). Patients should be examined every 3 to 4 months during the first 2 years and every 6 months thereafter. About one-half of patients discovered to have recurrent cancer have symptoms, and 75% to 80% of recurrences are detected initially on physical examination. Particular attention should be given to peripheral lymph nodes, the abdomen, and the pelvis. Very few asymptomatic recurrences are detected by vaginal cytology.
Chest x-ray every 12 months is an important method of posttreatment surveillance. Almost one-half of all asymptomatic recurrences are detected by chest x-ray. Other radiologic studies, such as CT scans, are not indicated for routine follow-up of patients who do not have symptoms.