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Endometrial Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Recurrent Endometrial Cancer

For patients with localized recurrences (pelvis and periaortic lymph nodes) or distant metastases in selected sites, radiation therapy may be an effective palliative therapy. In rare instances, pelvic radiation therapy may be curative in pure vaginal recurrence when no prior radiation therapy has been used. Patients positive for estrogen and progesterone receptors respond best to progestin therapy. Among 115 patients with advanced endometrial cancer who were treated with progestins, 75% (42 of 56 patients) of those with detectable progesterone receptors in their tumors before treatment responded, compared with only 7% without detectable progesterone receptors (4 of 59 patients).[1] A receptor-poor status may predict not only poor response to progestins but also a better response to cytotoxic chemotherapy.[2] Evidence suggests that tamoxifen (20 mg twice a day) will give a response rate of 20% in those who do not respond to standard progesterone therapy.[3]

Several randomized trials by the Gynecologic Oncology Group have utilized the known antitumor activity of doxorubicin. The addition of cisplatin to doxorubicin increased response rates and progression-free survival (PFS) over doxorubicin alone but without an effect on overall survival (OS).[4] However, in a trial conducted in a subset of patients with stage III or IV disease with residual tumors smaller than 2 cm and no parenchymal organ involvement, the use of the combination of cisplatin and doxorubicin resulted in improved OS compared with whole-abdominal radiation therapy (adjusted hazard ratio, 0.68; 95% confidence interval limits, 0.52–0.89; P = .02; 5-year survival rate of 55% vs. 42%).[5][Level of evidence: 1iiA] In a subsequent trial, paclitaxel with doxorubicin had a similar outcome to cisplatin with doxorubicin.[6,7] The three-drug regimen (doxorubicin, cisplatin, and paclitaxel) with granulocyte colony-stimulating factor, however, was significantly superior to cisplatin plus doxorubicin: response rates were 57% versus 34%, PFS was 8.3 months versus 5.3 months, and OS was 15.3 months versus 12.3 months, respectively. The superior regimen was associated with a 12% grade 3 and a 27% grade 2 peripheral neuropathy.[6,7][Level of evidence: 1iiDiv]

Recommended Related to Cervical Cancer

Understanding Cervical Cancer -- the Basics

Cervical cancer is cancer of the cervix, the narrow neck at the lower part of a woman's uterus, just above the vagina (Figure 1). The cervix connects the uterus to the vagina. Approximately eight out of 10 cervical cancers originate in surface cells lining the cervix (squamous cell carcinomas). These cancers do not form suddenly. Over time, healthy cervical cells can become abnormal in appearance -- this is called dysplasia. Although these cells are not cancerous, they can eventually become...

Read the Understanding Cervical Cancer -- the Basics article > >

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