Uterine serous histologies have higher rates of recurrence than do other stage I endometrioid carcinomas. The outcomes in institutional case series that utilize a policy of adjuvant carboplatin plus paclitaxel, occasionally including radiation therapy, for this histologic subtype, have been published and form the basis of management guidelines.[1,2,3,4,5,6,7] The Gynecologic Oncology Group (GOG-0249 [NCT00807768]) trial is comparing this chemotherapy regimen to pelvic radiation.
Since infection with human papillomavirus (HPV) is the most important risk factor for cervical cancer and precancers, it is important to avoid genital HPV infection. This may mean delaying sex, limiting the number of sex partners, and avoiding a sex partner who has had several other partners. Condoms are important to prevent the spread of sexually transmitted diseases, but they can't give full protection against HPV since there may be skin-to-skin contact of exposed areas which can transmit the virus...
A total hysterectomy and bilateral salpingo-oophorectomy should be done if the tumor:
Is well or moderately differentiated.
Involves the upper 66% of the corpus.
Has negative peritoneal cytology.
Is without vascular space invasion.
Has less than a 50% myometrial invasion.
Selected pelvic lymph nodes may be removed. If they are negative, no postoperative treatment is indicated. Postoperative treatment with a vaginal cylinder is advocated by some clinicians.
For all other cases and cell types, a pelvic and selective periaortic node sampling should be combined with the total hysterectomy and bilateral salpingo-oophorectomy, if there are no medical or technical contraindications. One study found that node dissection per se did not significantly add to the overall morbidity from hysterectomy. While the radiation therapy will reduce the incidence of local and regional recurrence, improved survival has not been proven and toxic effects are worse.[10,11,12,13,14] Results of two randomized trials on the use of adjuvant radiation therapy in patients with stage I disease did not show improved survival but did show reduced locoregional recurrence (3%-4% vs. 12%-14% after 5-6 years' median follow-up, P <.001) with an increase in side effects.[13,15,16][Level of evidence: 1iiDii] Results of a study by the Danish Endometrial Cancer Group also suggest that the absence of radiation does not improve the survival of patients with stage I, intermediate-risk disease (grade 1 and 2 with >50% myometrial invasion or grade 3 with <50% myometrial invasion).
The PORTEC-2 (NCT00411138) trial randomly assigned patients with stage I endometrial cancer who did not undergo lymph node dissection to undergo vaginal brachytherapy (VBT) or external-beam radiation therapy (EBRT), with prevention of vaginal recurrence as the primary outcome. At 5 years, there was no difference in the rates of vaginal recurrence, locoregional recurrence, progression-free survival or overall survival (OS) (84.8% [95% confidence interval-CI-, 79.3-90.3] vs. 79.6% [95% CI, 71.2-88.0] for VBT and EBRT, respectively; P = .57). There were significantly fewer gastrointestinal toxic effects and significantly improved quality of life in the VBT group, making VBT the preferred option for adjuvant treatment of patients with stage I disease.[18,19][Level of evidence: 1iA]