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2/2021
vol. 13
abstract:
Review paper
Adjuvant vaginal interventional radiotherapy
in early-stage non-endometrioid carcinoma
of corpus uteri: a systematic review
Valentina Lancellotta
2
,
Valentina Cerboneschi
5
,
Mattia Falchetto Osti
15
,
1.
Department of Radiotherapy, Policlinico Umberto I, “Sapienza” University of Rome, Rome, Italy
2.
Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia – Gemelli ART (Advanced Radiation Therapy), Interventional Oncology Center (IOC), Roma, Italy
3.
Radiotherapy Unit, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
4.
Radiotherapy Unit, S. Spirito Hospital, Pescara, Italy
5.
Radiotherapy Unit, Department of Oncology, San Luca Hospital, Lucca, Italy
6.
Radiotherapy Unit, Presidio Ospedaliero San Filippo Neri, Roma, Italy
7.
Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
8.
Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
9.
Department of Oncology – Radiotherapy, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
10.
Division of Radiation Oncology, ASST-Lecco, Ospedale A. Manzoni, Lecco, Italy
11.
Presidente Fondazione Area Radiologica, Roma, Italy
12.
UOC Radioterapia Oncologica, Azienda Ospedaliera “Brotzu”, Cagliari, Italy
13.
Radiotherapy Unit, Dipartimento di Scienze Biomediche, Sperimentali e Cliniche Mario Serio, University of Florence, Firenze, Italy
14.
Department of Medicine and Surgery and Translational Medicine, Gynecology Oncology, Sant’ Andrea Hospital, “Sapienza” University, Rome, Italy
15.
Department of Medicine and Surgery and Translational Medicine, Radiotherapy Oncology, Sant’ Andrea Hospital, “Sapienza” University, Rome, Italy
J Contemp Brachytherapy 2021; 13, 2: 231–243
Online publish date: 2021/04/14
Introduction
This systematic review focused on rare histological types of corpus uteri malignancy, including uterine carcinosarcoma (UCS), uterine clear cell carcinoma (UCCC), and uterine papillary serous carcinoma (UPSC), and it is proposed to assist with clinical decision-making. Adjuvant treatment decisions must be made based on available evidences. We mainly investigated the role of vaginal interventional radiotherapy (VIRt) in UCS, UCCC, and UPSC managements.
Material and methods
A systematic research using PubMed and Cochrane library was conducted to identify full articles evaluating the efficacy of VIRt in early-stage UPSC, UCCC, and UCS. A search in ClinicalTrials.gov was performed in order to detect ongoing or recently completed trials as well as in PROSPERO for ongoing or recently completed systematic reviews. Survival outcomes and toxicity rates were obtained.
Results
All studies were retrospective. For UCS, the number of evaluated patients was 432. The 2- to 5-year average local control (LC) was 91% (range, 74.2-96%), disease-free survival (DFS) 88% (range, 82-94%), overall survival (OS) 79% (range, 53.8-84.3%), the average 5-year cancer-specific survival (CSS) was 70% (range, 70-94%), and G3-G4 toxicity was 0%. For UCCC, the number of investigated patients was 335 (UCCC – 124, mixed – 211), with an average 5-year LC of 100%, DFS of 83% (range, 82-90%), OS of 93% (range, 83-100%), and G3-G4 toxicity of 0%. For UPSC, the number of examined patients was 1,092 (UPSC – 866, mixed – 226). The average 5-year LC was 97% (range, 87.1-100%), DFS 84% (range, 74.7-95.6%), OS 93% (range, 71.9-100%), CSS 89% (range, 78.9-94%), and G3-G4 toxicity was 0%.
Conclusions
These data suggest that in adequately selected early-stage UPSC and UCCC patients, VIRt alone may be suitable in women who underwent surgical staging and received adjuvant chemotherapy. In early-stage UCS, a multidisciplinary therapeutic approach has to be planned, considering high-rate of pelvic and distant relapses.
keywords:
endometrial cancer, rare tumor, adjuvant treatment, brachytherapy, radiotherapy
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