Vol.13, No 3, 2006 pp. 133 - 138
UC 618.14-006.6:615.38
ADJUVANT CHEMOTHERAPY IN THE TREATMENT
OF ENDOMETRIAL CANCER
Zorica Stanojević1, Biljana Đorđević2, Ilinka Todorovska1, Vekoslav Lilić3, Radomir Živadinović3
1Clinic of Oncology, Clinical Center Niš
2Institute of Pathology, Medical School, University of Niš
3Clinic of Gynecology and Obstetrics, Clinical Center Niš
 E-mail: marko.st@bankerinter.net
Summary. Endometrial carcinoma is the most common and curable gynecologic neoplasm. The five-year survival for women with surgical stage I disease ranges from 85% to 90%, stage II 74% to 83%, stage III 57% to 66%, and stage IV 20% to 25%. The staging of endometrial cancer, according to the International Federation of Gynecology and Obstetrics (FIGO), is surgical. Recent studies suggest a therapeutic benefit associated with extensive retroperitoneal lymph node evaluation to determine the disease extent and thereby more effectively direct potentially life-saving adjuvant therapy. Due to the increasing number of endometrial cancer patients who undergo surgical staging, some independent prognostic factors have been identified in early stages (stage I-II), including lymph-vascular space involvement, histologic grade 3, aggressive histologic subtypes (uterine papillary serous carcinoma, clear cell carcinoma), depth of myometrial invasion, cervical invasion and the age of patients. Adjuvant radiation therapy, known to have survival benefit in advanced-stage disease, may also have survival benefit in intermediate-risk surgical stage I on the basis of results from a Gynecologic Oncology Group study, but it is followed by a significant risk of serious complications. Based on randomized clinical trials, this review has identified that there is a limited body of evidence that is available to help clinicians make decisions about the adjuvant chemotherapy treatment of patients with high-risk stage I and II, as well as stage IIIA endometrial cancer. Further investigations should be required to define the subgroup of patients who benefit from postoperative adjuvant chemotherapy. Furthermore, the optimal regimen is still in question as all of them (AP, CAP, TC, TAP) cause significant toxicity. Thereby, combination of carboplatin plus paclitaxel represents an efficacious, low-toxicity regimen for managing intermediate-risk surgical stage I, as well as advanced or recurrent endometrial cancer.
Key words: Endometrial cancer, adjuvant chemotherapy, cisplatin, paclitaxel, doxorubicin
ADJUVANTNA HEMIOTERAPIJA U LEČENJU KARCINOMA ENDOMETRIJUMA
Kratak sadržaj: Karcinom endometrijuma je najčešća i uglavnom izlečiva neoplazma genitalnih organa žene. Petogodišnje preživljavanje u stadijumu I bolesti je 85-90%, stadijumu II 74-83%, stadijumu III 57-66% i stadijumu IV 20-25%. Stadiranje karcinoma endometrijuma je hirurško u skladu sa preporukama Internacionalnog udruženja ginekologa i akušera (FIGO). Rezultati nedavno sprovedenih studija ukazuju na značaj evaluacije retroperitonealnih limfnih nodusa sa ciljem da se odredi proširenost bolesti i primeni adjuvantna terapija. S obzirom na činjenicu da se sve češće sprovodi hirurški steidžing karcinoma endometrijuma, definisani su nezavisni prognostički faktori u ranom stadijumu bolesti (st.I i II) koji podrazumevaju limfo-vaskularnu invaziju, histološki gradus 3, agresivne histološke tipove (serozni papilarni karcinom, svetloćelijski karcinom), dubinu invazije miometrijuma, zahvatanje grlića materice i godine života bolesnice. Na osnovu rezultata Ginekološko-onkološke grupe (GOG), adjuvantna radioterapija u hirurškom stadijumu I i II poboljšava preživljavanje, mada je praćena sa ozbiljnim komplikacijama. Do sada sprovedeni randomizovani klinički trajai u vezi sa primenom adjuvantne hemioterapije nisu brojni i ne sadrže dovoljno podataka koji mogu da pomognu kliničarima u donošenju odluke o primeni ovog vida terapije kod bolesnica sa visokim rizikom u ranom stadijumu karcinoma endometrijuma. Potrebna su dalja istraživanja koja će omogućiti da se definišu visoko rizične grupe bolesnica sa karcinomom endometrijuma koje će imati koristi od primene adjuvantne hemioterapije, kao i da se ustanovi koji je od hemioterapijski protokola (AC, CAP, TC, TAP) najefikasniji.
Ključne reči: karcinom endometrijuma, adjuvantna hemioterapija, cisplatin, paclitaxel, doxorubicin