State-of-the-art treatment program increases survival from the aggressive uterine papillary serous carcinoma

A state-of-the-art treatment program developed at Yale School of Medicine increases survival from the aggressive uterine papillary serous carcinoma (UPSC) and spares some patients the need for additional therapy.

The results are presented in the lead article of September's Gynecologic Oncology. The research team, led by senior author Peter E. Schwartz, M.D., The John Slade Ely Professor and Vice Chairman of the Department of Obstetrics, Gynecology & Reproductive Sciences, determined that a combination of platinum-based chemotherapy and vaginal radiation was the most effective treatment for the disease.

"Our study defines a standard of care for this aggressive and growing form of uterine cancer," said Schwartz, who is also assistant chief of obstetrics and gynecology at Yale-New Haven Hospital. The procedure more accurately determines the complete stage and appropriate treatment and reduces the recurrence of the cancer.

The incidence of UPSC has increased since it was first identified in 1981. About 160 to 170 new cases of uterine cancer per year are seen at Yale. About seven percent are UPSC. UPSC is found in higher rates in African American women than in white women. The disease microscopically looks like ovarian cancer and spreads just as rapidly.

"Until now, there has been no consistent management of the disease," said first author Michael G. Kelly, M.D., fellow and instructor in the Department of Obstetrics, Gynecology & Reproductive Sciences at Yale. "With this method, we've been able to see who needs additional treatment after surgery and who does not. By reducing recurrence, we are helping to increase the survival rates of women with this form of uterine cancer. Once the disease recurs, virtually no one is cured."

The team reviewed 74 stage one patients with UPSC who underwent complete surgical staging, or hysterectomy with removal of pelvic and para-aortic lymph nodes and fat pads, at Yale between 1987 and 2004. Cancer recurred in 43 percent of early stage patients who did not receive chemotherapy, while in the 20 percent of patients who received platinum-based chemotherapy there were no recurrences. About 14 patients were spared additional radiation treatment.