- Email: [email protected]
Residual tumor after neoadjuvant chemotherapy and interval debulking surgery for advanced endometrial cancer
Gynecologic Oncology 114 (2009) 370–372
Contents lists available at ScienceDirect
Gynecologic Oncology j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / y g y n o
Letters to the Editor Residual tumor after neoadjuvant chemotherapy and interval debulking surgery for advanced endometrial cancer
Response to “Residual tumor after neoadjuvant chemotherapy and interval debulking for advanced endometrial cancer”
To the Editor,
To the Editor,
We read with much interest the paper published by Landrum et al. reporting on the role of primary cytoreduction for advanced endometrial carcinoma [1]. The authors showed that optimal cytoreduction, defined as ≤1 cm residual disease, was associated with a survival benefit (Hazard ratio 2.4). We are interested to know in what proportion of patients cytoreduction to no residual tumor was achieved and how this relates to the median survival. Optimal cytoreduction to b1 cm residual disease was achieved in 87% of the patients, but data on no residual disease were not shown. We have shown previously that neoadjuvant chemotherapy followed by interval debulking surgery for advanced endometrial cancer resulted in no residual disease in 79–100% all patients [2,3]. Similar to its ovarian counterpart, the median survival and progression-free interval in patients with advanced endometrial cancer depend on the amount of residual disease [4–6]. Besides a potential improvement in clinical outcome, interval debulking surgery is associated with less morbidity and shorter hospitalization.
Thank you for your recent letter [1] addressing our study entitled “Does applying an ovarian cancer treatment paradigm result in similar outcomes? A case-control analysis [2].” A review of our study of 55 patients with Stage IVb endometrial cancer revealed that 48 patients (87%) had less than 1 cm of disease remaining at the end of primary cytoreductive surgery. A survival advantage was noted for this group of patients with a hazard ratio of 2.4. Of this number, 30 patients (55%) had no residual disease and 18 patients (33%) had b1 cm of residual disease. When these two groups were separated and survival curves created by Kaplan–Meier method, there were no significant differences by log-rank analysis. Based on these and other retrospective data [3,4] optimal cytoreduction appears to provide a survival benefit for patients with advanced endometrial cancer undergoing primary surgery. There may be a role for neoadjuvant chemotherapy followed by interval debulking in subgroups of patients with poor performance status or unresectable disease, but to date, the limited data that we have, supports surgical cytoreduction.
Conflict of interest statement The authors declare that there are no conflicts of interest.
References References [1] Landrum LM, Moore KN, Myers TKN, Lanneau GS, McMeekin DS, Walker JL, et al. Stage IVB endometrial cancer: does applying an ovarian cancer treatment paradigm result in similar outcomes? A case-control analysis. Gynecol Oncol 2009;112(2):337–41. [2] Despierre E, Moerman P, Vergote I, Amant F. Is there a role for neoadjuvant chemotherapy in the treatment of stage IV serous endometrial carcinoma? Int J Gynecol Cancer 2006;16(Suppl 1):273–7. [3] Vandenput I, Moerman Ph, Leunen K, et al. Neoadjuvant chemotherapy followed by intervaldebulking surgery for stage IV uterine papillary serous carcinoma: an interim analysis. 2009 Oral Abstract IGCS Bangkok. [4] Bristow RE, Duska LR, Montz FJ. The role of cytoreductive surgery in the management of Stage IV uterine papillary serous carcinoma. Gynecol Oncol 2001;81:92–9. [5] Memarzadeh S, Holschneider CH, Bristow RE, Jones NL, Fu YS, Karlan BY, et al. FIGO stage III and IV uterine papillary serous carcinoma: impact of residual disease on survival. Int J Gynecol Cancer 2002;12(5):454–8. [6] Thomas MB, Mariani A, Cliby WA, Keeney GL, Podratz KC, Dowdy SC. Role of cytoreduction in stage III and IV uterine papillary serous carcinoma. Gynecol Oncol 2007;107(2):190–3.
Frédéric Amant⁎ Evelyn Despierre Ingrid Vandenput Division of Gynecological Oncology, Leuven Cancer Institute (LKI), UZ Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium, Herestraat 49, 3000 Leuven, Belgium E-mail address: [email protected] ⁎Corresponding author. Fax: +32 16 344629.
[1] Amant F, Despierre E, Vandenput I. Letter to the editor entitled “residual tumor after neoadjuvant chemotherapy and interval debulking for advanced endometrial cancer”. Gynecol Oncol 2009. [2] Landrum LM, Moore KN, Myers TKN, Lanneau GS, McMeekin DS, Walker JL, et al. Stage IVb endometrial cancer: does applying an ovarian cancer treatment paradigm result in similar outcomes? A case-control analysis. Gynecol Oncol 2009;112(2): 337–41. [3] Bristow RE, Duska LR, Montz FJ. The role of cytoreductive surgery in the management of stage IV uterine papillary serous carcinoma. Gynecol Oncol 2001;81:92–9. [4] Chi DS, Welshinger M, Venkatraman ES, Barakat RR. The role of surgical cytoreduction in stage IV endometrial carcinoma. Gynecol Oncol 1997;67(1):56–60.
Lisa M. Landrum* D. Scott McMeekin Section of Gynecology Oncology, University of Oklahoma Health Sciences Center, WP 2410 PO Box 26901, Oklahoma City, OK 73190, USA E-mail address: [email protected] *Corresponding author. Fax: +1 405 271 2976 18 April 2009
19 March 2009 doi:10.1016/j.ygyno.2009.03.024 0090-8258/$ – see front matter © 2009 Elsevier Inc. All rights reserved.
doi:10.1016/j.ygyno.2009.04.029
Contents lists available at ScienceDirect
Gynecologic Oncology j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / y g y n o
Letters to the Editor Residual tumor after neoadjuvant chemotherapy and interval debulking surgery for advanced endometrial cancer
Response to “Residual tumor after neoadjuvant chemotherapy and interval debulking for advanced endometrial cancer”
To the Editor,
To the Editor,
We read with much interest the paper published by Landrum et al. reporting on the role of primary cytoreduction for advanced endometrial carcinoma [1]. The authors showed that optimal cytoreduction, defined as ≤1 cm residual disease, was associated with a survival benefit (Hazard ratio 2.4). We are interested to know in what proportion of patients cytoreduction to no residual tumor was achieved and how this relates to the median survival. Optimal cytoreduction to b1 cm residual disease was achieved in 87% of the patients, but data on no residual disease were not shown. We have shown previously that neoadjuvant chemotherapy followed by interval debulking surgery for advanced endometrial cancer resulted in no residual disease in 79–100% all patients [2,3]. Similar to its ovarian counterpart, the median survival and progression-free interval in patients with advanced endometrial cancer depend on the amount of residual disease [4–6]. Besides a potential improvement in clinical outcome, interval debulking surgery is associated with less morbidity and shorter hospitalization.
Thank you for your recent letter [1] addressing our study entitled “Does applying an ovarian cancer treatment paradigm result in similar outcomes? A case-control analysis [2].” A review of our study of 55 patients with Stage IVb endometrial cancer revealed that 48 patients (87%) had less than 1 cm of disease remaining at the end of primary cytoreductive surgery. A survival advantage was noted for this group of patients with a hazard ratio of 2.4. Of this number, 30 patients (55%) had no residual disease and 18 patients (33%) had b1 cm of residual disease. When these two groups were separated and survival curves created by Kaplan–Meier method, there were no significant differences by log-rank analysis. Based on these and other retrospective data [3,4] optimal cytoreduction appears to provide a survival benefit for patients with advanced endometrial cancer undergoing primary surgery. There may be a role for neoadjuvant chemotherapy followed by interval debulking in subgroups of patients with poor performance status or unresectable disease, but to date, the limited data that we have, supports surgical cytoreduction.
Conflict of interest statement The authors declare that there are no conflicts of interest.
References References [1] Landrum LM, Moore KN, Myers TKN, Lanneau GS, McMeekin DS, Walker JL, et al. Stage IVB endometrial cancer: does applying an ovarian cancer treatment paradigm result in similar outcomes? A case-control analysis. Gynecol Oncol 2009;112(2):337–41. [2] Despierre E, Moerman P, Vergote I, Amant F. Is there a role for neoadjuvant chemotherapy in the treatment of stage IV serous endometrial carcinoma? Int J Gynecol Cancer 2006;16(Suppl 1):273–7. [3] Vandenput I, Moerman Ph, Leunen K, et al. Neoadjuvant chemotherapy followed by intervaldebulking surgery for stage IV uterine papillary serous carcinoma: an interim analysis. 2009 Oral Abstract IGCS Bangkok. [4] Bristow RE, Duska LR, Montz FJ. The role of cytoreductive surgery in the management of Stage IV uterine papillary serous carcinoma. Gynecol Oncol 2001;81:92–9. [5] Memarzadeh S, Holschneider CH, Bristow RE, Jones NL, Fu YS, Karlan BY, et al. FIGO stage III and IV uterine papillary serous carcinoma: impact of residual disease on survival. Int J Gynecol Cancer 2002;12(5):454–8. [6] Thomas MB, Mariani A, Cliby WA, Keeney GL, Podratz KC, Dowdy SC. Role of cytoreduction in stage III and IV uterine papillary serous carcinoma. Gynecol Oncol 2007;107(2):190–3.
Frédéric Amant⁎ Evelyn Despierre Ingrid Vandenput Division of Gynecological Oncology, Leuven Cancer Institute (LKI), UZ Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium, Herestraat 49, 3000 Leuven, Belgium E-mail address: [email protected] ⁎Corresponding author. Fax: +32 16 344629.
[1] Amant F, Despierre E, Vandenput I. Letter to the editor entitled “residual tumor after neoadjuvant chemotherapy and interval debulking for advanced endometrial cancer”. Gynecol Oncol 2009. [2] Landrum LM, Moore KN, Myers TKN, Lanneau GS, McMeekin DS, Walker JL, et al. Stage IVb endometrial cancer: does applying an ovarian cancer treatment paradigm result in similar outcomes? A case-control analysis. Gynecol Oncol 2009;112(2): 337–41. [3] Bristow RE, Duska LR, Montz FJ. The role of cytoreductive surgery in the management of stage IV uterine papillary serous carcinoma. Gynecol Oncol 2001;81:92–9. [4] Chi DS, Welshinger M, Venkatraman ES, Barakat RR. The role of surgical cytoreduction in stage IV endometrial carcinoma. Gynecol Oncol 1997;67(1):56–60.
Lisa M. Landrum* D. Scott McMeekin Section of Gynecology Oncology, University of Oklahoma Health Sciences Center, WP 2410 PO Box 26901, Oklahoma City, OK 73190, USA E-mail address: [email protected] *Corresponding author. Fax: +1 405 271 2976 18 April 2009
19 March 2009 doi:10.1016/j.ygyno.2009.03.024 0090-8258/$ – see front matter © 2009 Elsevier Inc. All rights reserved.
doi:10.1016/j.ygyno.2009.04.029