This article is more than 5 years old. Information may no longer be current.
Platinum-based therapy best for clear cell endometrial cancer
SGO recommendations for treatment incorporate comprehensive surgical staging, and long-term surveillance.
Click Here to Manage Email Alerts
Due to its relative rarity, determining the optimal treatment for clear cell endometrial cancer may be difficult based on available data. According to an evidence-based medicine summary published by the Society of Gynecologic Oncologists Clinical Practice Committee, comprehensive surgical staging and platinum-based adjuvant chemotherapy in combination with paclitaxel or doxorubicin should be considered as part of the treatment of women with primary or recurrent clear cell endometrial adenocarcinoma.
Because of the high rate for recurrence, researchers also suggested careful, long-term surveillance following treatment.
“This information is very important because the number of women
affected [by clear cell endometrial cancer] is small when compared with the
other types of endometrial cancer. However, it is aggressive in behavior,
spreads very quickly and does not respond well to chemotherapy when compared
with the other types of endometrial cancer. When adding all of this together it
makes the women who suffer from this histology an important subgroup to pay
very close attention to,” Alexander Olawaiye, MD, assistant
professor of obstetrics and gynecology, Magee-Women's Hospital of the
University of Pittsburgh Medical Center, told HemOnc Today.
Click
here to listen to the interview with Dr. Olawaiye.
In response to the lacking consensus regarding management of clear cell endometrial adenocarcinoma, Olawaiye and colleagues began a series of reviews to address these gynecologic malignancies.
The researchers extrapolated data from randomized, controlled, prospective, retrospective and nonrandomized trials. All studies included at least 30 women diagnosed with clear cell endometrial adenocarcinoma between Jan. 1, 1966 and Dec. 31, 2008.
Their findings were published in Gynecologic Oncology.
Disease-specific findings
Findings indicated that although clear cell histology was diagnosed in less than 6% of endometrial cancers, the incidence increased with age.
“Compared to endometrioid, clear cell endometrial adenocarcinoma may be more common in older women, among tamoxifen-treated breast cancer patients and women diagnosed with endometrial cancer following pelvic radiation for another condition,” the researchers wrote.
The majority of women diagnosed with clear cell endometrial adenocarcinoma have presented with postmenopausal bleeding. Although rare, some women are diagnosed with the disease after an abnormal Pap smear. However, data from the review suggested that the same tests that are used to diagnose other types of endometrial cancers may be effective at diagnosing clear cell endometrial adenocarcinoma. According to the results of a 2007 study conducted by Huang et al a diagnosis with sensitivity of 99% or higher may be obtained by endometrial biopsy.
Treatment recommendations
The presentation of clear cell endometrial adenocarcinoma is also more likely to appear as extrauterine spread when compared with lower-grade endometrioid histologies. Missed opportunities for improved survival may occur if complete surgical staging is not performed.
“Women diagnosed with clear cell endometrial cancer should have a maximum attempt at cleaning the peritoneal cavity of the cancer because the more aggressive the cytoreduction effort is, the better the chances of a good outcome,” Olawaiye said.
Although treatment with adjuvant pelvic or abdominal radiotherapy was not beneficial in treating clear cell endometrial adenocarcinoma, efficacy was demonstrated for adjuvant chemotherapy with cisplatinum, paclitaxel and doxorubicin in either doublet or triplet form.
The researchers added that more studies are needed to include adjuvant chemotherapy and radiation in women diagnosed with clear cell endometrial adenocarcinoma.
“Clinically this information is important because most of what is published in the literature is heavily weighted toward the common variants of endometrial cancer,” Olawaiye said. “Because very few women are affected by clear cell endometrial cancer there are not many studies with large numbers. So when the clinician is looking for guidance as to what is the best thing to do for these women, there is not a lot of information available, and the data will have to be extrapolated from studies that are conducted on the more common types of endometrial cancers.” – by Jennifer Southall
For more information: