Background: To investigate the pattern of failure and the prognosis followi
ng pathological staging for uterine papillary serous carcinoma (UPSC).
Patients and methods: A retrospective review was conducted of 22 patients w
ith UPSC, treated between 1989 and 1998 at a single institution. All patien
ts were surgically staged. Two patients with advanced disease received chem
otherapy only. Two patients with early-stage disease were followed without
further treatment. Eighteen patients received postoperative irradiation; ei
ght patients received whole abdominal irradiation (WART), and the remaining
10 patients, pelvic irradiation (PRT). In addition, seven of these patient
s received vaginal cuff irradiation with low-dose-rate or high-dose-rate br
achytherapy. Toxicity, pattern of failure, and survival were evaluated and
compared to the literature.
Results: Seven patients (32%) developed distant metastases, three out of se
ven (42%) after WART. Four out of seven patients who had distant metastases
died from disease progression during subsequent chemotherapy. All patients
with distant metastases had locally advanced-stage disease at presentation
(six stage III, one stage IV). Four patients with pelvic recurrences devel
oped concurrent (2) and subsequent (2) distant metastases. Three patients h
ad isolated distant metastases. No patient with early stage-disease (stage
I and II) died from disease progression.
Conclusion: Pathological staging should be performed for all patients with
UPSC to determine the prognosis as well as to tailor the treatment. The rol
e of abdominal irradiation in the treatment of UPSC is yet to be determined
; however, such an approach may not be necessary for the control of disease
for patients with early-stage (I and II) disease. Patients with locally ad
vanced-stage (stage III) disease are at risk of local regional failures and
distant metastases despite WART. Therefore, the benefit of WART for advanc
ed-stage disease is also questionable. Paclitaxel-based chemotherapy is cur
rently being investigated in this setting.