Jason D Wright1, Yongmei Huang2, Alexander Melamed3, Benjamin B Albright4, Grace C Hillyer5, Rebecca Previs4, M S Dawn L Hershman6. 1. Columbia University Vagelos College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, USA; NewYork-Presbyterian Hospital, USA. Electronic address: jw2459@columbia.edu. 2. Columbia University Vagelos College of Physicians and Surgeons, USA. 3. Columbia University Vagelos College of Physicians and Surgeons, USA; Herbert Irving Comprehensive Cancer Center, USA; NewYork-Presbyterian Hospital, USA. 4. Duke University School of Medicine, USA. 5. Joseph L. Mailman School of Public Health, Columbia University, USA; Herbert Irving Comprehensive Cancer Center, USA. 6. Columbia University Vagelos College of Physicians and Surgeons, USA; Joseph L. Mailman School of Public Health, Columbia University, USA; Herbert Irving Comprehensive Cancer Center, USA; NewYork-Presbyterian Hospital, USA.
Abstract
OBJECTIVE: Neoadjuvant chemotherapy (NACT) has emerged as an alternative to primary cytoreductive surgery (PCS) for stage IV uterine cancer. We examined utilization, perioperative outcomes and survival for NACT and PCS for stage IV uterine cancer. METHODS: The Surveillance, Epidemiology, End Results-Medicare database was used to identify women with stage IV uterine cancer treated from 2000 to 2015. Women were classified as NACT or PCS. Interval cytoreductive surgery (after NACT) or chemotherapy (after PCS) were recorded. The extent of surgery and perioperative outcomes were estimated for the groups. Multivariable proportional hazards models and Kaplan-Meier analyses were used to examine survival. RESULTS: Among 3037 women, 1629 (53.6%) were treated with primary cytoreductive surgery, 554 (18.2%) with NACT, and 854 (28.1%) received no treatment. Use of NACT increased from 9.5% to 29.2%. After NACT, interval hysterectomy was performed in 159 (28.6%), while within the PCS group, 1052 (64.6%) received chemotherapy. Extended cytoreductive procedures were performed in 71.7% of women who received NACT vs. 79.1% after PCS (P = 0.03). The complication rate was 52.8% for NACT versus 56.2% for PCS (P = 0.42); medical complications were more frequently seen in the PCS group (39.4% versus 28.9%; P = 0.01). There was no difference in cancer specific (P = 0.48) or overall survival (P = 0.25) in women who received both chemotherapy and surgery regardless of whether the initial treatment was NACT or PCS. CONCLUSION: Use of NACT is increasing for advanced stage uterine cancer. There was no difference in survival between NACT and primary cytoreductive surgery and NACT was associated with fewer perioperative medical complications.
OBJECTIVE: Neoadjuvant chemotherapy (NACT) has emerged as an alternative to primary cytoreductive surgery (PCS) for stage IV uterine cancer. We examined utilization, perioperative outcomes and survival for NACT and PCS for stage IV uterine cancer. METHODS: The Surveillance, Epidemiology, End Results-Medicare database was used to identify women with stage IV uterine cancer treated from 2000 to 2015. Women were classified as NACT or PCS. Interval cytoreductive surgery (after NACT) or chemotherapy (after PCS) were recorded. The extent of surgery and perioperative outcomes were estimated for the groups. Multivariable proportional hazards models and Kaplan-Meier analyses were used to examine survival. RESULTS: Among 3037 women, 1629 (53.6%) were treated with primary cytoreductive surgery, 554 (18.2%) with NACT, and 854 (28.1%) received no treatment. Use of NACT increased from 9.5% to 29.2%. After NACT, interval hysterectomy was performed in 159 (28.6%), while within the PCS group, 1052 (64.6%) received chemotherapy. Extended cytoreductive procedures were performed in 71.7% of women who received NACT vs. 79.1% after PCS (P = 0.03). The complication rate was 52.8% for NACT versus 56.2% for PCS (P = 0.42); medical complications were more frequently seen in the PCS group (39.4% versus 28.9%; P = 0.01). There was no difference in cancer specific (P = 0.48) or overall survival (P = 0.25) in women who received both chemotherapy and surgery regardless of whether the initial treatment was NACT or PCS. CONCLUSION: Use of NACT is increasing for advanced stage uterine cancer. There was no difference in survival between NACT and primary cytoreductive surgery and NACT was associated with fewer perioperative medical complications.
Authors: Sean Kehoe; Jane Hook; Matthew Nankivell; Gordon C Jayson; Henry Kitchener; Tito Lopes; David Luesley; Timothy Perren; Selina Bannoo; Monica Mascarenhas; Stephen Dobbs; Sharadah Essapen; Jeremy Twigg; Jonathan Herod; Glenn McCluggage; Mahesh Parmar; Ann-Marie Swart Journal: Lancet Date: 2015-05-19 Impact factor: 79.321
Authors: N M de Lange; N P M Ezendam; J S Kwon; I Vandenput; D Mirchandani; F Amant; L J M van der Putten; J M A Pijnenborg Journal: Curr Oncol Date: 2019-04-01 Impact factor: 3.677
Authors: Jason D Wright; Thomas J Herzog; Alfred I Neugut; William M Burke; Yu-Shiang Lu; Sharyn N Lewin; Dawn L Hershman Journal: Obstet Gynecol Date: 2012-10 Impact factor: 7.661
Authors: I Vandenput; B Van Calster; A Capoen; K Leunen; P Berteloot; P Neven; Ph Moerman; I Vergote; F Amant Journal: Br J Cancer Date: 2009-06-30 Impact factor: 7.640