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Debate 34A - Should an Attempt at Debulking Grossly Metastatic Endometrial Cancer be Undertaken?

Yes

from Section IV - Endometrial Cancer

Published online by Cambridge University Press:  20 July 2023

Dennis S. Chi
Affiliation:
Memorial Sloan-Kettering Cancer Center, New York
Nisha Lakhi
Affiliation:
Richmond University Medical Center, Staten Island
Nicoletta Colombo
Affiliation:
University of Milan-Bicocca
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Summary

Five to 10 percent of endometrial cancer (EC) patients are presented at advanced stage with a poor prognosis. There is no optimal treatment for stage III–IV EC. Combination of chemotherapy and radiation improved survival compared to monotherapy. Although the effect of combination treatment proves to be effective, optimal sequence of treatment is not clear. One approach is the sandwich method (three cycles of chemotherapy followed by radiation and then three more cycles of chemotherapy), other regimes are six cycles of chemotherapy followed by radiation (sequential treatment) or concomitant chemoradiotherapy. There are no randomized trials comparing these regimes but each has its own advantages and also some drawbacks. Either sandwich therapy or sequential regime seems to be reasonable approaches with similar oncologic outcome but sequential regime, particularly for stage IIIC2, is well tolerated with less toxicity and treatment breaks. Despite well-established combination therapies, prognosis of stage IIIC disease is still poor with a high rate of distant recurrences pointing out need for a better systemic therapy.

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Publisher: Cambridge University Press
Print publication year: 2023

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References

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Bristow, RE, et al. Stage IVB endometrial carcinoma: the role of cytoreductive surgery and determinants of survival. Gynecol Oncol 2000;78(2):8591.CrossRefGoogle ScholarPubMed
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Du Bois, AA, et al. Randomized phase III study to evaluate the impact of secondary cytoreductive surgery in recurrent ovarian cancer: final analysis of AGO DESKTOP III/ENGOT-ov20. J Clin Oncol 2020;38:6000).CrossRefGoogle Scholar
Eto, T, et al. Status of treatment for the overall population of patients with stage IVB endometrial cancer, and evaluation of the role of preoperative chemotherapy: a retrospective multi-institutional study of 426 patients in Japan. Gynecol Oncol 2013;131(3):574580.CrossRefGoogle ScholarPubMed

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