Yale Bulletin and Calendar

September 23, 2005|Volume 34, Number 4

Treatment boosts survival from uterine cancer

A state-of-the-art treatment program developed at the School of Medicine increases survival from the aggressive uterine papillary serous carcinoma (UPSC) and spares some patients the need for added therapy.

The results are presented in the lead article of September's Gynecologic Oncology. The research team -- led by senior author Dr. Peter E. Schwartz, the John Slade Ely Professor and vice chair of the Department of Obstetrics, Gynecology & Reproductive Sciences (Ob/Gyn) -- determined that a combination of platinum-based chemotherapy and vaginal radiation was the most effective treatment for the disease.

"Our study defines a standard of care for this aggressive and growing form of uterine cancer," says Schwartz, who is also assistant chief of obstetrics and gynecology at Yale-New Haven Hospital and director of the Ovarian Cancer Research Program in the Yale Cancer Center. The procedure more accurately determines the complete stage and appropriate treatment, and reduces the recurrence of the cancer, he explains.

The incidence of UPSC has increased since it was first identified in 1981. About 160 to 170 new cases per year are seen at Yale. UPSC is found in higher rates in African-American women than in white women. The disease microscopically looks like ovarian cancer and spreads just as rapidly.

"Until now, there has been no consistent management of the disease," says first author Dr. Michael G. Kelly, fellow and instructor in Ob/Gyn. "With this method, we've been able to see who needs additional treatment after surgery and who does not. By reducing recurrence, we are helping to increase the survival rates of women with this form of uterine cancer. Once the disease recurs, virtually no one is cured."

The team reviewed 74 stage-1 patients with UPSC who underwent complete surgical staging, or hysterectomy with removal of pelvic and para-aortic lymph nodes and fat pads, at Yale between 1987 and 2004. Cancer recurred in 43% of early-stage patients who did not receive chemotherapy, while in the 20% of patients who received platinum-based chemotherapy, there were no recurrences. About 14 patients were spared additional radiation treatment.

Other authors included David M. O'Malley, Pei Hui, Dr. Jessica McAlpine, Dr. Herbert Yu, Dr. Thomas J. Rutherford and Dr. Masoud Azodi.

-- By Karen Peart

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