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Review
. 2021 Apr;13(2):231-243.
doi: 10.5114/jcb.2021.105292. Epub 2021 Apr 14.

Adjuvant vaginal interventional radiotherapy in early-stage non-endometrioid carcinoma of corpus uteri: a systematic review

Francesca De Felice  1 , Valentina Lancellotta  2 , Lisa Vicenzi  3 , Sara Costantini  3 , Alfredo Antonacci  4 , Valentina Cerboneschi  5 , Daniela di Cristino  6 , Luca Tagliaferri  2 , Annamaria Cerrotta  7 , Andrea Vavassori  8 , Sergio Gribaudo  9 , Alessandro Colombo  10 , Francesco Lucà  11 , Raffaele Barbara  12 , Monica Mangoni  13 , Francesco Marampon  1 , Daniela Musio  1 , Filippo Bellati  14 , Ilary Ruscito  14 , Francesco Torcia  14 , Vincenzo Tombolini  1 , Mattia Falchetto Osti  15 , Vitaliana De Sanctis  15
Affiliations
Review

Adjuvant vaginal interventional radiotherapy in early-stage non-endometrioid carcinoma of corpus uteri: a systematic review

Francesca De Felice et al. J Contemp Brachytherapy. 2021 Apr.

Abstract

Purpose: This systematic review focused on rare histological types of corpus uteri malignancy, including uterine carcinosarcoma (UCS), uterine clear cell carcinoma (UCCC), and uterine papillary serous carcinoma (UPSC), and it is proposed to assist with clinical decision-making. Adjuvant treatment decisions must be made based on available evidences. We mainly investigated the role of vaginal interventional radiotherapy (VIRt) in UCS, UCCC, and UPSC managements.

Material and methods: A systematic research using PubMed and Cochrane library was conducted to identify full articles evaluating the efficacy of VIRt in early-stage UPSC, UCCC, and UCS. A search in ClinicalTrials.gov was performed in order to detect ongoing or recently completed trials as well as in PROSPERO for ongoing or recently completed systematic reviews. Survival outcomes and toxicity rates were obtained.

Results: All studies were retrospective. For UCS, the number of evaluated patients was 432. The 2- to 5-year average local control (LC) was 91% (range, 74.2-96%), disease-free survival (DFS) 88% (range, 82-94%), overall survival (OS) 79% (range, 53.8-84.3%), the average 5-year cancer-specific survival (CSS) was 70% (range, 70-94%), and G3-G4 toxicity was 0%. For UCCC, the number of investigated patients was 335 (UCCC - 124, mixed - 211), with an average 5-year LC of 100%, DFS of 83% (range, 82-90%), OS of 93% (range, 83-100%), and G3-G4 toxicity of 0%. For UPSC, the number of examined patients was 1,092 (UPSC - 866, mixed - 226). The average 5-year LC was 97% (range, 87.1-100%), DFS 84% (range, 74.7-95.6%), OS 93% (range, 71.9-100%), CSS 89% (range, 78.9-94%), and G3-G4 toxicity was 0%.

Conclusions: These data suggest that in adequately selected early-stage UPSC and UCCC patients, VIRt alone may be suitable in women who underwent surgical staging and received adjuvant chemotherapy. In early-stage UCS, a multidisciplinary therapeutic approach has to be planned, considering high-rate of pelvic and distant relapses.

Keywords: adjuvant treatment; brachytherapy; endometrial cancer; radiotherapy; rare tumor.

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Conflict of interest statement

The authors report no conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA flow-chart for uterine carcinosarcoma (UCS)
Fig. 2
Fig. 2
PRISMA flow-chart for uterine clear cell carcinoma (UCCC)
Fig. 3
Fig. 3
PRISMA flow-chart for uterine papillary serous carcinoma (UPSC)
See this image and copyright information in PMC

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