endometrial Flashcards
etiology and prognosis -4
most common gyn cancer (100000/yr vs 4000/yr cervical due to screening)
5yr OS for stage I >90%
poor histology and advanced dz->poor prognosis, just as bad as ovarian
requires multi-modal tx
tx basic concepts - surgery -2
GOAL IS CURE
total hysterectomy with pelvic and para-aortic LN dissection
radical “debulking” for large volume advanced dz
tx basic concepts - XRT -3
pelvic, vaginal brachytherapy, tumor directed
targeted in metastatic dz
used post-op as primary tx in select pts
tx basic concepts - chemo -2
adjuvant for pts at high risk of recurrence, if given is with XRT
advanced / recurrent dz
tx basic concepts - hormonal -1
IS THIS USED IN ADJUVANT SETTING?
recurrent dz in well-differentiated tumors
treatment - early stage dz (stage I and II - has not spread outside of uterus) -3
IS CHEMO GIVEN?
surgery +/- XRT (XRT is brachytherapy to vagina to reduce local recurrence)
tumor direct XRT for non-surgical candidates
chemotherapy is NOT USED alone, only with XRT for high recurrence risk
treatment - advanced stage dz (stage III: LN +, outside uterus- stage IV: invades bladder and/or bowel mucosa and/or distant mets) -3
IS CHEMO GIVEN?
IS XRT GIVEN?
WHAT 2 CHOICES ARE AVAILABLE?
surgery (complete debulking) + adjuvant tx (combo of chemo-XRT but tx choice is not std)
TAP: doxo 45 D1 +cis 50 D1 +pac 160 D2 +gcsf q21d x7 (cat 1, note incorrect cis-pac sequence) (MORE PN, MYALGIAS, HEME TOX)
AP: doxo 50-60 +cis 50 q21d x7 (cat 1, reduce doxo dose to 45 if given after XRT)
DISAGREEMENT ON SEQUENCING - MOST GO SURGERY - CHEMO - XRT (B/C XRT BEFORE LEADS TO TOO MUCH MYELOSUPPRESSION TO TOLERATE CHEMO)
why does paclitaxel go BEFORE cisplatin?
decreases clearance of cisplatin and increases toxicity if given after
sequencing of surgery, XRT, chemo
historically was surgery, XRT, chemo BUT NOW is surgery, chemo, XRT because before worse bone marrow suppression.
NOTE: if doing chemo post XRT make sure to reduce doxo dose to 45 from 50-60.
recurrent dz - 1st line tx concepts -4
concept of platinum sensitive dz - DOES NOT APPLY LIKE FOR OVARIAN
short life expectancy
if tumor expresses ER or PR use po endocrine tx (DO NOT USE IF SEROUS HISTOLOGY as not effective)
oral hormone followed by single agent chemo at progression is reasonable -KEY!!!
recurrent dz - WITHOUT PREVIOUS ADJUVANT CHEMO - 1st line -6
MAY HAVE GOTTEN SURGERY + XRT
IS CHEMO AN OPTION?
TAP: doxo 45 +cis 50 +pac 160 +gcsf (cat 1)
OS 15.3 vs 12.3 mo vs AP
neurotox significantly greater in TAP vs AP arm (27 vs 4)
AP (also cat 1)
not everyone can tolerate -> use pac 175 +carbo 6 q21d OR low dose weekly PAC to reduce tox -> both of which are very well tolerated in elderly (phase II data)
cis 30 D1 +gem 900 D1,8 q21d (phase II)
recurrent dz - WITH PREVIOUS ADJUVANT platinum CHEMO - 1st line, or after hormonal relapse -9
single agent, continue to progression or toxicity, remember life expetency limited
#bev #carbo #doce #peg lipo doxo #cis #doxo #pac #much smaller list than ovarian or cervical
recurrent dz - hormonal agent choices and dose - 1st line -3
GIVE IF TUMOR EXPRESSES ER/PR +)
DO NOT USE FOR PAPILLARY SEROUS (THEY ARE NOT ER/PR +)
tam 20-40mg qd
megestrol 40mg QID
medroxyprogesterone 200-1000mg daily or wkly
early stage dz - adverse risk factors -candidates for adjuvant tx (which reduces risk of recurrence) (5pts)
high grade tumor -G3
tamoxifen ADR (4pts)
hot flashes,
N,
irregular bleeding,
wt gain