Upsc/CC

Question 0

What is the % of disease outside the uterus for upsc? Rate of recurrence?
CC? rate of recurrence?

Answer 0

UPSC:60%, recurs 30-80%. Half of pts are stages II - IV at presentation
CC: 50%

Question 1

Is upsc a/w breast ca?

Answer 1

Perhaps. In study if upsc, 30% had first degree relative w breast ca and 10% had personal hx of breast ca. Some relationship notes also for BRCA pts. So may consider offering prophylactic hyst

Question 2

What are common molecular profile for upsc?

Answer 2

p53, and amplification of her2neu

Question 3

Is US helpful in detecting UPSC?

Answer 3

Wang reported that 35% of upsc had ES < or= 5

Question 4

Do you treat stage IA UPSC?

Answer 4

43% recurrence rate in pts with residual dz in specimen that were observed. Thus tx with carb/taxol if residual disease, consider brachy (no recurrences for those with chemo/brachy vs 19% recurrence for chemo only- Kelly)

Question 5

What is the data for treating early UPSC?

Answer 5

Fader 2009: Stage I UPSC: CT +/- RT patients had a lower risk of recurrence (11.2%) compared with patients who received RT alone (25%, P = .146) or OBS (30.3%, P = .016). Recurrence was 17%. 88% of those are NOT salvageable
Kelly: Overall, out of 31% who got combination chemo/cuff, only 3% recurred (1 patient). This is compared to the 47% of patients that did not get treatment, where 20/43 recurred, and 13/20 received RT.
No one recurred at the vaginal apex, compared to 6/31 (20%) that did not get cuffRT.
***The omission of vaginal brachy is associated with a high rate of recurrence, even if chemo is used…..therefore cuffRT should be offered to all patients

Question 6

What is the data for debulking UPSC ? CC?

Answer 6

UPSC:Mayo reported on 70 patients with stage 3C/4 disease and found a significant longer DFI and OS in patients that had no visible disease, vs optimal and suboptimal. 51m vs 14m vs 12m. Outcomes in patients with disease was not effected by chemotherapy

CC: Patients with no visible residual disease after cytoreduction had a significant improvement in median PFS (17 vs. 7months, pb0.001), and OS (40 vs. 18months, p=0.02) compared to patients with any residual disease after surgery. THomas 2008

Question 7

Can you treat early CC with RT alone?

Answer 7

Thomas 2008. 22 PATIENTS WERE FULLY SS I/II (>20 LN) AND TREATED WITH VB. THE 5 YR SURVIVAL WAS STAGE I = 79% AND STAGE II =77%
52% WERE UPSTAGED AT THE TIME OF SURGERY
IN THIS STUDY,