For advanced disease with spreading outside the uterus, newer studies (19) have shown that chemotherapy is more effective than radiation therapy. A recent Cochran analysis showed clear evidence for improvement of survival by postoperative chemotherapy.
The combination of cisplatin and doxorubicin was considered standard treatment (18). A more recent study has shown that the addition of paclitaxel extends survival time (20). However, these regimens have relatively severe side effects, and many patients are in poor physical condition. At Oslo University Hospital, the combination of carboplatin and paclitaxel is used. This combination is under testing in a phase III study where it is compared with the cisplatin, doxorubicin, and paclitaxel regimen (GOG#0209).
For hormone receptor-positive tumors (ER/PR), about the same response rate can be achieved with hormonal treatment as chemotherapy. Therefore, it is recommended in most cases to start hormonal treatment and reserve chemotherapy for cases where hormonal treatment does not achieve the desired effect. In patients with hormone receptor-negative tumors, hormone treatment cannot be expected to have an effect. Serous papillary tumors do not have hormone receptors, and tumors of low differentiation rarely have hormone receptors.
Treatment with progestins has shown a response rate of 15–30%. The treatment response is related to the detection of the hormone receptor. Oral treatment is as effective as parenteral treatment. Actual drugs are Farlutal® and Megace® daily. Blocking of estrogen production in postmenopausal women using aromatase inhibitors is an experimental treatment currently under evaluation.
Treatment for recurrence
- Patients with localized recurrence in the pelvis who have not previously had radiation treatment are given irradiation to the pelvic tumor.
- For localized pelvic recurrence, previously irradiated, chemotherapy or hormonal therapy is given. In rare cases, surgery may be appropriate.
- For recurrence in the upper abdomen, chemotherapy or hormonal treatment is given.
- For recurrence in the lungs, chemotherapy or hormonal treatment is given. For localized recurrence, surgery may be appropriate if systemic treatment does not provide complete remission.
- For brain metastases, surgery may be appropriate for a solitary metastasis, otherwise radiation treatment is given.
- For bone metastases, radiation may be given to prevent fractures. Additional systemic treatment may also be appropriate such as chemotherapy or hormonal treatment.