Adjuvant therapy of uterine clear cell carcinoma: a review

Arch Gynecol Obstet. 2016 Mar;293(3):485-92. doi: 10.1007/s00404-015-3973-x. Epub 2015 Dec 1.

Abstract

Purpose: Uterine clear-cell carcinoma (UCCC) is a rare subset of type II endometrial carcinoma with a poor prognosis relative to the most common type of endometrioid carcinoma. Due to its rarity, there has been limited direct evidence of the efficacy of specific adjuvant therapy posthysterectomy in women with UCCC. We present a review of current literature regarding adjuvant therapy of uterine clear cell carcinoma.

Methods: We searched for English-language publications through Pubmed using a combination of the following key words: endometrial carcinoma, clear cell carcinoma, recurrence, prognosis, adjuvant therapy, radiation treatment and chemotherapy. Due to the rarity of UCCC, studies were not limited by design or number of patients.

Results: There is a paucity of randomized prospective controlled studies focusing on UCCC adjuvant therapy. Findings have largely been derived from retrospective studies of type II endometrial carcinomas or all endometrial cancers as a group. Very few retrospective studies were found to focus on UCCC adjuvant therapy, although certain larger studies did have subset analyses of UCCC patients.

Conclusions: For early stage disease, locoregional radiotherapy, especially vaginal brachytherapy, has evidence of efficacy. The therapeutic gain of radiotherapy may be further improved with the addition of systemic chemotherapy. Evidence for combined radiation therapy with systemic chemotherapy in women with advanced stage UCCC has remained debatable. UCCC-specific studies are needed to determine the best adjuvant therapy for UCCC without the confounding effects of USC and other endometrial cancers.

Keywords: Adjuvant; Chemotherapy; Clear cell; Endometrial carcinoma; Hysterectomy; Prognosis; Radiation therapy.

Publication types

  • Review

MeSH terms

  • Adenocarcinoma, Clear Cell / pathology
  • Adenocarcinoma, Clear Cell / surgery
  • Adenocarcinoma, Clear Cell / therapy*
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Brachytherapy
  • Chemotherapy, Adjuvant*
  • Combined Modality Therapy
  • Endometrial Neoplasms / pathology
  • Endometrial Neoplasms / therapy*
  • Female
  • Humans
  • Middle Aged
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Staging
  • Prognosis
  • Prospective Studies
  • Radiotherapy, Adjuvant*
  • Retrospective Studies
  • Treatment Outcome
  • Uterine Neoplasms / pathology
  • Uterine Neoplasms / surgery
  • Uterine Neoplasms / therapy*