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Yale procedure cuts recurrence of aggressive uterine cancer

September 22, 2005

A state-of-the-art treatment program developed at Yale School of Medicine increases survival from the aggressive uterine papillary serous carcinoma (UPSC) and spares some patients the need for additional therapy.

The results are presented in the lead article of September's Gynecologic Oncology. The research team, led by senior author Peter E. Schwartz, M.D., The John Slade Ely Professor of Obstetrics and Gynecology and Vice Chair and Director, determined that a combination of platinum-based chemotherapy and vaginal radiation was the most effective treatment for the disease.

"Our study defines a standard of care for this aggressive and growing form of uterine cancer," said Schwartz. The procedure more accurately determines the complete stage and appropriate treatment and reduces the recurrence of the cancer.

The incidence of UPSC has increased since it was first identified in 1981. Researchers initially thought the disease was easy to treat, but since 1990, the number of UPSC deaths has almost doubled. About 160 to 170 new cases per year are seen at Yale. UPSC is found in higher rates in African American women than in white women. The disease looks like ovarian cancer and spreads just as rapidly, therefore chemotherapy alone was traditionally used as treatment.

"Until now, there has been no consistent management of the disease," said first author Michael G. Kelly, M.D., fellow and instructor in the Department of Obstetrics, Gynecology & Reproductive Sciences at Yale. "With this method, we've been able to see who needs additional treatment after surgery and who does not. By reducing recurrence, we are helping to increase the survival rates of women with this form of uterine cancer. Once the disease recurs, virtually no one is cured."

The team reviewed 74 stage 1 patients with UPSC who underwent complete surgical staging, or hysterectomy with removal of lymph nodes and fat pads, at Yale between 1987 and 2004. Cancer recurred in 43 percent of early stage patients who did not receive chemotherapy, while in the 20 percent of patients who received platinum-based chemotherapy there were no recurrences. About 14 patients were spared additional radiation treatment.

Other authors included David M. O'Malley, Pei Hui, Jessica McAlpine, M.D., Herbert Yu, M.D., Thomas J. Rutherford, M.D., and Masoud Azodi, M.D.

Yale University