endometrial

Question 1

etiology and prognosis -4

Answer 1

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

Question 2

tx basic concepts - surgery -2

GOAL IS CURE

Answer 2

total hysterectomy with pelvic and para-aortic LN dissection

radical “debulking” for large volume advanced dz

Question 3

tx basic concepts - XRT -3

Answer 3

pelvic, vaginal brachytherapy, tumor directed

targeted in metastatic dz

used post-op as primary tx in select pts

Question 4

tx basic concepts - chemo -2

Answer 4

adjuvant for pts at high risk of recurrence, if given is with XRT

advanced / recurrent dz

Question 5

tx basic concepts - hormonal -1

IS THIS USED IN ADJUVANT SETTING?

Answer 5

recurrent dz in well-differentiated tumors

Question 6

treatment - early stage dz (stage I and II - has not spread outside of uterus) -3

IS CHEMO GIVEN?

Answer 6

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

Question 7

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?

Answer 7

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)

Question 8

why does paclitaxel go BEFORE cisplatin?

Answer 8

decreases clearance of cisplatin and increases toxicity if given after

Question 9

sequencing of surgery, XRT, chemo

Answer 9

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.

Question 10

recurrent dz - 1st line tx concepts -4

Answer 10

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!!!

Question 11

recurrent dz - WITHOUT PREVIOUS ADJUVANT CHEMO - 1st line -6

MAY HAVE GOTTEN SURGERY + XRT

IS CHEMO AN OPTION?

Answer 11

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)

Question 12

recurrent dz - WITH PREVIOUS ADJUVANT platinum CHEMO - 1st line, or after hormonal relapse -9

Answer 12

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

Question 13

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 +)

Answer 13

tam 20-40mg qd

megestrol 40mg QID

medroxyprogesterone 200-1000mg daily or wkly

Question 14

early stage dz - adverse risk factors -candidates for adjuvant tx (which reduces risk of recurrence) (5pts)

Answer 14

high grade tumor -G3

Question 15

tamoxifen ADR (4pts)

Answer 15

hot flashes,

N,

irregular bleeding,

wt gain

Question 16

megestrol ADR (4pts)

Answer 16

wt gain,

appetite stimulation,

N,

abnormal glucose control

Question 17

medroxyprogesterone ADR (3pts)

Answer 17

breast tenderness,

irregular bleeding,

abnormal glucose control