Executive summary of the American Radium Society appropriate use criteria for management of uterine clear cell and serous carcinomas.

BACKGROUND

Uterine clear cell and serous carcinomas have a high propensity for locoregional and distant spread, tend to be more advanced at presentation, and carry a higher risk of recurrence and death than endometrioid cancers. Limited prospective data exist to guide evidence-based management of these rare malignancies.

OBJECTIVE

The American Radium Society sought to summarize evidence-based guidelines developed by a multidisciplinary expert panel that help to guide the management of uterine clear cell and serous carcinomas.

METHODS

The American Radium Society Appropriate Use Criteria presented in this manuscript were developed by a multidisciplinary expert panel using an extensive analysis of current published literature from peer-reviewed journals. A well-established methodology (modified Delphi) was used to rate the appropriate use of diagnostic and therapeutic procedures for the management of uterine clear cell and serous carcinomas.

RESULTS

The primary treatment for non-metastatic uterine clear cell and serous carcinomas is complete surgical staging, with total hysterectomy, salpingo-oophorectomy, omentectomy, and lymph node staging. Even in early-stage disease, patients with uterine clear cell and serous carcinomas have a worse prognosis than those with type I endometrial cancers, warranting consideration for adjuvant therapy regardless of the stage. Given the aggressive nature of these malignancies, and until further research determines the most appropriate adjuvant therapy, it may be reasonable to counsel patients about combined-modality treatment with systemic chemotherapy and radiotherapy.

CONCLUSION

Patients diagnosed with uterine clear cell and serous carcinomas should undergo complete surgical staging. Multimodal adjuvant therapies should be considered in the treatment of both early-stage and advanced-stage disease. Further prospective studies or multi-institutional retrospective studies are warranted to determine optimal sequencing of therapy and appropriate management of patients based on their unique risk factors. Long-term surveillance is indicated due to the high risk of locoregional and distant recurrence.

Informations de copyright

© IGCS and ESGO 2022. No commercial re-use. See rights and permissions. Published by BMJ.

Déclaration de conflit d'intérêts

Competing interests: All panelists were required to declare all conflicts of interest for the previous 36 months prior to initiating work on this document. These complete disclosure forms are retained by the American Radium Society (ARS) in perpetuity. The ARS Appropriate Use Criteria Steering Committee reviewed these disclosures with the chair and co-chair of this document and approved participation of the panelists prior to starting development of this work. Disclosures potentially relevant to the content of this guideline are provided. List of any potentially relevant conflicts of interest for the past 3 years for guideline chair, guideline co-chair, all voting and non-voting panelists: MB: consulting fee/honoraria (Elekta, Inc.). DG: consulting fee/honoraria (AstraZeneca, Merck). RLC: grants for clinical trials (NIH, Gateway Foundation, V-Foundation, Judy Rees/Albert Pisani MD Ovarian Cancer Research Fund, AstraZeneca, Merck, Clovis, Genmab, Roche/Genentech, Janssen); consulting fee/honoraria (AstraZeneca, Tesaro, Medivation, Clovis, Gamamab, Genmab, Roche/Genentech, Janssen, Agenus, Regeneron, OncoQuest). MH: consulting fee/Honoraria (Varian Brachytherapy; AstraZeneca). SJ: consulting fee/honoraria (AstraZeneca, Varian). WS, Jr: consulting fee/honoraria (Merck, Carl Zeiss, Varian).