Clear-cell and papillary serous cancer: treatment options

Clear-cell carcinoma (CCC) and serous papillary carcinoma of the endometriu m (UPSC) are rare subtypes of endometrial carcinoma (10%). The histological diagnosis can be made on the dilation and curettage specimens in both type s in a very high percentage of the cases. This is important in the planning of treatment. CCC and UPSC are associated with about 50% of all relapses o ccurring in endometrial carcinoma, and the 5-year survival rate is, on aver age, 42% and 27% respectively. Surgico-pathological stage, age, and vessel invasion are independent prognostic factors for both groups. The recurrence rate is extremely high, and the most frequent extra-pelvic sites of relaps e are the upper abdomen, lungs and liver. Stage la patients treated with co mplete surgical staging alone have a low risk of relapse and need not be of fered adjuvant systemic therapy or pelvic radiation. The treatment of patie nts with CCC and UPSC stage Ib, Ic, II and III should include radical debul king surgery and some form of adjuvant therapy, but it is nor, clear which type is most effective. Adjuvant pelvic radiotherapy plus intracavitary rad iotherapy is usually given in early-stage disease and pelvic radio therapy/ or whole abdomen irradiation plus adjuvant systemic chemotherapy (PAC) in a dvanced disease. However, we are urgently waiting for a large prospective r andomized study to compare both modalities. Paclitaxel, alone or in combina tion, is currently being tested in phase II studies.