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.
- Radiation Oncology
- Uterine Cancer
- Endometrial Neoplasms
- Uterine Neoplasms
Data availability statement
Data are available in a public, open access repository. Not Applicable.
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Collaborators The American Radium Society Appropriate Use Criteria (ARS AUC) Expert Panel on Radiation Oncology–Gynecology: Tracy Sherertz MD, Anuja Jhingran MD, Matthew Biagioli MD, David Gaffney MD PhD, Mohamed Elshaikh MD, Robert Coleman MD, Matthew Harkenrider MD, Elizabeth Kidd MD, Shruti Jolly MD, Catheryn Yashar MD, Lorraine Portelance MD, Andrew Wahl MD, Aradhana Venkatesan MD, Linna Li MD, William Small Jr MD.
Contributors The American Radium Society Appropriate Use Criteria (ARS AUC) seek and encourage collaboration with other organizations on the development of the criteria through representation on expert panels. Participation by representatives from collaborative organizations on the expert panel does not necessarily imply individual or society endorsement of the panel document. For the purposes of this publication, author TS acted as guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
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).
Provenance and peer review Not commissioned; externally peer reviewed.
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