Intraperitoneal radioactive phosphorus (32P) and vaginal brachytherapy as adjuvant treatment for uterine papillary serous carcinoma and clear cell carcinoma: The Indiana University experience

Abstract Purpose To evaluate the outcomes of surgically staged patients with Stage I–IIIA uterine papillary serous carcinoma (UPSC) and clear cell carcinoma (CCC) of the uterus treated at Indiana University with intraperitoneal 32 P and vaginal brachytherapy. Methods Between 1997 and 2004, a total of 28 patients with Stage I–IIIA UPSC and CCC were treated with a standardized adjuvant therapy. All patients underwent comprehensive surgical staging with negative pelvic and para-aortic lymph nodes and no gross residual disease. After a Technetium-99m distribution study, 32 P was administered intraperitoneally. Subsequently, high dose rate (HDR) vaginal cuff brachytherapy was delivered to a total dose of 2100 cGy in three fractions prescribed to 0.5 cm depth. The records of these 28 patients were reviewed, including 18 patients who were treated on Hoosier Oncology Group 97-01 (Phase II trial), and whose followup was updated. Results Intraperitoneal 32 P was administered at a median of 4 weeks from surgery, followed by vaginal brachytherapy. One patient had no available followup information and is not included in the analysis. The median followup for the 27 evaluable patients was 40.9 months. No patients had Grade 2, 3, or 4 complications related to their adjuvant treatment. There were 4 patients with recurrent disease: 2 initially relapsed intraperitoneally, 1 in the distal vagina, and 1 had a scar recurrence. Three patients have died of the disease. For all 27 patients, the 3-year overall survival, cause-specific survival, and disease-free survival were 84.2%, 90.7%, and 74.4%, respectively. Conclusions Adjuvant therapy for UPSC and CCC with intraperitoneal 32 P and vaginal brachytherapy after adequate surgical staging and maximal cytoreduction is well tolerated and appears to be effective. Further study is warranted.