ONCOLOGY Recurrent endometrial carcinoma: prognosis for patients with recurrence within 6 to 12 months is worse relative to those relapsing at 12 months or later Takahito Miyake, MD, PhD; Yutaka Ueda, MD, PhD; Tomomi Egawa-Takata, MD; Shinya Matsuzaki, MD; Takuhei Yokoyama, MD; Yukari Miyoshi, MD; Toshihiro Kimura, MD, PhD; Kiyoshi Yoshino, MD, PhD; Masami Fujita, MD, PhD; Masato Yamasaki, MD, PhD; Takayuki Enomoto, MD, PhD; Tadashi Kimura, MD, PhD OBJECTIVE: We evaluated association of prognosis of endometrial car- cinoma patients and treatment-free intervals (TFIs). STUDY DESIGN: We compared the effectiveness of second-line che- motherapy performed for patients with TFIs of 6-12 months and 12 or more months following a first-line chemotherapy based on taxane (pac- litaxel) and carboplatin, with or without the anthracycline (TC). RESULTS: Progression-free and overall survivals were significantly shorter in patients with TFIs of 6-12 months than those with TFIs of 12 or more months. Among the patients who received similar second-line chemotherapy, response rates of 15 patients with TFIs of 12 or more months and 7 patients with TFIs of 6-12 months were 67% and 43%, respectively. Progression-free survival was significantly worse in those with TFIs of 6-12 months (median, 7 months) than those with TFIs of 12 or more months (median, 12 months). CONCLUSION: Our small retrospective analysis suggests that recurrent endometrial carcinomas with TFIs of 6-12 months can be regarded as being partially sensitive to TC-based chemotherapy. Key words: chemotherapy, endometrial cancer, partially sensitive, prognosis, treatment-free interval Cite this article as: Miyake T, Ueda Y, Egawa-Takata T, et al. Recurrent endometrial carcinoma: prognosis for patients with recurrence within 6 to 12 months is worse relative to those relapsing at 12 months or later. Am J Obstet Gynecol 2011;204:xx-xx. E ndometrial carcinoma is the fourth most common cancer of women in the United States, and its incidence has been increasing steadily during the last 3 decades. 1 The prognosis for early-stage endometrial carcinomas is often ex- tremely good; however, it remains ex- tremely difficult to completely cure the more advanced and the recurrent cases. Irradiation has been performed as the standard postoperative adjuvant therapy for cases with obvious risk factors for re- currence and for almost all advanced cases. 2 Recently, systemic chemotherapy has begun to be used as an adjuvant ther- apy for advanced cases because it has been reported to significantly improve the prognosis of these cases. 3,4 Like endometrial cancer, ovarian car- cinoma is also common in the United States. The gold standard of therapy for ovarian carcinomas includes aggressive cytoreductive surgery coupled with che- motherapy. The significant effect of the surgical debulking step for ovarian car- cinomas has been supported by the sub- sequent high sensitivity of any remaining tumor to chemotherapy. 1 The length of the treatment-free interval (TFI) before tumor recurrence has been demon- strated to be a strong indicator for the likely response to the application of a second-line chemotherapy for the ovar- ian carcinomas. Those relapsing within 6 months of the end of first-line treatment often had disease that was likely to be highly resistant to the original first- line drugs and also usually had a low response rate to other second-line chemotherapies. By contrast, patients with TFIs of 6 or more months had a higher chance of re- sponding well, either to a rechallenge with the platinum-based first-line treat- ment (defined as platinum sensitive) or to other drugs. 5 Among them, those with a TFI of 6-12 months, although consid- ered as partially sensitive cases, still exhibited a relatively worse response to second-line chemotherapy using car- boplatin (after a standard first-line com- bination chemotherapy using paclitaxel and carboplatin [TC]) than those with a TFI of 12 or more months. 6 For those ovarian carcinoma patients with a 6-12 month TFI after the first-line TC ther- apy, a combination chemotherapy of pegylated liposomal doxorubicin and carboplatin was shown to provide a bet- ter prognosis. 7 Recently, the effectiveness of similar types of chemotherapy for advanced en- dometrial cancer cases, using combina- tions of platinum, taxane, and adriamy- From the Department of Obstetrics and Gynecology, Osaka Rosai Hospital (Drs Miyake and Yamasaki); the Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine (Drs Ueda, Matsuzaki, Yokoyama, Miyoshi, Kimura, Yoshino, Fujita, Enomoto, and Kimura); and the Department of Obstetrics and Gynecology, Osaka Police Hospital (Dr Egawa-Takata), Osaka, Japan. Received Oct. 25, 2010; revised Dec. 12, 2010; accepted Feb. 9, 2011. Reprints: Yutaka Ueda, MD, PhD, Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka 565-0871, Japan. ZVF03563@nifty.ne.jp. 0002-9378/$36.00 © 2011 Mosby, Inc. All rights reserved. doi: 10.1016/j.ajog.2011.02.034 Research www. AJOG.org MONTH 2011 American Journal of Obstetrics & Gynecology 1.e1