A 58-year-old woman with Stage IIIA (FIGO 2009) uterine serous carcinoma involving the uterine serosa and adnexa, with negative lymph nodes, undergoes complete surgical staging including total hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, and infracolic omentectomy. What is the recommended adjuvant therapy?

• A Pelvic radiotherapy alone
• B Hormonal therapy with megestrol acetate
• C Vaginal brachytherapy alone
• D Chemotherapy with carboplatin and paclitaxel for 6 cycles ✓

Explanation

Uterine serous carcinoma is an aggressive Type II histology that behaves like ovarian carcinoma, with early peritoneal and haematogenous spread. Adjuvant chemotherapy with carboplatin and paclitaxel for 6 cycles is standard for Stage III serous carcinoma based on GOG 249 and GOG 258 data. Radiotherapy alone is insufficient for advanced serous histology. Vaginal brachytherapy is used for intermediate-risk endometrioid carcinoma, not advanced serous carcinoma. Hormonal therapy has no role in serous carcinoma.

Reference: Williams Gynecology, 4th ed.

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