International Journal of Clinical Therapeutics and Diagnosis (IJCTD)    Special Issue on "Endometrial Cancer: Pathogenesis, Diagnosis And Treatment"    IJCTD-2332-2926-S1-003

Current Treatment Approach of Endometrial Cancer


Androutsopoulos G*, Michail G, Adonakis G, Decavalas G

Department of Obstetrics and Gynecology, University of Patras, Medical School, Rion, Greece.

*Corresponding Author

Georgios Androutsopoulos MD,
Assistant Professor,
Department of Obstetrics and Gynecology,
University of Patras,
Medical School, Rion 26504, Greece.
Tel: +306974088092
E-mail: androutsopoulos@upatras.gr
            androutsopoulosgeorgios@hotmail.com

Article Type: Review Article
Received: December 24, 2014; Accepted: February 09, 2015; Published: February 12, 2015

Citation: Androutsopoulos G, Michail G, Adonakis G, Decavalas G (2015) Current Treatment Approach of Endometrial Cancer. Int J Clin Ther Diagn. S1:003 8-11. doi: dx.doi.org/10.19070/2332-2926-SI01003

Copyright: Androutsopoulos G© 2015. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.



Abstract

Systematic surgical staging is the primary treatment, for most patients with endometrial cancer and includes: total hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy and complete resection of all disease. Especially in patients with type II endometrial cancer, systematic surgical staging includes additional omentectomy, appendectomy and biopsy of any suspected lesion. Although pelvic washings are no longer part of FIGO surgical staging system for endometrial cancer, they should be reported separately.

Especially in endometrial cancer patients with increased risk for recurrence or at advanced stage disease, it is necessary a more aggressive treatment approach with postoperative adjuvant radiotherapy and/or chemotherapy.

Postoperative adjuvant radiotherapy in endometrial cancer patients includes vaginal brachytherapy and external radiotherapy. Vaginal brachytherapy is the adjuvant treatment of choice for intermediate risk endometrial cancer patients. External pelvic radiotherapy is the adjuvant treatment of choice only in high risk endometrial cancer patients.

Postoperative adjuvant chemotherapy has very important role for endometrial cancer patients with advanced stage disease.

The combination of adjuvant chemotherapy and radiotherapy is promising in high risk endometrial cancer patients or in endometrial cancer patients at advanced stage disease.

Molecular targeted therapies have only modest effect in unselected endometrial cancer patients. Especially the role of ErbBtargeted therapies in selected EC patients, should be further investigated.



1.Introduction
2.Surgical Treatment
3.Adjuvant Treatment
    3.1 Radiotherapy
    3.2 Chemotherapy
    3.3 Chemotherapy and Radiotherapy
    3.4 Molecular Targeted Therapies
4.References


Introduction

The most common malignancy of the female genital tract, is endometrial cancer (EC) [1]. It mainly occurs in postmenopausal women.[1-4] Overall, 2.64% of women will develop EC during their lifetime [1]. The most common symptom in patients with EC is abnormal uterine bleeding [2].

Based on clinical and pathological characteristics, sporadic EC classified into 2 types [5,6]. Type I EC, constitutes the majority of sporadic EC cases (70-80%) [5,6]. It is well differentiated, endometrioid in histology, has less aggressive clinical course and favorable prognosis [5-7]. Type II EC, constitutes the minority of sporadic EC cases (10-20%) [5,6]. It is poorly differentiated, papillary serous or clear cell in histology, has aggressive clinical course and poor prognosis [5,6,8,9].


Surgical Treatment

Systematic surgical staging is the primary treatment, for most patients with EC [2-4], 10-15] That therapeutic approach allows a clearer decision for the appropriate postoperative adjuvant therapy [Figure 1] [11].


Figure 1. Endometrial cancer treatment [2- 4, 11- 13, 15, 30, 33, 40, 42, 44, 51, 54].


In patients with EC, systematic surgical staging includes: total hysterectomy, bilateral salpingo-oophorectomy, pelvic and paraaortic lymphadenectomy and complete resection of all disease [2,11,13,14] Especially in patients with type II EC, systematic surgical staging includes additional omentectomy, appendectomy and biopsy of any suspected lesion [14,16]. Although pelvic washings are no longer part of FIGO surgical staging system for EC, they should be reported separately [12].

Appropriate surgical staging has diagnostic, prognostic and therapeutic advantages for women with EC [2-4,11]. Moreover, it facilitates the implementation of targeted therapy maximizing the survival and minimizing the morbidity of overtreatment (radiation injury) and the effects of undertreatment (recurrent disease, increased mortality) [11].

Pelvic and para-aortic lymphadenectomy is very important for the surgical staging in patients with EC [3, 4, 10, 11, 13]. It identifies precisely the extent of the disease and affects the prognosis of EC patients [10, 14, 17]. Actually, it is the only way to diagnose EC patients with stage IIIc disease [11, 12,2, 18, 19]. Undoubtedly, it provides important informations for the need, type and extent of postoperative adjuvant treatment [10, 14, 17, 20].

Furthermore, pelvic and para-aortic lymphadenectomy has significant therapeutic advantages for patients with EC [21-23]. It is correlated with enhanced survival in patients with advanced stage type I EC and in all patients with type II EC [2, 21, 22, 24, 25]. However, it has no survival effect in patients with early stage type I EC [2, 13, 26, 27].

It appears that pelvic and para-aortic lymphadenectomy can be avoided safely in patients with early stage well differentiated type I EC [11, 26-29]. However pelvic and para-aortic lymphadenectomy should be performed in patients with advanced stage type I EC and in all patients with type II EC [3, 4, 24, 30, 31]. Also in any case of doubt, lymphadenectomy should be performed rather than avoided [3, 4, 30].

The extent of pelvic and para-aortic lymph node dissection (more than 14 lymph nodes) is an independent risk factor for postoperative complications [26, 29,32]. Especially in elderly patients and in patients with various comorbidities (obesity, diabetes, coronary artery disease), intraoperative and postoperative morbidity must be carefully weighed against any survival advantage [11, 32-34].

In most EC patients, systematic surgical staging performed with laparotomy [14, 35, 36]. Especially in EC patients with early stage disease, systematic surgical staging can be performed with minimally invasive techniques (laparoscopy, robotic-assisted surgery) [2, 11, 13, 14, 35-38].

Minimally invasive surgery associated with smaller incisions, improved visualization, shorter hospital stay, less need for analgesics, quicker recovery and lower risk of complications (blood loss, wound infection, herniation, ileus) [11, 13, 14, 35-38]. Especially in overweight and elderly patients, minimally invasive surgery associated with significant advantages [11, 35-39]. Compared minimally invasive surgery and laparotomy, there are relatively small differences in recurrence rates [35, 36]. However, minimally invasive surgery and laparotomy associated with similar overall and disease-free survival [13, 14, 35, 36]


Adjuvant Treatment

Especially in EC patients with increased risk for recurrence or at advanced stage disease, it is necessary a more aggressive treatment approach with postoperative adjuvant radiotherapy and/or chemotherapy [Figure 1] [2, 10, 14, 15, 30].

Radiotherapy

Postoperative adjuvant radiotherapy in EC patients includes vaginal brachytherapy and external radiotherapy [Figure 1] [14, 40].

Vaginal brachytherapy in EC patients with early stage disease is well tolerated, reduces the risk of local recurrences but has no impact on overall survival [40-43]. Furthermore, it is associated with less side effects and better quality of life [40-43]. It is the adjuvant treatment of choice for intermediate risk EC patients (stage IA grade 3 endometrioid type EC, stage IB grade 1-2 endometrioid type EC) [Figure 1] [14, 40-42, 44-46].

Especially for intermediate risk EC patients, vaginal brachytherapy is equivalent to external pelvic radiotherapy in achieving local control of disease [14, 40, 41, 44, 45]. Moreover vaginal brachytherapy in those EC patients, have significant advantages in the quality of life [14, 40, 41, 44, 45].

External pelvic radiotherapy in EC patients with early stage disease, reduces the risk of local recurrences but has no impact on overall survival [11, 40- 42, 47, 48]. Nevertheless, it is associated with significant morbidity and reduction in quality of life [41, 47]. It is the adjuvant treatment of choice only in high risk EC patients (stage IB grade 3 endometrioid type EC, stage I non-endometrioid type EC) [Figure 1] [14, 43-45].

In EC patients with advanced stage disease, although external pelvic radiotherapy reduces the risk of local recurrences it has no impact on overall survival [11, 40, 44].

Whole abdomen radiotherapy in EC patients with advanced stage disease, has tolerable toxicity and may improve survival [49]. Nevertheless, it can be used only in patients with completely resected disease [49].


Chemotherapy

Postoperative adjuvant chemotherapy has very important role for EC patients with advanced stage disease [Figure 1] [2, 10, 14, 40, 50, 51]. The most active chemotherapeutic agents for EC patients with advanced stage disease, are: taxanes, anthracyclines and platinum compounds [50, 52].

Adjuvant chemotherapy has only modest effect in progression free survival and overall survival, although it achieves high response rates [50]. Furthermore in EC patients with advanced stage disease, adjuvant chemotherapy is more effective than whole abdomen radiotherapy [30, 53].


Chemotherapy and Radiotherapy

The combination of adjuvant chemotherapy and radiotherapy is promising in high risk EC patients or in EC patients at advanced stage disease [Figure 1] [40,50, 54]. Especially in EC patients with completely resected disease, the combination of adjuvant chemotherapy and radiotherapy reduce the risk of relapse or death and increase overall survival [14, 40, 55]. Furthermore, the combination of adjuvant chemotherapy and radiotherapy is more effective than adjuvant radiotherapy alone [40, 50, 55].


Molecular Targeted Therapies

In recent years, molecular targeted therapies have only modest effect in unselected EC patients [50]. They usually target the signaling pathways of EGFR, VEGFR and PI3K/PTEN/AKT/ mTOR [56-58].

Especially the role of ErbB-targeted therapies in selected EC patients, should be further investigated in clinical trials [15, 58-68]. Perhaps ErbB-targeted therapies may be used as adjuvant treatment in type II EC patients with EGFR and ErbB-2 overexpression [15, 59, 65, 67-69]. Moreover further studies into the molecular pathways of EC, may increase our knowledge and lead to the discovery of new generation molecules with greater therapeutic efficacy [63].


References

  1. Siegel R, Naishadham D, Jemal A. Cancer statistics (2013) CA Cancer J Clin 63(1):11-30.
  2. Sorosky, J. I (2012) Endometrial cancer. Obstetrics & Gynecology, 120(2, Part 1), 383-397.
  3. Androutsopoulos G. (2012) Current treatment options in patients with endometrial cancer. J Community Med Health Educ 2(12):e113.
  4. Androutsopoulos G, Decavalas G. (2013) Management of endometrial cancer. Int J Translation Community Dis 1(1):1-3.
  5. Bokhman J. (1983) Two pathogenetic types of endometrial carcinoma. Gynecol Oncol 15(1):10-7.
  6. Doll A, Abal M, Rigau M, Monge M, Gonzalez M, et al. (2008) Novel molecular profiles of endometrial cancer-new light through old windows. J Steroid Biochem Mol Biol 108(3-5):221-29.
  7. Sherman M, Sturgeon S, Brinton L, Potischman N, Kurman R, et al. (1997) Risk factors and hormone levels in patients with serous and endometrioid uterine carcinomas. Mod Pathol 10(10):963-8.
  8. Abeler V, Kjorstad K. (1991) Clear cell carcinoma of the endometrium: a histopathological and clinical study of 97 cases. Gynecol Oncol 40(3):207-17.
  9. Goff B, Kato D, Schmidt R, Ek M, Ferry J, et al. (1994) Uterine papillary serous carcinoma: patterns of metastatic spread. Gynecol Oncol 54(3):264-8.
  10. Bakkum-Gamez JN, Gonzalez-Bosquet J, Laack NN, Mariani A, Dowdy SC. (2008) Current issues in the management of endometrial cancer. Mayo Clin Proc 83(1):97-112.
  11. ACOG. ACOG practice bulletin #65: management of endometrial cancer (2005) Obstet Gynecol 106(2):413-25.
  12. Pecorelli S. (2009) Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet 105(2):103-4.
  13. Burke W, Orr J, Leitao M, Salom E, Gehrig P, et al. (2014) Endometrial cancer: a review and current management strategies: part I. Gynecol Oncol 134(2):385-92.
  14. Colombo N, Preti E, Landoni F, Carinelli S, Colombo A, et al. (2011) Endometrial cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of oncology, 22(suppl 6), vi35-vi39.
  15. Androutsopoulos G, Decavalas G (2014) Endometrial cancer: current treatment strategies. World J Oncol Res 1(1):1-4.
  16. Geisler J, Geisler H, Melton M, Wiemann M. (1999) What staging surgery should be performed on patients with uterine papillary serous carcinoma? Gynecol Oncol 74(3):465–7.
  17. Mariani A, Dowdy S, Cliby W, Gostout B, Jones M, et al. (2008) Prospective assessment of lymphatic dissemination in endometrial cancer: a paradigm shift in surgical staging. Gynecol Oncol 109(1):11-8.
  18. Creasman W, Morrow C, Bundy B, Homesley H, Graham J, et al. (1987) Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer 60(8 Suppl):2035-41.
  19. McMeekin D, Lashbrook D, Gold M, Johnson G, Walker J, et al. (2001) Analysis of FIGO Stage IIIc endometrial cancer patients. Gynecol Oncol 81(2):273-8.
  20. Mariani A, Dowdy S, Keeney G, Long H, Lesnick T, et al. (2004) High-risk endometrial cancer subgroups: candidates for target-based adjuvant therapy. Gynecol Oncol 95(1):120-6.
  21. Cragun J, Havrilesky L, Calingaert B, Synan I, Secord A, et al. (2005) Retrospective analysis of selective lymphadenectomy in apparent early-stage endometrial cancer. J Clin Oncol 23(16):3668-75.
  22. Kilgore L, Partridge E, Alvarez R, Austin J, Shingleton H, et al. (1995) Adenocarcinoma of the endometrium: survival comparisons of patients with and without pelvic node sampling. Gynecol Oncol 56(1):29-33.
  23. Mariani A, Webb M, Galli L, Podratz K. (2000) Potential therapeutic role of para-aortic lymphadenectomy in node-positive endometrial cancer. Gynecol Oncol 76(3):348-56.
  24. Lutman C, Havrilesky L, Cragun J, Secord A, Calingaert B, et al. (2006) Pelvic lymph node count is an important prognostic variable for FIGO stage I and II endometrial carcinoma with high-risk histology. Gynecol Oncol 102(1):92-7.
  25. Chan J, Cheung M, Huh W, Osann K, Husain A, et al. (2006) Therapeutic role of lymph node resection in endometrioid corpus cancer: a study of 12,333 patients. Cancer 107(8):1823-30.
  26. Benedetti Panici P, Basile S, Maneschi F, Alberto Lissoni A, et al. (2008) Systematic pelvic lymphadenectomy vs. no lymphadenectomy in earlystage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst 100(23):1707-16.
  27. Kitchener H, Swart A, Qian Q, Amos C, Parmar M (2009) Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet 373(9658):125-36.
  28. Mariani A, Dowdy S, Podratz K (2009) The role of pelvic and para-aortic lymph node dissection in the surgical treatment of endometrial cancer: a view from the USA. The Obstetrician & Gynaecologist 11:199–204.
  29. May K, Bryant A, Dickinson H, Kehoe S, Morrison J (2010) Lymphadenectomy for the management of endometrial cancer. Cochrane Database Syst Rev (1):CD007585.
  30. Marnitz S, Kohler C (2012) Current therapy of patients with endometrial carcinoma. A critical review. Strahlenther Onkol 188(1):12-20.
  31. Nezhat F, Chang L, Solima E (2012) What is the role of lymphadenectomy in surgical management of patients with endometrial carcinoma? J Minim Invasive Gynecol 19(2):172-5.
  32. Franchi M, Ghezzi F, Riva C, Miglierina M, Buttarelli M, et al. (2001) Postoperative complications after pelvic lymphadenectomy for the surgical staging of endometrial cancer. J Surg Oncol 78(4):232-7; discussion 37-40.
  33. Lachance J, Darus C, Rice L (2008) Surgical management and postoperative treatment of endometrial carcinoma. Rev Obstet Gynecol 1(3):97-105.
  34. Lowery W, Gehrig P, Ko E, Secord A, Chino J, et al. (2012) Surgical staging for endometrial cancer in the elderly - is there a role for lymphadenectomy? Gynecol Oncol 126(1):12-5.
  35. Galaal K, Bryant A, Fisher A, Al-Khaduri M, Kew F, et al. (2012) Laparoscopy versus laparotomy for the management of early stage endometrial cancer. Cochrane Database Syst Rev 9:CD006655.
  36. Walker J, Piedmonte M, Spirtos N, Eisenkop S, Schlaerth J, et al. (2012) Recurrence and survival after random assignment to laparoscopy versus laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group LAP2 Study. J Clin Oncol 30(7):695-700.
  37. Walker J, Piedmonte M, Spirtos N, Eisenkop S, Schlaerth J, et al. (2009) Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2. J Clin Oncol 27(32):5331-6.
  38. Nezhat F (2008) Minimally invasive surgery in gynecologic oncology: laparoscopy versus robotics. Gynecol Oncol 111(2 Suppl):S29-32.
  39. Fleming N, Ramirez P (2012) Robotic surgery in gynecologic oncology. Curr Opin Oncol 24(5):547-53.
  40. Burke W, Orr J, Leitao M, Salom E, Gehrig P, et al. (2014) Endometrial cancer: a review and current management strategies: part II. Gynecol Oncol 134(2):393-402.
  41. Kong A, Johnson N, Kitchener H. C, Lawrie T. A (2012) Adjuvant radiotherapy for stage I endometrial cancer: an updated Cochrane systematic review and meta-analysis. Journal of the National Cancer Institute 104(21):1625-1634.
  42. Creutzberg C, Nout R (2011) The role of radiotherapy in endometrial cancer: current evidence and trends. Curr Oncol Rep 13(6):472-8.
  43. Creutzberg C (2004) GOG-99: ending the controversy regarding pelvic radiotherapy for endometrial carcinoma? Gynecol Oncol 92(3):740-3.
  44. Nout R, Smit V, Putter H, Jurgenliemk-Schulz I, Jobsen J, et al. (2010) Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): an open-label, non-inferiority, randomised trial. Lancet 375(9717):816-23.
  45. Chino J, Jones E, Berchuck A, Secord A, Havrilesky L (2012) The influence of radiation modality and lymph node dissection on survival in early-stage endometrial cancer. Int J Radiat Oncol Biol Phys 82(5):1872-9.
  46. Sorbe B, Horvath G, Andersson H, Boman K, Lundgren C, et al. (2012) External pelvic and vaginal irradiation versus vaginal irradiation alone as postoperative therapy in medium-risk endometrial carcinoma: a prospective, randomized study--quality-of-life analysis. Int J Gynecol Cancer 22(7):1281-8.
  47. Creutzberg C, van Putten W, Koper P, Lybeert M, Jobsen J, et al. (2000) Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC Study Group. Post Operative Radiation Therapy in Endometrial Carcinoma. Lancet 355(9213):1404-11.
  48. Keys H, Roberts J, Brunetto V, Zaino R, Spirtos N, et al. (2004) A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study. Gynecol Oncol 92(3):744-51.
  49. Sutton G, Axelrod J, Bundy B, Roy T, Homesley H, et al. (2005) Whole abdominal radiotherapy in the adjuvant treatment of patients with stage III and IV endometrial cancer: a gynecologic oncology group study. Gynecol Oncol 97(3):755-63.
  50. Hogberg T (2011) What is the role of chemotherapy in endometrial cancer? Curr Oncol Rep 13(6):433-41.
  51. Wright J, Barrena Medel N, Sehouli J, Fujiwara K, Herzog T (2012) Contemporary management of endometrial cancer. Lancet 379(9823):1352-60.
  52. Fleming G, Brunetto V, Cella D, Look K, Reid G, et al. (2004) Phase III trial of doxorubicin plus cisplatin with or without paclitaxel plus filgrastim in advanced endometrial carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol 22(11):2159-66.
  53. Randall M, Filiaci V, Muss H, Spirtos N, Mannel R, et al. (2006) Randomized phase III trial of whole-abdominal irradiation versus doxorubicin and cisplatin chemotherapy in advanced endometrial carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol 24(1):36-44.
  54. Schwandt A, Chen W, Martra F, Zola P, Debernardo R, et al. (2011) Chemotherapy plus radiation in advanced-stage endometrial cancer. Int J Gynecol Cancer 21(9):1622-7.
  55. Hogberg T, Signorelli M, de Oliveira C, Fossati R, Lissoni A, et al. (2010) Sequential adjuvant chemotherapy and radiotherapy in endometrial cancer- -results from two randomised studies. Eur J Cancer 46(13):2422-31.
  56. Dedes K, Wetterskog D, Ashworth A, Kaye S, Reis-Filho J (2011) Emerging therapeutic targets in endometrial cancer. Nat Rev Clin Oncol 8(5):261-71.
  57. Tsoref D, Oza AM (2011) Recent advances in systemic therapy for advanced endometrial cancer. Curr Opin Oncol 23(5):494-500.
  58. Kieser K, Oza A (2005) What's new in systemic therapy for endometrial cancer. Curr Opin Oncol 17(5):500-4.
  59. Konecny G, Santos L, Winterhoff B, Hatmal M, Keeney GL, et al. (2009) HER2 gene amplification and EGFR expression in a large cohort of surgically staged patients with nonendometrioid (type II) endometrial cancer. Br J Cancer 100(1):89-95.
  60. Santin A, Bellone S, Roman J, McKenney J, Pecorelli S (2008) Trastuzumab treatment in patients with advanced or recurrent endometrial carcinoma overexpressing HER2/neu. Int J Gynaecol Obstet 102(2):128-31.
  61. [61]. Oza A, Eisenhauer E, Elit L, Cutz J, Sakurada A, et al. (2008) Phase II study of erlotinib in recurrent or metastatic endometrial cancer: NCIC IND-148.J Clin Oncol 26(26):4319-25.
  62. Fleming G, Sill M, Darcy K, McMeekin D, Thigpen J, et al. (2010) Phase II trial of trastuzumab in women with advanced or recurrent, HER2-positive endometrial carcinoma: a Gynecologic Oncology Group study. Gynecol Oncol 116(1):15-20.
  63. Adonakis G, Androutsopoulos G (2012) The role of ErbB receptors in endometrial cancer. In: Saldivar J, editor. Cancer of the uterine endometrium - advances and controversies: InTech 23-38.
  64. Roque D, Santin A (2013) Updates in therapy for uterine serous carcinoma. Curr Opin Obstet Gynecol 25(1):29-37.
  65. Androutsopoulos G, Adonakis G, Decavalas G (2014) ErbB targeted therapy in endometrial cancer. In: Farghaly S, editor. Endometrial cancer: current epidemiology, detection and management: Nova Science Publishers.
  66. Adonakis G, Androutsopoulos G, Koumoundourou D, Liava A, Ravazoula P, et al. (2008) Expression of the epidermal growth factor system in endometrial cancer. Eur J Gynaecol Oncol 29(5):450-4.
  67. Androutsopoulos G, Michail G, Adonakis G, Decavalas G (2014) Molecular biology, expression and clinical significance of ErbB receptors in endometrial cancer. Hel J Obst Gynecol 13(3):77-83.
  68. Androutsopoulos G, Michail G, Adonakis G, Decavalas G (2014) ErbB receptors and ErbB targeted therapies in endometrial cancer. J Cancer Ther 5(6):483-92.
  69. Androutsopoulos G, Adonakis G, Liava A, Ravazoula P, Decavalas G (2013) Expression and potential role of ErbB receptors in type II endometrial cancer. Eur J Obstet Gynecol Reprod Biol 168(2):204-8.

         Indexed in

               

       Total Visitors

SciDoc Counter

Get in Touch

SciDoc Publishers
16192 Coastal Highway
Lewes, Delaware 19958
Tel :+1-(302)-703-1005
Fax :+1-(302)-351-7355
Email: contact.scidoc@scidoc.org


Creative Commons License
SciDoc Publishers is licensed under a Creative Commons Attribution 4.0 International License.