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Salvage of isolated vaginal recurrences in women with surgical stage I endometrial cancer: a multiinstitutional experience
  1. W. K. Huh*,
  2. JR J. M. Straughn*,
  3. A. Mariani,
  4. K. C. Podratz,
  5. L. J. Havrilesky,
  6. A. Alvarez-Secord,
  7. M. A. Gold§,
  8. D. S. Mcmeekin§,
  9. S. Modesitt,
  10. A. L. Cooper,
  11. M. A. Powell,
  12. D. G. Mutch,
  13. S. Nag#,
  14. R. D. Alvarez* and
  15. D. E. Cohn#
  1. *Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, Alabama;
  2. Department of Obstetrics/Gynecology, Mayo Clinic, Rochester, Minnesota;
  3. Department of Obstetrics/Gynecology, Duke University School of Medicine, Durham, North Carolina;
  4. §Department of Obstetrics/Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma;
  5. Division of Gynecologic Oncology, University of Kentucky School of Medicine, Lexington, Kentucky;
  6. Department of Obstetrics/Gynecology, Washington University School of Medicine, St. Louis, Missouri; and
  7. #Division of Gynecologic Oncology, The Ohio State University, Columbus, Ohio
  1. Address correspondence and reprint requests to: Warner K. Huh, MD, Division of Gynecologic Oncology, University of Alabama at Birmingham, 619 19th Street South, OHB Room 538, Birmingham, AL 35249, USA. Email: whuh{at}uab.edu

Abstract

The objective of this study was to evaluate the treatment outcomes and risk factors of women with surgical stage I endometrial adenocarcinoma who were initially treated with surgery alone and subsequently developed isolated vaginal recurrences. Patients with surgical stage I endometrial adenocarcinoma diagnosed from 1975 to 2002 were identified from tumor registry databases at seven institutions. All patients were treated with surgery alone including a total hysterectomy, bilateral salpingo-oophorectomy, pelvic (+/− para-aortic) lymph node dissection, and peritoneal cytology and did not receive postoperative radiation therapy. Vaginal recurrences were documented histologically. Metastatic disease in the chest and abdomen was excluded by radiologic studies. Overall survival was calculated by the Kaplan–Meier method. Sixty-nine women with surgical stage I endometrial cancer with isolated vaginal recurrences were identified. Of the 69 patients, 10 (15%) were diagnosed with stage IA disease, 43 (62%) were diagnosed with stage IB disease, and 16 (23%) were diagnosed with stage IC disease. Patients diagnosed with grade 1 disease were 22 (32%), grade 2 disease were 26 (38%), and grade 3 disease were 21 (30%). Among women, 81% with isolated vaginal recurrences were salvaged with radiation therapy. The mean time to recurrence was 24 months, and the mean follow-up was 63 months. Among women, 18% died from subsequent recurrent disease. The 5-year overall survival was 75%. The majority of isolated vaginal recurrences in women with surgical stage I endometrial cancer can be successfully salvaged with radiation therapy, further questioning the role of adjuvant therapy for patients with uterine-confined endometrial cancer at the time of initial diagnosis

  • endometrial cancer
  • recurrence
  • salvage
  • vaginal

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