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Use of Aggressive Surveillance for Locoregional Endometrial Cancer After Local Therapy
  1. Pratyusha Yalamanchi, MD, MBA*,
  2. Jacob E. Shabason, MD*,
  3. Xiaochen Zhang, MPH,
  4. Emily M. Ko, MD, MSCR and
  5. Lilie L. Lin, MD*
  1. *Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA;
  2. Public Health Sciences, College of Medicine, Penn State University, Hershey, PA; and
  3. Department of Gynecology Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
  1. Address correspondence and reprint requests to Pratyusha Yalamanchi, MD, MBA, Department of Radiation Oncology, PCAM-2 West, 3400 Civic Center Blvd, Philadelphia, PA 19104. E-mail: pyalamanchi{at}gmail.com.

Abstract

Purpose/Objectives Current guidelines do not recommend routine surveillance imaging as part of follow-up care for patients treated for locoregional endometrial carcinoma. This study seeks to determine the potential benefit of routine surveillance imaging by evaluating outcomes of patients whose recurrences were detected on routine surveillance compared to those whose recurrences were identified after presenting with symptoms.

Materials/Methods We conducted a retrospective review of patients who developed recurrence after surgical treatment, with or without adjuvant therapy, for locoregional endometrial carcinoma. A total of 149 patients were identified with adequate clinical information regarding the recurrence. Cox proportional hazards regression analysis was used to estimate overall survival and progression-free survival.

Results The median age of patients at diagnosis was 69.2 years (range, 38.0-99.5 years). Initial stages included stage I, 49.7%; stage II, 10.1%; stage III, 38.3%; and stage IV, 1.3%. Histologic diagnoses included endometrioid adenocarcinoma, 48.3%; and other diagnoses (including papillary serous carcinoma, clear cell carcinoma, and carcinosarcoma), 51.7%. Patients were initially treated with a variety of therapies: surgery alone in 20.8%, surgery and radiation in 25.5%, surgery and chemotherapy in 12.1%, and trimodality therapy in 41.6%. Sites of recurrence included 20.8% vaginal, 14.8% pelvic and 64.4% distant sites. Recurrences were detected asymptomatically in 86 patients (57.7%) and symptomatically in 63 patients (42.3%). Of those detected asymptomatically, 80.2% were detected by imaging. Overall, when comparing symptomatic versus asymptomatic recurrences, there was no difference in overall survival (hazard ratio, 1.24; 95% confidence interval, 0.84-1.83; P = 0.29) or progression-free survival (hazard ratio, 1.14; 95% confidence interval, 0.77-1.70; P = 0.52).

Conclusions Patients who develop asymptomatic recurrences of their endometrial carcinoma do not seem to have a better prognosis than those who present with symptomatic recurrences. Thus, these results do not support routine imaging surveillance for patients treated for locoregional endometrial carcinoma. Further prospective evaluation is needed.

  • Endometrial cancer
  • Surveillance

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Footnotes

  • Yalamanchi and Shabason are co–first authors.

  • This work was presented at the ASTRO 2015 Annual Meeting.

  • The authors declare no conflicts of interest.

  • Research for this work was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number KL2TR001879. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

  • Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal’s Web site (www.ijgc.net).

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