Recurrent early stage endometrial cancer: Patterns of recurrence and results of salvage therapy.

Autor: Francis SR; Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA., Ager BJ; Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA., Do OA; Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA., Huang YJ; Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA., Soisson AP; Department of Obstetrics and Gynecology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA., Dodson MK; Department of Obstetrics and Gynecology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA., Werner TL; Department of Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA., Sause WT; Department of Radiation Oncology, Intermountain Medical Group, Intermountain Healthcare, Salt Lake City, UT, USA., Grant JD; Department of Radiation Oncology, Intermountain Medical Group, Intermountain Healthcare, Salt Lake City, UT, USA., Gaffney DK; Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA. Electronic address: david.gaffney@hci.utah.edu.
Jazyk: angličtina
Zdroj: Gynecologic oncology [Gynecol Oncol] 2019 Jul; Vol. 154 (1), pp. 38-44. Date of Electronic Publication: 2019 Apr 24.
DOI: 10.1016/j.ygyno.2019.04.676
Abstrakt: Objective: To analyze our institutional experience and oncologic outcomes for salvage treatment for the recurrence of early-stage endometrial cancer patients.
Methods: We included women of all ages diagnosed with FIGO stage I-II, any grade endometrial cancer from 2000 to 2016 at our institutions who were treated with at least a hysterectomy. Recurrences in the pelvis and/or vagina were considered locoregional recurrences (LRR). Overall survival (OS) was assessed using Kaplan-Meier survival analysis. Univariate (UV) and multivariate (MV) Cox proportional hazards modeling was also used.
Results: A total of 2691 women were analyzed. The majority had endometrioid histology (91%), stage IA disease (61%), and were grade 1 (57%). With a median follow-up of 6.1 years, the overall rate of recurrence was 7.2%, and the rate of LRR was 3.7%. Women with vaginal-only recurrences had a longer median OS after recurrence (14.0 years) compared to both pelvic (1.2 years) and distant (1.0 year) failures. For women with vaginal-only recurrences, salvage radiotherapy (RT) was the only factor associated with improved OS on MVA (HR 0.1, p = .04). For women with pelvic recurrences, salvage surgery (HR 0.3, p = .01), salvage RT (HR 0.3, p < .01), and salvage chemotherapy (HR 0.4, p = .03) were associated with improved OS.
Conclusions: Failure rates for women with early-stage endometrial cancer are low. Women with vaginal-only recurrences have improved OS compared to pelvic or distant recurrences. Salvage RT appears to be an important factor for treatment of women with vaginal-only recurrences. Aggressive multimodality treatment may be beneficial for women with pelvic recurrences.
(Copyright © 2019 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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