TITLE:
Patterns of Recurrence in Low-Risk Endometrial Cancer
AUTHORS:
Taylor Hodge, Yael Naaman, Thomas Cade, Deborah Neesham, Antonia Jones, Orla McNally
KEYWORDS:
Endometrial Cancer, Recurrence, Surveillance, Survivorship, Vaginal Vault
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.12 No.11,
November
15,
2022
ABSTRACT: Objective: Endometrial cancer is the most common gynaecological cancer in high-income countries and has a good prognosis,
particularly when diagnosed early. Early stage, low-grade endometrial cancer
has a low risk of recurrence, and is detectable on routine follow up.
This study aims to identify rates and patterns
of recurrence in low-risk endometrial cancer patients and provide evidence for transitioning to community-based follow-up care. Methods: Retrospective study of patients with early-stage, low-grade endometrioid
endometrial adenocarcinoma treated with surgery from January 1981 to December
2018. The rate and patterns of recurrence were identified and analysed. Results: Of 1215 eligible patients, 24 developed recurrent disease (1.98%). The majority
of recurrences were pelvic (70%), and confined to the vaginal vault (41.7%).
The median duration of follow up was 44.4 months, and time from primary surgery to diagnosis of recurrent disease
was 30.5 months. No significant differences were found between the group of
patients who recurred and the group of patients who did not. Twelve (50%)
patients with recurrences were asymptomatic, but of these, 10 (83%) had
obvious findings during routine surveillance
physical examination. The remaining 12 patients (50%) presented with
symptoms that prompted investigation that led to the recurrence diagnosis. 78%
of recurrences were treated with combination therapy (surgical excision,
chemotherapy, radiotherapy and hormonal). Ten patients (42%) had salvageable disease. For the non-salvageable cases, there was
a mean of 2.1 years from recurrence diagnosis to death. Conclusions: The low recurrence rate of low-risk
endometrial cancer following primary surgical management, and the
feasibility of detection of recurrent disease, support transitioning
surveillance to community-based settings.