Detection and patterns of treatment failure in 300 consecutive cases of “early” endometrial cancer after primary surgery

Podczaski, Edward S.; Kaminski, Paul F.; Gurski, Karen J.; MacNeill, Colin; Stryker, John A.; Singapuri, Kishor; Hackett, Thomas E.; Sorosky, Joel I.; Zaino, Richard J.

doi:10.1016/0090-8258(92)90134-5

Cited by 112 publications

(98 citation statements)

References 11 publications

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“…However, some investigators have made noteworthy observations. In 1992, Podczaski and coworkers from Hershey Medical Center reported that the site of recurrence, time interval of surgery to recurrence, and use of postoperative pelvic radiotherapy were statistically related to patient prognosis [32]. In 1988, Curran and colleagues from the Fox Chase Cancer Center in Philadelphia applied a primary vaginal carcinoma staging system to vaginal recurrences of endometrial carcinoma and observed that a higher rate of pelvic control was observed for apical than for suburethral recurrences [19].…”

Section: Discussionmentioning

confidence: 99%

Interstitial Brachytherapy for Vaginal Recurrences of Endometrial Carcinoma

Tewari¹,

Cappuccini²,

Brewster³

et al. 1999

Gynecologic Oncology

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Objective. The aim of this study was to evaluate the efficacy of interstitial brachytherapy in the management of vaginal recurrences of endometrial carcinoma.Methods. Thirty patients received interstitial irradiation, with or without external beam radiotherapy. They were followed for a minimum of 5 years or until death.Results. The median age was 66 years at initial diagnosis of endometrial cancer. FIGO stages included Stage I (n ‫؍‬ 18), Stage II (n ‫؍‬ 7), and Stage III (n ‫؍‬ 5). All patients were treated originally by total abdominal hysterectomy and bilateral salpingooophorectomy, with or without lymphadenectomy, and 13 (43%) also received postoperative adjuvant whole pelvis radiotherapy as part of their primary treatment. Vaginal recurrences were diagnosed at a mean interval of 29 months after hysterectomy (range, 3-119 months). No patient had clinical evidence of pelvic sidewall extension or of distant metastatic disease. All patients were treated with interstitial brachytherapy; each implant delivered a mean maximal tumor dose of 25.5 Gy. Eighteen patients (60%) also received external beam radiotherapy (mean dose, 48 Gy) as part of their treatment for vaginal recurrence. Twenty-eight patients (93%) experienced a complete clinical response. Ten patients relapsed in the vagina (n ‫؍‬ 5) or at distant sites (n ‫؍‬ 5). Eleven patients are dead of disease. From the time of vaginal recurrence, the median overall survival was 60 months and the cause of death adjusted 5-year survival rate was 65%. Major morbidity included radiation proctitis (n ‫؍‬ 2), fistula (n ‫؍‬ 2), and radiation stricture (n ‫؍‬ 1).Conclusion. Interstitial irradiation resulted in favorable local control as well as a 5-year survival rate and morbidity comparable to that reported previously for conventional brachytherapy.

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Section: Discussionmentioning

confidence: 99%

Interstitial Brachytherapy for Vaginal Recurrences of Endometrial Carcinoma

Tewari¹,

Cappuccini²,

Brewster³

et al. 1999

Gynecologic Oncology

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“…A review of the routine follow-up management of patients after treatment for EC identified 11 studies [258][259][260][261][262][263][264][265][266][267][268] from a range of countries, including one study from England 263 and one from Scotland, 262 covering the period 1977-97. 269 The management was designed to identify recurrence of EC and included clinical examination, smear of the vaginal vault, chest X-ray, ultrasound and CT scans, although the study from England reported only occasional clinical examinations and the study from Scotland only occasional clinical examinations and occasional smear.…”

Section: Cost Of Follow-up Management Of Endometrial Cancermentioning

confidence: 99%

A systematic review and economic evaluation of diagnostic strategies for Lynch syndrome

Snowsill

Huxley

Hoyle

et al. 2014

Health Technology Assessment

106

234

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BackgroundLynch syndrome (LS) is an inherited autosomal dominant disorder characterised by an increased risk of colorectal cancer (CRC) and other cancers, and caused by mutations in the deoxyribonucleic acid (DNA) mismatch repair genes.ObjectiveTo evaluate the accuracy and cost-effectiveness of strategies to identify LS in newly diagnosed early-onset CRC patients (aged < 50 years). Cascade testing of relatives is employed in all strategies for individuals in whom LS is identified.Data sources and methodsSystematic reviews were conducted of the test accuracy of microsatellite instability (MSI) testing or immunohistochemistry (IHC) in individuals with CRC at risk of LS, and of economic evidence relating to diagnostic strategies for LS. Reviews were carried out in April 2012 (test accuracy); and in February 2012, repeated in February 2013 (economic evaluations). Databases searched included MEDLINE (1946 to April week 3, 2012), EMBASE (1980 to week 17, 2012) and Web of Science (inception to 30 April 2012), and risk of bias for test accuracy was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) quality appraisal tool. A de novo economic model of diagnostic strategies for LS was developed.ResultsInconsistencies in study designs precluded pooling of diagnostic test accuracy results from a previous systematic review and nine subsequent primary studies. These were of mixed quality, with significant methodological concerns identified for most. IHC and MSI can both play a part in diagnosing LS but neither is gold standard. No UK studies evaluated the cost-effectiveness of diagnosing and managing LS, although studies from other countries generally found some strategies to be cost-effective compared with no testing.The de novo model demonstrated that all strategies were cost-effective compared with no testing at a threshold of £20,000 per quality-adjusted life-year (QALY), with the most cost-effective strategy utilising MSI andBRAFtesting [incremental cost-effectiveness ratio (ICER) = £5491 per QALY]. The maximum health benefit to the population of interest would be obtained using universal germline testing, but this would not be a cost-effective use of NHS resources compared with the next best strategy. When the age limit was raised from 50 to 60 and 70 years, the ICERs compared with no testing increased but remained below £20,000 per QALY (except for universal germline testing with an age limit of 70 years). The total net health benefit increased with the age limit as more individuals with LS were identified. Uncertainty was evaluated through univariate sensitivity analyses, which suggested that the parameters substantially affecting cost-effectiveness: were the risk of CRC for individuals with LS; the average number of relatives identified per index patient; the effectiveness of colonoscopy in preventing metachronous CRC; the cost of colonoscopy; the duration of the psychological impact of genetic testing on health-related quality of life (HRQoL); and the impact of prophylactic hysterectomy and bilateral salpingo-oophorectomy on HRQoL (this had the potential to make all testing strategies more expensive and less effective than no testing).LimitationsThe absence of high-quality data for the impact of prophylactic gynaecological surgery and the psychological impact of genetic testing on HRQoL is an acknowledged limitation.ConclusionsResults suggest that reflex testing for LS in newly diagnosed CRC patients aged < 50 years is cost-effective. Such testing may also be cost-effective in newly diagnosed CRC patients aged < 60 or < 70 years. Results are subject to uncertainty due to a number of parameters, for some of which good estimates were not identified. We recommend future research to estimate the cost-effectiveness of testing for LS in individuals with newly diagnosed endometrial or ovarian cancer, and the inclusion of aspirin chemoprevention. Further research is required to accurately estimate the impact of interventions on HRQoL.Study registrationThis study is registered as PROSPERO CRD42012002436.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…These recommendations recognize that the value of intensive surveillance has not been demonstrated in this disease, and ancillary testing is therefore not recommended. [68][69][70][71] A review of the biomedical literature for routine intensive postoperative surveillance in patients with clinical stage I and II endometrial cancer showed an approximately 15% recurrence rate; 72 58% of the patients had symptomatic recurrences. For most patients, disease recurred within 3 years of initial treatment.…”

Section: Postoperative Surveillancementioning

confidence: 99%