Endometrial cancer in an increasingly obese population: Exploring alternative options when surgery may not cut it

Abstract

ObjectivesThe study objectives were to describe outcomes of obese patients with early endometrial cancer following primary non-surgical treatment, assess predictors of response, and estimate the increased surgical risk for these women.MethodsRetrospective chart review identified women with early stage endometrial cancer at a single institution with BMI ≥ 30 kg/m2 who did not undergo surgery as primary treatment modality due to obesity and medical co-morbidities. Clinicopathologic factors were abstracted, characteristics of responders vs. non-responders compared and the National Surgical Quality Improvement Program (NSQIP) surgical risk calculator utilized to quantify surgical risks.ResultsFifty-one patients were identified, with a mean BMI of 49.0 kg/m2. The NSQIP calculator predicted a significantly higher complication rate for our cohort compared to the expected average risk for hysterectomy (18.8% vs 7.2%, p < .0001). The majority of patients were treated with radiation alone (49%), followed by hormone therapy (45.1%). Response rates were 38.1% for women treated with hormones and 63.6% in the radiation group (p = .063). No significant differences were identified between responders and non-responders with regard to NSQIP scores, BMI, co-morbidities or age. Among those with persistent or progressive disease, 87.5% responded to secondary treatment. Only one death was from cancer progression. Two individuals died following treatment complications (one surgical, one chemotherapy); the remaining twelve deaths were due to pre-existing co-morbidities.ConclusionsHormone and radiation therapy are both viable options for obese patients deemed to have too significant risk of surgical complications. Pursuing surgical intervention in this population may do more harm than good.

The role of endometrial sampling for surveillance of recurrence in postmenopausal patients with medically inoperable stage I endometrial cancer

“…Though treatment of EC by progestin therapy is largely based on studies of younger women desiring future fertility, our study, along with others, suggests there may also be a role for progestin therapy to treat postmenopausal women if RT is not feasible or desired ( Baker et al, 2012 , Staples et al, 2018 ). Macchia and colleagues reported on 9 women aged ≥65 years treated with LNG-IUD followed by palliative radiation (30 Gy) and showed a high bleeding remission rate of 88.8% ( Macchia et al, 2016 ).…”

“…Furthermore, Staples et al reported on 51 obese patients with stage I-II EC, all grades, with mean age of 66 and mean BMI of 49.0 kg/m 2 ( Staples et al, 2018 ). Though likely underpowered, their response rates were notably lower for women treated with hormonal therapy compared to RT (38.1% vs. 63.6%, p = 0.063).…”

Evaluation of Uterine Brachytherapy as Primary Treatment Option for Elderly Patients with Medically Inoperable Endometrial Cancer—A Single-Center Experience and Review of the Literature

“…However, there are data showing a benefit for local radiotherapy. For example, Staples et al [ 28 ] could show that initial response to treatment in the form of complete or partial remission was much better after local irradiation than after hormone therapy alone. Furthermore, a review by Dutta et al from 2017 [ 10 ] showed that any radiotherapy is associated with a benefit, compared to no local therapy in elderly patients with inoperable endometrial cancer.…”

Combined Approach to Surgical Treatment of Endometrial Cancer in Patients With Morbid Obesity

“…Больные неоднократно обращаются в различные учреждения, где получают отказ от операции и направляются на лучевую и гормональную терапию. При отсутствии альтернатив данный подход к лечению рассматривается как достаточно эффективный [11,12].…”