Management of Recurrent Endometrioid Endometrial Carcinoma: An Overview

Abstract

In this paper, an overview of the literature on the management of recurrent endometrial cancer is presented, focusing on patients with histopathologic endometrioid type of tumors. The different treatment modalities are described, and a management recommendation scheme is presented. Indications for surgical treatment depend on resectability, site and size of the tumor, and performance status of the patient. Indications for radiotherapy depend on the site of the recurrence and also on the initial therapy received. When considering systemic treatment for patients with recurrent endometrial cancer, it is important to take into account the general health status and condition of the patient as well as which prior therapy the patient has received. The treatments of choice for patients with hormone-sensitive tumors (positive receptor levels, low-grade tumors, and long disease-free interval) are progestagens as first-line treatment and tamoxifen as second-line treatment. Patients with high-grade tumors, negative hormone receptor levels, and short treatment-free interval are best treated with chemotherapy. Paclitaxel, doxorubicin, and cisplatin are the most active combination therapy for these patients but with significant toxicity. In phase II studies, the combination therapy with paclitaxel and carboplatin seems to be as effective but less toxic and can be administered in outpatient clinic. The literature on the management of patients with recurrent endometrial cancer is discussed in detail. The different sites of recurrent disease (ie, local, regional, and/or distant) are evaluated separately; management recommendations are proposed, and alternative approaches are given.

Defining Prognostic Variables in Recurrent Endometrioid Endometrial Cancer

“…11 Modalities include local treatment with surgery or radiotherapy, systemic treatment with chemotherapy or hormonal therapy, or an appropriate combination of any of these strategies. 7,11,12 Recurrent endometrial cancer portends a worse overall prognosis and presents unique challenges given the heterogeneity of presentation. This study excluded the less common high-risk histological subtypes and focused on endometrioid carcinoma of the uterus as it accounts for approximately 80% of all endometrial cancers.…”

Dubens Eksenteracinės Operacijos – Ultraradikalios Operacijos Klaipėdos Universitetinėje Ligoninėje

“…Išplitęs ar recidyvavęs vulvos ir makšties vėžys taip pat laikomas indikacija šiai operacijai [7,11,14,17,20,30]. Diskutuojama dėl dubens eksenteracijos pasirinkimo esant endometro ar kiaušidžių vėžiui, nes šios lokalizacijos onkoprocesai turi tendenciją greitai metastazuoti iš dubens ertmės ir turi gerą jautrumą chemoterapijai [14,33]. Mūsų studijoje dubens eksenteracinės operacijos buvo atliktos 5 moterims dėl recidyvuojančio gimdos kaklelio vėžio ir po 1 dėl gimdos, kiaušidžių, tiesiosios žarnos vėžio.…”

Antiangiogenic Treatment Concepts in Gynecologic Oncology

“…It is frequently diagnosed at an early stage as women affected often present by abnormal vaginal bleeding. At an early stage endometrial cancer can be treated surgically with curable intention (van Wijk et al, 2009). In patients with highrisk endometrial cancer postoperative pelvic radiotherapy, adjuvant radiation therapy or adjuvant chemotherapy have shown to improve outcome (Ray et al, 2009).…”

“…However, about 13% of all patients with endometrial cancer develop recurrent disease. (Van Wijk et al, 2009). In the treatment of recurrent endometrial cancer different therapeutic modalities consisting of radiotherapy, surgery and systemic therapies as chemotherapy and hormone therapy are in use (Ray et al, 2009).…”