Patterns and utility of routine surveillance in high grade endometrial cancer

Abstract

Objective To evaluate surveillance methods and their utility in detecting recurrence of disease in a high grade endometrial cancer population. Methods We performed a multi-institutional retrospective chart review of women diagnosed with high grade endometrial cancer between the years 2000 and 2011. Surveillance data was abstracted and analyzed. Surveillance method leading to detection of recurrence was identified and compared by stage of disease and site of recurrence. Results Two hundred and fifty-four patients met the criteria for inclusion. Vaginal cytology was performed in the majority of early stage patients, but was utilized less in advanced stage patients. CA-125 and CT imaging were used more frequently in advanced stage patients compared to early stage. Thirty-six percent of patients experienced a recurrence and the majority of initial recurrences (76%) had a distant component. Modalities that detected cancer recurrences were: symptoms (56%), physical exam (18%), surveillance CT (15%), CA-125 (10%), and vaginal cytology (1%). All local recurrences were detected by symptoms or physical exam findings. While the majority of loco-regional and distant recurrences (68%) were detected by symptoms or physical exam, 28% were detected by surveillance CT scan or CA 125. One loco-regional recurrence was identified by vaginal cytology but no recurrences with a distant component detected by this modality. Conclusions Symptoms and physical examination identify the majority of high grade endometrial cancer recurrences, while vaginal cytology is the least likely surveillance modality to identify a recurrence. The role of CT and CA-125 surveillance outside of a clinical trial needs to be further reviewed

Prognostic Significance of POLE Exonuclease Domain Mutations in High-Grade Endometrioid Endometrial Cancer on Survival and Recurrence: A Subanalysis

“…24,25 Therefore, these high-grade tumors are typically treated more aggressively (chemotherapy and/or radiation), and patients are often subjected to more rigorous surveillance following treatment based on this histology alone. 26 Our survival analyses reveal a strong, yet highly variable, trend toward improved outcomes in both RFS and OS consistent with recent publications. 17Y19 Given the modest number of grade 3 cases in our study, we did not break down outcome by stage.…”

“…27 Despite recommendations from the National Comprehensive Cancer Network and the Society of Gynecologic Oncology discouraging the routine use of modalities other than symptoms and physical examination in asymptomatic women undergoing surveillance, the use of additional surveillance methods, including CA-125 testing, vaginal cytology, and computed tomography imaging, is well documented among current practitioners caring for women with high-grade EC. 26 Hunn et al 26 recently reported on a multi-institutional retrospective review of 254 women with high-grade EC from 2000 to 2011, with the most common histotype being grade 3 EEC (34%). Vaginal cytology was performed in 72% of the high-grade cohort (more frequently in the early-stage patients (82%).…”

Brazilian Society of Surgical Oncology guidelines for surgical treatment of endometrial cancer in regions with limited resources

“…The combination of anamnesis and complete gynecological examination can detect 70% to 80% of recurrences of EC. Complementary examinations do not significantly increase the rate of detection of recurrence among asymptomatic reference patients …”

“…For patients with stage III and IV disease, chest, abdominal, and pelvic CT scans should be performed every 6 months for the first 3 years and every 6 to 12 months for the next 2 years . Pelvic MRI can be performed in patients with persistent EC after 6 months with or without treatment failure …”

“…Complementary examinations do not significantly increase the rate of detection of recurrence among asymptomatic reference patients. [80][81][82] CA-125 can be used in the follow-up of patients with high-grade tumors and serous histology, as long as these tumors are altered at the time of diagnosis. 83 For patients with stage III and IV disease, chest, abdominal, and pelvic CT scans should be performed every 6 months for the first 3 years and every 6 to 12 months for the next 2 years.…”