Recurrent early stage endometrial cancer: Patterns of recurrence and results of salvage therapy
To analyze our institutional experience and oncologic outcomes for salvage treatment for the recurrence of early-stage endometrial cancer patients. We included women of all ages diagnosed with FIGO stage I-II, any grade endometrial cancer from 2000 to 2016 at our institutions who were treated with a...
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| Veröffentlicht in: | Gynecologic oncology 2019-07, Vol.154 (1), p.38-44 |
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| creator | Francis, Samual R. Ager, Bryan J. Do, Olivia A. Huang, Yu-Huei Jessica Soisson, Andrew P. Dodson, Mark K. Werner, Theresa L. Sause, William T. Grant, Jonathan D. Gaffney, David K. |
| description | To analyze our institutional experience and oncologic outcomes for salvage treatment for the recurrence of early-stage endometrial cancer patients.
We included women of all ages diagnosed with FIGO stage I-II, any grade endometrial cancer from 2000 to 2016 at our institutions who were treated with at least a hysterectomy. Recurrences in the pelvis and/or vagina were considered locoregional recurrences (LRR). Overall survival (OS) was assessed using Kaplan-Meier survival analysis. Univariate (UV) and multivariate (MV) Cox proportional hazards modeling was also used.
A total of 2691 women were analyzed. The majority had endometrioid histology (91%), stage IA disease (61%), and were grade 1 (57%). With a median follow-up of 6.1 years, the overall rate of recurrence was 7.2%, and the rate of LRR was 3.7%. Women with vaginal-only recurrences had a longer median OS after recurrence (14.0 years) compared to both pelvic (1.2 years) and distant (1.0 year) failures. For women with vaginal-only recurrences, salvage radiotherapy (RT) was the only factor associated with improved OS on MVA (HR 0.1, p = .04). For women with pelvic recurrences, salvage surgery (HR 0.3, p = .01), salvage RT (HR 0.3, p |
| doi_str_mv | 10.1016/j.ygyno.2019.04.676 |
| format | Article |
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We included women of all ages diagnosed with FIGO stage I-II, any grade endometrial cancer from 2000 to 2016 at our institutions who were treated with at least a hysterectomy. Recurrences in the pelvis and/or vagina were considered locoregional recurrences (LRR). Overall survival (OS) was assessed using Kaplan-Meier survival analysis. Univariate (UV) and multivariate (MV) Cox proportional hazards modeling was also used.
A total of 2691 women were analyzed. The majority had endometrioid histology (91%), stage IA disease (61%), and were grade 1 (57%). With a median follow-up of 6.1 years, the overall rate of recurrence was 7.2%, and the rate of LRR was 3.7%. Women with vaginal-only recurrences had a longer median OS after recurrence (14.0 years) compared to both pelvic (1.2 years) and distant (1.0 year) failures. For women with vaginal-only recurrences, salvage radiotherapy (RT) was the only factor associated with improved OS on MVA (HR 0.1, p = .04). For women with pelvic recurrences, salvage surgery (HR 0.3, p = .01), salvage RT (HR 0.3, p < .01), and salvage chemotherapy (HR 0.4, p = .03) were associated with improved OS.
Failure rates for women with early-stage endometrial cancer are low. Women with vaginal-only recurrences have improved OS compared to pelvic or distant recurrences. Salvage RT appears to be an important factor for treatment of women with vaginal-only recurrences. Aggressive multimodality treatment may be beneficial for women with pelvic recurrences.
•Women with vaginal recurrences had significantly longer survival than women with pelvic or distant recurrences.•Salvage radiotherapy was the only factor we found associated with improved survival for vaginal recurrences.•Salvage surgery, radiotherapy, and chemotherapy were associated with improved survival for pelvic recurrences.•In the rare situation of a second locoregional recurrence, 50% of patients can be salvaged at 5 years.</description><identifier>ISSN: 0090-8258</identifier><identifier>EISSN: 1095-6859</identifier><identifier>DOI: 10.1016/j.ygyno.2019.04.676</identifier><identifier>PMID: 31029507</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Endometrial cancer ; Radiotherapy ; Recurrence ; Salvage treatment</subject><ispartof>Gynecologic oncology, 2019-07, Vol.154 (1), p.38-44</ispartof><rights>2019 Elsevier Inc.</rights><rights>Copyright © 2019. Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c425t-cef607d53ad2d34509c73e4202b752f1e2cd2029272a70fad079ae268e8ae3dc3</citedby><cites>FETCH-LOGICAL-c425t-cef607d53ad2d34509c73e4202b752f1e2cd2029272a70fad079ae268e8ae3dc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0090825819311746$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31029507$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Francis, Samual R.</creatorcontrib><creatorcontrib>Ager, Bryan J.</creatorcontrib><creatorcontrib>Do, Olivia A.</creatorcontrib><creatorcontrib>Huang, Yu-Huei Jessica</creatorcontrib><creatorcontrib>Soisson, Andrew P.</creatorcontrib><creatorcontrib>Dodson, Mark K.</creatorcontrib><creatorcontrib>Werner, Theresa L.</creatorcontrib><creatorcontrib>Sause, William T.</creatorcontrib><creatorcontrib>Grant, Jonathan D.</creatorcontrib><creatorcontrib>Gaffney, David K.</creatorcontrib><title>Recurrent early stage endometrial cancer: Patterns of recurrence and results of salvage therapy</title><title>Gynecologic oncology</title><addtitle>Gynecol Oncol</addtitle><description>To analyze our institutional experience and oncologic outcomes for salvage treatment for the recurrence of early-stage endometrial cancer patients.
We included women of all ages diagnosed with FIGO stage I-II, any grade endometrial cancer from 2000 to 2016 at our institutions who were treated with at least a hysterectomy. Recurrences in the pelvis and/or vagina were considered locoregional recurrences (LRR). Overall survival (OS) was assessed using Kaplan-Meier survival analysis. Univariate (UV) and multivariate (MV) Cox proportional hazards modeling was also used.
A total of 2691 women were analyzed. The majority had endometrioid histology (91%), stage IA disease (61%), and were grade 1 (57%). With a median follow-up of 6.1 years, the overall rate of recurrence was 7.2%, and the rate of LRR was 3.7%. Women with vaginal-only recurrences had a longer median OS after recurrence (14.0 years) compared to both pelvic (1.2 years) and distant (1.0 year) failures. For women with vaginal-only recurrences, salvage radiotherapy (RT) was the only factor associated with improved OS on MVA (HR 0.1, p = .04). For women with pelvic recurrences, salvage surgery (HR 0.3, p = .01), salvage RT (HR 0.3, p < .01), and salvage chemotherapy (HR 0.4, p = .03) were associated with improved OS.
Failure rates for women with early-stage endometrial cancer are low. Women with vaginal-only recurrences have improved OS compared to pelvic or distant recurrences. Salvage RT appears to be an important factor for treatment of women with vaginal-only recurrences. Aggressive multimodality treatment may be beneficial for women with pelvic recurrences.
•Women with vaginal recurrences had significantly longer survival than women with pelvic or distant recurrences.•Salvage radiotherapy was the only factor we found associated with improved survival for vaginal recurrences.•Salvage surgery, radiotherapy, and chemotherapy were associated with improved survival for pelvic recurrences.•In the rare situation of a second locoregional recurrence, 50% of patients can be salvaged at 5 years.</description><subject>Endometrial cancer</subject><subject>Radiotherapy</subject><subject>Recurrence</subject><subject>Salvage treatment</subject><issn>0090-8258</issn><issn>1095-6859</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp9kM1Lw0AQxRdRbK3-BYLk6CVxdpPNJoIHKX5BQRE9L9vdSU3JR93dFPLfm7TVo6fhMe-9YX6EXFKIKND0Zh31q75pIwY0jyCJUpEekSmFnIdpxvNjMgXIIcwYzybkzLk1AMRA2SmZxBRYzkFMiXxH3VmLjQ9Q2aoPnFcrDLAxbY3elqoKtGo02tvgTXmPtnFBWwT2kNIYqMYM0nWV322cqrZjg_9Cqzb9OTkpVOXw4jBn5PPx4WP-HC5en17m94tQJ4z7UGORgjA8VoaZOOGQaxFjwoAtBWcFRabNIHImmBJQKAMiV8jSDDOFsdHxjFzveze2_e7QeVmXTmNVqQbbzknGaCoETxM6WOO9VdvWOYuF3NiyVraXFORIVq7ljqwcyUpI5EB2SF0dDnTLGs1f5hflYLjbG3B4c1uilU6XIyFTDrS8NG3574EfwXKMmQ</recordid><startdate>20190701</startdate><enddate>20190701</enddate><creator>Francis, Samual R.</creator><creator>Ager, Bryan J.</creator><creator>Do, Olivia A.</creator><creator>Huang, Yu-Huei Jessica</creator><creator>Soisson, Andrew P.</creator><creator>Dodson, Mark K.</creator><creator>Werner, Theresa L.</creator><creator>Sause, William T.</creator><creator>Grant, Jonathan D.</creator><creator>Gaffney, David K.</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20190701</creationdate><title>Recurrent early stage endometrial cancer: Patterns of recurrence and results of salvage therapy</title><author>Francis, Samual R. ; Ager, Bryan J. ; Do, Olivia A. ; Huang, Yu-Huei Jessica ; Soisson, Andrew P. ; Dodson, Mark K. ; Werner, Theresa L. ; Sause, William T. ; Grant, Jonathan D. ; Gaffney, David K.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c425t-cef607d53ad2d34509c73e4202b752f1e2cd2029272a70fad079ae268e8ae3dc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Endometrial cancer</topic><topic>Radiotherapy</topic><topic>Recurrence</topic><topic>Salvage treatment</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Francis, Samual R.</creatorcontrib><creatorcontrib>Ager, Bryan J.</creatorcontrib><creatorcontrib>Do, Olivia A.</creatorcontrib><creatorcontrib>Huang, Yu-Huei Jessica</creatorcontrib><creatorcontrib>Soisson, Andrew P.</creatorcontrib><creatorcontrib>Dodson, Mark K.</creatorcontrib><creatorcontrib>Werner, Theresa L.</creatorcontrib><creatorcontrib>Sause, William T.</creatorcontrib><creatorcontrib>Grant, Jonathan D.</creatorcontrib><creatorcontrib>Gaffney, David K.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Gynecologic oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Francis, Samual R.</au><au>Ager, Bryan J.</au><au>Do, Olivia A.</au><au>Huang, Yu-Huei Jessica</au><au>Soisson, Andrew P.</au><au>Dodson, Mark K.</au><au>Werner, Theresa L.</au><au>Sause, William T.</au><au>Grant, Jonathan D.</au><au>Gaffney, David K.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Recurrent early stage endometrial cancer: Patterns of recurrence and results of salvage therapy</atitle><jtitle>Gynecologic oncology</jtitle><addtitle>Gynecol Oncol</addtitle><date>2019-07-01</date><risdate>2019</risdate><volume>154</volume><issue>1</issue><spage>38</spage><epage>44</epage><pages>38-44</pages><issn>0090-8258</issn><eissn>1095-6859</eissn><abstract>To analyze our institutional experience and oncologic outcomes for salvage treatment for the recurrence of early-stage endometrial cancer patients.
We included women of all ages diagnosed with FIGO stage I-II, any grade endometrial cancer from 2000 to 2016 at our institutions who were treated with at least a hysterectomy. Recurrences in the pelvis and/or vagina were considered locoregional recurrences (LRR). Overall survival (OS) was assessed using Kaplan-Meier survival analysis. Univariate (UV) and multivariate (MV) Cox proportional hazards modeling was also used.
A total of 2691 women were analyzed. The majority had endometrioid histology (91%), stage IA disease (61%), and were grade 1 (57%). With a median follow-up of 6.1 years, the overall rate of recurrence was 7.2%, and the rate of LRR was 3.7%. Women with vaginal-only recurrences had a longer median OS after recurrence (14.0 years) compared to both pelvic (1.2 years) and distant (1.0 year) failures. For women with vaginal-only recurrences, salvage radiotherapy (RT) was the only factor associated with improved OS on MVA (HR 0.1, p = .04). For women with pelvic recurrences, salvage surgery (HR 0.3, p = .01), salvage RT (HR 0.3, p < .01), and salvage chemotherapy (HR 0.4, p = .03) were associated with improved OS.
Failure rates for women with early-stage endometrial cancer are low. Women with vaginal-only recurrences have improved OS compared to pelvic or distant recurrences. Salvage RT appears to be an important factor for treatment of women with vaginal-only recurrences. Aggressive multimodality treatment may be beneficial for women with pelvic recurrences.
•Women with vaginal recurrences had significantly longer survival than women with pelvic or distant recurrences.•Salvage radiotherapy was the only factor we found associated with improved survival for vaginal recurrences.•Salvage surgery, radiotherapy, and chemotherapy were associated with improved survival for pelvic recurrences.•In the rare situation of a second locoregional recurrence, 50% of patients can be salvaged at 5 years.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31029507</pmid><doi>10.1016/j.ygyno.2019.04.676</doi><tpages>7</tpages></addata></record> |
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| subjects | Endometrial cancer Radiotherapy Recurrence Salvage treatment |
| title | Recurrent early stage endometrial cancer: Patterns of recurrence and results of salvage therapy |
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