Elsevier

Gynecologic Oncology

Volume 59, Issue 2, November 1995, Pages 221-225
Gynecologic Oncology

REGULAR ARTICLE
Surveillance for Recurrent Endometrial Carcinoma: Development of a Follow-up Scheme

https://doi.org/10.1006/gyno.1995.0012Get rights and content

Abstract

We examined the method of diagnosis for a group of women who developed recurrent endometrial carcinoma after being rendered clinically disease-free by primary therapy. We then used this information to develop a follow-up protocol that maximizes the chances for detecting recurrence while minimizing surveillance costs. In brief, we evaluated all women with clinical stage I endometrial carcinoma who were treated with curative intent during a 7-year period. Medical records were examined to identify patients who had tumor recurrence diagnosed during follow-up in our clinic. Clinical presentation, time to diagnosis, method of diagnosis, and subsequent outcome were analyzed. This information was used to design a surveillance protocol for further clinical testing. Ninety-six percent of 412 women treated between 1985 and 1992 were clinically disease-free after primary surgery with or without adjuvant treatment. Median follow-up is 64 months. Overall, 44 patients (11%) developed recurrent cancer after a median interval of 14.8 months. Complete follow-up data were available for the 39 patients who had their recurrence diagnosed in our clinic. The cumulative percentages of diagnosed recurrences were 51, 82, and 95% at 12, 24, and 36 months, respectively. Sixteen women (41%) had symptoms that led to the identification of recurrent disease. Recurrences in the 23 asymptomatic women (59%) were diagnosed by physical examination in 13, chest radiograph in 1, serum CA-125 level in 6, vaginal cytology in 1, and computed tomography in 2. Only 1 patient with a grade 1 adenocarcinoma had treatment failure. At the time of analysis, 30 patients with recurrent cancer had died of disease, 6 were alive with disease, and 3 were free of disease. A surveillance scheme consisting of an examination, vaginal cytology, and serum CA-125, combined with immediate evaluation of symptomatic women, could be expected to identify 95% of recurrences. Such an approach, performed at 6- to 12-month intervals for 3 years, could be limited to patients with grade 2–3 adenocarcinomas or variant cell types. However, given the high failure rate of salvage therapy, the prompt detection of recurrence may not convey a survival advantage.

References (0)

Cited by (107)

  • Follow-up of endometrial cancer

    2014, Bulletin du Cancer
  • Post treatment surveillance of type II endometrial cancer patients

    2013, Gynecologic Oncology
    Citation Excerpt :

    The site of relapse was the most important predictor of survival in their study. Other studies have similarly questioned the value of early recurrence detection and have validated the high failure rate of salvage therapy in endometrial cancer recurrence of all subtypes [11,17,18]. This raises the question of whether surveillance for endometrial cancer, at least for low-risk endometrial cancer, should be relinquished altogether.

View all citing articles on Scopus
View full text