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Could Different Follow-Up Modalities Play a Role in the Diagnosis of Asymptomatic Endometrial Cancer Relapses?: An Italian Multicentric Retrospective Analysis

Carrara, Luisa MD*; Gadducci, Angiolo MD; Landoni, Fabio MD; Maggino, Tiziano MD§; Scambia, Giovanni MD; Galletto, Luciano MD; Lissoni, Andrea Alberto MD#; Fuso, Luca MD, PhD**; Zola, Paolo MD**; Sartori, Enrico MD*

International Journal of Gynecological Cancer: July 2012 - Volume 22 - Issue 6 - p 1013–1019
doi: 10.1097/IGC.0b013e31825ad3ee
Uterine Cancer

Objective To determine current practice and to assess the value of routine follow-up procedures for endometrial cancer surveillance. To discuss whether such procedures are feasible and effective to identify asymptomatic recurrences and describe the pattern of relapse detected by procedures.

Methods The records of 282 consecutive women with recurrent endometrial cancer treated from 1986 to 2005 were retrospectively collected in 8 Italian institutions. Primary disease, clinical history, and recurrence features and data were analyzed.

Results Thirty-five (12.4%) of 282 patients had recurrence in vaginal vault, 51 patients (18.0%) had recurrence in central pelvis, 14 patients (4.9%) had recurrence in pelvic wall, and 39 patients (13.8%) had recurrence in lymph nodes. One-hundred twenty-eight patients (45.3%) showed a distant relapse, whereas 15 patients (5.3%) developed both distant relapse and local relapse. The site of relapse influenced survival because the patients with vaginal vault recurrences lived significantly longer than the patients with recurrences in other sites. Eighty (28.4%) of the 282 patients became symptomatic and anticipated the scheduled visit, 37 (13.1 %) of the patients reported their symptoms during the follow-up meeting, and 165 (58.5 %) of the patients were asymptomatic and the diagnostic path was introduced by a planned visit or examination. Among the asymptomatic patients, the first procedure that led to further examinations was clinical visit alone for 60 (36.4%) of 165 patients, imaging for 103 patients (62.4%), and cytologic examination for 2 patients (1.2%). Symptoms at recurrence can predict survival: patients with an asymptomatic recurrence had a median survival time from relapse of 35 months versus 13 months if they had a symptomatic repetition (P = 0.0001).

Conclusions Follow-up after endometrial cancer treatment varies in Italy. In this retrospective study, women with asymptomatic recurrence have shown a better clinical outcome compared with those with symptomatic relapse. The optimal approach is actually unknown, and guidelines comparing follow-up protocols have not been established. Prospective cost-effectiveness studies are needed.

*Department of Gynecology and Obstetrics, University of Brescia, Brescia; †Department of Gynecology and Obstetrics, University of Pisa, Pisa; ‡European Institute of Oncology, Milan; §Unit of Gynaecology and Obstetrics, Ospedale “Umberto I°”, Venezia-Mestre; ∥Department of Gynecology and Obstetrics, Catholic University of Rome, Rome; ¶Unit of Gynecology and Obstetrics, Ospedale “Edoardo Agnelli”, Pinerolo, Turin; #Unit of Gynecology and Oncology, Ospedale “San Gerardo”, Monza; and **Department of Gynecology and Obstetrics, University of Turin, Turin, Italy.

Address correspondence and reprint requests to Luisa Carrara, MD, Department of Gynecology and Obstetrics, University of Brescia, Spedali Civili Brescia, P.le Spedali Civili 1, 25123 Brescia, Italy. E-mail:

The authors declare that there are no conflicts of interest.

Received March 16, 2012

Accepted April 17, 2012

Copyright © 2012 by IGCS and ESGO