SINGAPORE—Long after surgery to excise endometrial cancer, the disease may—in a small percentage of women—recur, researchers reported here at the 2015 European Society of Medical Oncology Asia Cancer Symposium.
In a retrospective study that reviewed the outcomes in 2,385 women treated with surgery for endometrial cancer, 22 recurrences occurred after five years, said Akimasa Takahashi, MD, PhD, Assistant Professor of Oncology at the Cancer Institute Hospital for Japanese Foundation for Cancer Research in Tokyo.
In nine of those 22 cases, the recurrences were more than 10 years after the initial treatment. One patient experienced a recurrence 32.2 years after the initial curative surgery, he said.
At his poster presentation, Takahashi said that 2,233 of these women seen at the institution between 1970 and December 2009 were treated with curative intent. There were 258 recurrences, but 236 of these recurrences occurred within five years of the initial surgery. The other 22 occurred after that five-year window, he told OT.
“We believe patients with endometrioid G1 and G2 cancers should be closely monitored and actively followed for more than five years,” he said.
“Three quarters of endometrial cancer patients are confined to the uterus and treated at an early stage,” he noted, “but 15 percent to 20 percent recur after primary surgery, generally within three years of primary treatment. The recurrence of endometrial cancer more than five years following surgery for curative resection is a serious concern for patients.”
Takahashi said the data for late recurrence is missing in the medical literature, and hence, he and his colleagues attempted to describe the risk and frequency of late recurrence.
Risk of Recurrence
The median age for recurrence was 58 years. Eleven of the patients who recurred—50 percent of these women—were originally diagnosed with Stage 1 disease; three patients were diagnosed with Stage 2 endometrial cancer; and eight other women were diagnosed with Stage 3 cancer. In the multivariate analysis, stage of disease at original presentation was not a factor for risk of recurrence after five years, Takahashi said.
He said there might be a relationship between histology and recurrence. Endometrioid G1 cancer was diagnosed in 11 of the women who recurred; endometrioid G2 cancer was diagnosed in 10 of the women who experienced recurrences; and endometrioid G3 cancer was found in one woman who late had a recurrence.
After surgery, 12 of the women who experienced recurrence had not further therapy. Six of the women who had recurrences underwent post-surgery chemotherapy and four women had post-surgery radiation therapy.
Takahashi said that seven lesions recurred in the lungs, the most common site among the women who had recurrence after five years. There were four recurrences observed in the lymph nodes; three recurrences occurred in the vaginal vault; and eight women experienced recurrences in multiple areas. Six women with recurrences underwent surgery; 10 had chemotherapy; five had radiotherapy; one patient had hormonal therapy; and seven patients were given best supportive career. Several patients were treated with multiple modalities, the researchers reported.
All patients who recurred after 10 years were originally diagnosed with endometrioid G1 cancer. Five of these patients were diagnosed with Stage IA; two women had positive peritoneal cytology; and two were found to have positive lymph nodes.
Among these patients, two were treated with surgery alone; two were treated with surgery plus chemotherapy; one was treated with surgery and radiation; one woman was treated with chemotherapy followed by radiation; two received chemotherapy; and one woman received radiation. Five of the women were treated surgically; three patients were treated with chemotherapy.
Takahashi said that as far as he has been able to determine, the case series he presented is the largest of its kind to scrutinize late recurrences in endometrial cancer.
In commenting on the study, Jill Whyte, MD, a gynecological oncologist at Northwell Health Cancer Institute in Lake Success, New York, told OT, “As illustrated by this abstract, late recurrence of endometrial cancer—those occurring beyond five years—are extremely rare. These recurrences occurred in fewer than 1 percent of patients undergoing curative intent treatment of endometrial cancer.
“The study showed that the recurrences were almost exclusively in patients with low grade disease and most had not had any therapy beyond initial surgery,” she added. “Rather than infer that we are making disease indolent, I think this abstract is showing that the vast majority of patients are, in fact, cured of their disease with initial surgery.”