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Regional recurrence of endometrial cancer is a challenging yet potentially curable group of patients without defined standard of care. Our aim is to determine optimal methods of salvage therapy for regionally recurrent endometrial cancer. Twenty-two cases of nodal, pelvic, or peritoneal cavity recurrences of endometrial cancer were identified from a single institution database. Univariable Cox proportional hazards models were used to estimate the risk of a second recurrence or death. Kaplan-Meier plots were used to estimate the probability of progression free survival and overall survival among patients in three cohorts: Multimodality therapy (surgery, chemotherapy, and external beam radiotherapy [EBRT] +/− vaginal brachytherapy), non-surgery (chemotherapy or EBRT, or both), and surgery cohort (surgery +/− chemotherapy OR EBRT). Thirteen recurrences (59%) were regional including the pelvic and paraaortic nodes, while nine recurrences (41%) were abdominal. For the entire cohort, the probability of progression free survival at 2 years was 51% (95% CI, 26% - 72%). The 2-year probability of progression free survival was 62% in the multimodality cohort, 40% in the non-surgery cohort, and 38% in the surgery cohort. The 2-year probability of overall survival was 69% (95% CI, 38% - 86%) across our population. At 40 months of follow up, the only living patients belonged to the multimodality cohort. We found no significant association of a definitive salvage regimen for recurrent endometrial cancer of the pelvis and peritoneal cavity. Aggressive use of multimodality therapy with surgery followed by tumor-directed radiotherapy and chemotherapy offers potentially curative therapy for these patients.

was longest for patients with breast conservation receiving lumpectomy and radiation (BCT), 5.0 years, and shortest for patients with lumpectomy alone, 2.4 years, consistent with our recent change in practice to allow observation in patients with low risk tumors. Overall, there were 2 ipsilateral recurrences in 28 patients treated with lumpectomy alone, 2 in patients treated with mastectomy, and 19 in patients treated with BCT. Five and 15 year ipsilateral recurrence rate was 6% and 32.6% respectively for patients treated with BCT versus 1% and 2.8% respectively for those treated with mastectomy. Ten of the 19 recurrences in patients treated with BCT were invasive ductal carcinoma (IDC), of which 9 patients received HDR brachytherapy as either APBI (2) or as a boost (7). Nine of the 19 recurrences in the BCT population were DCIS and none of these patients underwent HDR based APBI, while only two of the nine had HDR boost. Time to ipsilateral DCIS recurrence ranged from 0.6 to 17.7 years, with a median of 2.9 years. Time to ipsilateral IDC recurrence ranged from 0.5 to 15.5 years, with a median of 9.3 years. Conclusion: Our findings are consistent with historical data, showing a low rate of recurrence for mastectomy as compared to BCT and equivalent numbers of DCIS and invasive recurrences. However, 15 year recurrence rates in the lumpectomy and radiation group were higher than expected, 32.6%. Furthermore, a majority of our IDC recurrences received catheter based APBI. While the numbers are small, these findings certainly warrant caution for use of APBI for patients with DCIS.

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