An Evaluation of Routine Follow-Up of Patients Treated for Endometrial Carcinoma

Shumsky, A.G.; Stuart, Gavin; Brasher, Penny; Nation, Jill; Robertson, D. Ian; Sangkarat, Suthi

doi:10.1006/gyno.1994.1282

Cited by 105 publications

(112 citation statements)

References 0 publications

Supporting

Mentioning

100

Contrasting

Unclassified

Order By: Relevance

“…For instance, the utility of a whole-body technique is shown by the fact that 50% of the recurrences occurred both above and below the diaphragm, while 15% occurred only above the diaphragm and 35% only below it. These results are in line with the pattern of recurrence commonly reported in the literature [1,2,3,4,5,6,34]. Currently, in patients with endometrial carcinoma, systemic chemotherapy and/or progesterone therapy is advocated for disseminated recurrent disease [2,16,17].…”

Section: Discussionsupporting

confidence: 81%

“…As a consequence, routine follow-up strategies are based on institutional experiences, but their effectiveness is a matter of controversy. While most recurrences from endometrial cancer occur within the first 2 years following treatment, the conventional work-up at control visits, including gynaecological examination ± vaginal Pap smears, chest X-rays and ultrasonography, is rarely effective in diagnosing asymptomatic recurrences [4,5,6]. After recent surgery or radiation therapy, the detection of recurrent disease only on the basis of CT or MRI may be extremely difficult given the acute oedema or inflammation surrounding the site of primary tumour.…”

Section: Discussionmentioning

confidence: 99%

“…However, unlike the routine follow-up protocol, whole-body FDG PET was able to accurately localise the sites of recurrence over the entire body within a single imaging procedure. Moreover, the value of PET was further illustrated by its ability to detect unsuspected recurrences in 12% of women with confirmed recurrent disease: by contrast, the sensitivity of routine follow-up in detecting asymptomatic recurrences is known to be very low [4,5,6].…”

Section: Discussionmentioning

confidence: 99%

“…Patients with localised recurrences are classically treated by surgery and/or radiation, while those with disseminated recurrent disease are good candidates for hormonal therapy or systemic chemotherapy regimens [2,3]. With the routine protocol, however, the detection of recurrences has been shown to be suboptimal, particularly in asymptomatic patients [4,5,6]. Indeed, soon after treatment and sometimes later in follow-up, the accuracy of morphological imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI) for the diagnosis of recurrences may be limited by the post-surgical or post-radiation changes.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Usefulness of 18F-FDG PET in the post-therapy surveillance of endometrial carcinoma

Belhocine¹,

Barsy²,

Hustinx³

et al. 2002

Eur J Nucl Med

123

View full text Add to dashboard Cite

Abstract. The aim of this study was to assess the usefulness of fluorine-18 fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET) in the post-therapy surveillance of endometrial carcinomas. Forty-one fully corrected whole-body PET studies were performed in 34 women with previously treated endometrial cancers as a part of their follow-up programme. In 28 studies, FDG PET was indicated to localise a recurrence suspected at the control visits on the basis of clinical examination and/or radiological abnormalities (chest X-ray, CT or MRI) and/or elevated tumour marker levels (CA125, CEA). Another 13 studies were performed as a simple surveillance procedure. Overall, in 26 studies PET detected recurrent disease, which was confirmed either by histology (n=7) or by clinical and radiological outcomes (n=19). In 88% of the cases, the PET findings confirmed recurrence suggested by routine follow-up. In the remaining 12% of cases, PET detected asymptomatic recurrences that were unsuspected at the control visits. Whole-body PET accurately localised the site of confirmed recurrences as being above and below the diaphragm in 50%, only below the diaphragm in 35% and only above the diaphragm in 15%. In one patient, however, PET missed microscopic lung metastases shown on thoracic CT, and in three studies, metabolic imaging results were not confirmed. In 11 of 12 negative PET studies, no subsequent clinical or radiological recurrences were observed with a median follow-up of 10 months. Overall, the results of PET agreed well with the final diagnosis (Cohen's kappa coefficient =0.78). In 9/26 patients (35%) with confirmed recurrences, the PET findings significantly altered the treatment choice by detecting either clinically or radiologically unsuspected distant metastases. The sensitivity, specificity, diagnostic accuracy and positive and negative predictive values of FDG PET imaging in the post-therapy surveillance of endometrial carcinomas were 96%, 78%, 90%, 89% and 91%, respectively. Indeed, the high likelihood ratio for a positive test result (4.5) and the low likelihood ratio for a negative test result (0.05) demonstrated the clinical utility of metabolic imaging in "ruling in" disease as well as "ruling out" recurrence. In conclusion, whole-body FDG PET appears useful in the post-therapy surveillance of endometrial cancers, both for the accurate localisation of suspected recurrences and for the detection of asymptomatic recurrent disease.

show abstract

Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Usefulness of 18F-FDG PET in the post-therapy surveillance of endometrial carcinoma

Belhocine¹,

Barsy²,

Hustinx³

et al. 2002

Eur J Nucl Med

123

View full text Add to dashboard Cite

show abstract

“…Recurrence of endometrial cancer is often symptomatic although reported to vary from 40-91% (23)(24)(25)27,28,(30)(31)(32). Most recurrences (70-95 %) occur within three years of initial treatment [31,33].…”

Section: Follow-up In Gynaecological Oncologymentioning

confidence: 99%

The future for follow-up of gynaecological cancer in Europe. Summary of available data and overview of ongoing trials

Leeson

Beaver

Ezendam

et al. 2017

European Journal of Obstetrics & Gynecology and Reproductiv

View full text Add to dashboard Cite

After completing treatment, most patients follow a pre-determined schedule of regular hospital outpatient appointments, which includes clinical examinations, consultations and routine tests. More work is needed on alternative strategies for all gynaecological cancer types. New models will likely include risk stratification with early discharge from secondary care for early stage disease with fast track access to specialist services for suspected cancer recurrence or other problems.

show abstract

Endometrial Cancer

Naumann

2011

Gynecologic Oncology

View full text Add to dashboard Cite

An Evaluation of Routine Follow-Up of Patients Treated for Endometrial Carcinoma

Cited by 105 publications

References 0 publications

Usefulness of 18F-FDG PET in the post-therapy surveillance of endometrial carcinoma

Usefulness of 18F-FDG PET in the post-therapy surveillance of endometrial carcinoma

The future for follow-up of gynaecological cancer in Europe. Summary of available data and overview of ongoing trials

Endometrial Cancer

Contact Info

Product

Resources

About