Salvage treatment in recurrent endometrial cancer of the pelvis and peritoneal cavity

Abstract

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.

Recurrent Endometrial Cancer: Which Is the Best Treatment? Systematic Review of the Literature

“…Table 1 summarizes the characteristics of the included studies. They were only retrospective studies [ 13 , 14 , 15 , 16 ]. No studies were included for a quantitative analysis.…”

“…In 2019 McAlarnen et al conducted a retrospective study to analyse the survival and toxicity outcomes of patients with pelvic and abdominal recurrences (vaginal recurrences were excluded) of endometrial cancer [ 16 ]. There were 22 patients, 13 with pelvic recurrence and 9 with abdomen recurrence.…”

“…In this context, patients with locoregional recurrence only, long-term remissions may be achieved. Instead, for those in whom endometrial cancer recurs or progresses in distant sites, the treatment is often palliative than curative [ 16 , 29 ].…”

“…Moreover, additional therapy systems are necessary for the completion of the therapeutic program. In the article of McAlanern, despite salvage treatment was being statistically significant, the patient with multimodality treatment experienced a lower rate of recurrence [ 16 ].…”

Range of Resection in Endometrial Cancer—Clinical Issues of Made-to-Measure Surgery

“…Contrary to pelvic exenteration, cytoreductive surgery may extend beyond the pelvis and therefore can be considered a treatment option for patients with abdominal spread that were previously considered inoperable. A recent systematic review on this topic, gathering evidence from 11 retrospective studies comprising 1146 patients, concludes that cytoreduction (in combination with other methods) in recurrent endometrial cancer is associated with prolonged OS and PFS [147][148][149][150]. Similarly to ovarian cancer, completeness of resection was the most important prognostic factor, and the size of residual disease directly correlated with survival, with the reported median OS ranging from 39 to 76 months for complete debulking (no macroscopic disease) [148,151,152] and from 9 to 22 months for suboptimal debulking (>1 cm of residual disease) [151,153].…”