Metastatic Endometrial Tumors: The Experience of a Single Institution
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- Category: Vol. 82, September 2014
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Metastatic Endometrial Tumors: The Experience of a Single Institution, LOAIE EL-HELW and HANAA ELKHENINI
Abstract
Background: In patients with recurrent or metastatic endometrial tumours, cure is unlikely unless the recurrence is limited to an isolated resectable lesion.
Aim: We aimed to review the incidence and management of metastatic or recurrent endometrial cancer in our centre from August 2010 till August 2013.
Patients and Methods: Patients’ notes and electronic records were reviewed.
Results: A total of 237 patients with endometrial tumours were managed in our centre in that period. Eight patients (3.4%) had metastasis at initial presentation. Two hundred and twenty nine patients had early stages disease (I-III), 13 of them (5.7%) developed recurrence on follow-up. They were initially treated with total abdominal hysterectomy and bilateral salpingo-ophrectomy, followed by adjuvant pelvic radiotherapy in 9 patients (69%). Two of them had-in addition-adjuvant chemotherapy. Four patients (31%) had no indications for adjuvant treatment. On further follow-up, 10 of the 13 patients (76.9%) developed distant metastasis and 3 (23.1%) had isolated vaginal recurrences. The median time to recurrence was 9.5 months (range 1-16 months).
Overall, endometriod adenocarcinoma was the most com-mon histological subtype (71.5%) among patients with meta-static or recurrent disease. Other subtypes included clear cell (9.5%), endometrial stromal tumour (9.5%) and carcinosarcoma (9.5%).
Carboplatin and paclitaxel (CP) was the most commonly used palliative regimen (58.8%). Complete response to CP regimen was obtained in 33.3%, partial response in 22.3% and stable disease in 33.3%. Other regimens included Doxo-rubicin and ifosfamide (AI) or hormonal treatment (progesto-gens or aromatase inhibitors). Patients with isolated vaginal recurrence were treated with combination of pelvic irradiation and brachytherapy. The median progression free and overall survival durations were 9 months and 17 months respectively.
Conclusion: Patients with recurrent or metastatic endome-trial cancer have different tumour behaviours and pattern. Treatment should-therefore-be tailored to each patient. Distant metastasis is the most common pattern of recurrence in high risk patients; hence the role of adjuvant chemotherapy should be further evaluated. Ongoing randomized studies will-further-clarify that role.