1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65(1):5-29. |
Review/Other-Tx |
N/A |
To provide the expected numbers of new cancer cases and deaths in 2015 nationally and for each state, as well as a comprehensive overview of cancer incidence, mortality, and survival rates and trends using the most current population-based data. The article also estimates the total number of deaths averted nationally during the past 2 decades and by state in 2011 as a result of the continual decline in cancer death rates and present actual number of deaths reported in 2011 by age for the 10 leading causes of death and for the 5 leading causes of cancer death. |
Cancer death rates have been continuously declining for the past 2 decades. Overall, the risk of dying from cancer decreased by 22% between 1991 and 2011. Regionally, progress has been most rapid for residents of the Northeast, among whom death rates have declined by 25% to 30%, and slowest in the South, where rates declined by about 15%. Further reductions in cancer death rates can be accelerated by applying existing cancer control knowledge across all segments of the population, with an emphasis on those in the lowest socioeconomic bracket and other disadvantaged populations. |
4 |
2. Creutzberg CL, van Putten WL, Koper PC, et al. Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC Study Group. Post Operative Radiation Therapy in Endometrial Carcinoma. Lancet. 2000;355(9213):1404-1411. |
Experimental-Tx |
714 patients |
A multicenter prospective randomized trial to find whether postoperative pelvic RT improves locoregional control and survival for patients with stage-1 endometrial carcinoma. |
The median duration of follow-up was 52 months. 5-year actuarial locoregional recurrence rates were 4% in the RT group and 14% in the control group (P<0.001). Actuarial 5-year OS rates were similar in the two groups: 81% (RT) and 85% (controls), P=0.31. Endometrial-cancer-related death rates were 9% in the RT group and 6% in the control group (P=0.37). Treatment-related complications occurred in 25% of RT patients, and in 6% of the controls (P<0.0001). Two-thirds of the complications were grade 1. Grade 3-4 complications were seen in 8 patients, of which 7 were in the RT group (2%). 2-year survival after vaginal recurrence was 79%, in contrast to 21% after pelvic recurrence or distant metastases. Survival after relapse was significantly (P=0.02) better for patients in the control group. Multivariate analysis showed that for locoregional recurrence, RT and age below 60 years were significant favorable prognostic factors. |
1 |
3. Keys HM, Roberts JA, Brunetto VL, et al. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2004;92(3):744-751. |
Experimental-Tx |
392 patients |
To determine if adjunctive EBRT lowers the risk of recurrence and death in women with endometrial cancer FIGO stages IB, IC, and II (occult disease). |
392 women met all eligibility requirements (202 no additional therapy, 190 RT). Median follow-up was 69 months. In the entire study population, there were 44 recurrences and 66 deaths (32 disease or treatment-related deaths), and the estimated 2-year cumulative incidence of recurrence was 12% in the no additional therapy arm and 3% in the RT arm (relative hazard: 0.42; P=0.007). The treatment difference was particularly evident among the high intermediate risk subgroup (2-year cumulative incidence of recurrence in no additional therapy vs RT: 26% vs 6%; relative hazard = 0.42). Overall, radiation had a substantial impact on pelvic and vaginal recurrences (18 in no additional therapy and 3 in RT). The estimated 4-year survival was 86% in the no additional therapy arm and 92% for the RT arm, not significantly different (relative hazard: 0.86; P=0.557). |
1 |
4. Klopp AH, Jhingran A, Ramondetta L, Lu K, Gershenson DM, Eifel PJ. Node-positive adenocarcinoma of the endometrium: outcome and patterns of recurrence with and without external beam irradiation. Gynecol Oncol. 2009;115(1):6-11. |
Observational-Tx |
71 patients |
To evaluate treatment outcomes and patterns of recurrence in patients with node-positive FIGO stage IIIC adenocarcinoma of the uterus without serous or clear cell differentiation. |
39% (28/71) of patients had involved para-aortic lymph nodes, while 61% (43/71) had only pelvic lymph nodes. 5- and 10-year disease-specific survival rates were 63% and 54%, respectively; corresponding OS rates were 60% and 47%. Grade was strongly associated with disease-specific survival (76% vs 46% at 5 years for low-grade vs high-grade tumors, P=0.004). Cervical or adnexal involvement was associated with decreased disease-specific survival, but lymph-vascular space invasion, age, race, body mass index, and number and location of positive nodes were not. 5-year pelvic-relapse-free survival (98% vs 61%, P=0.001), disease-specific survival (78% vs 39%, P=0.01), and OS (73% vs 40%, P=0.03) were significantly better for the regional RT group than the systemic therapy group. In patients treated without regional RT, the most common site of relapse was the pelvis. Disease-specific survival was not significantly correlated with number of nodes removed in the regional RT group but was in patients treated without regional RT (P=0.001). |
2 |
5. Randall ME, Filiaci VL, Muss H, et al. Randomized phase III trial of whole-abdominal irradiation versus doxorubicin and cisplatin chemotherapy in advanced endometrial carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol. 2006;24(1):36-44. |
Experimental-Tx |
396 patients |
To compare WAI and doxorubicin-cisplatin chemotherapy in women with stage III or IV endometrial carcinoma having a maximum of 2 cm of postoperative residual disease. |
Most patient and tumor characteristics were well balanced. The median patient age was 63 years; 50% had endometrioid tumors. Median follow-up time was 74 months. The stage for progression adjusted for stage was 0.71 favoring doxorubicin-cisplatin (95% CI, 0.55 to 0.91; P<.01). At 60 months, 50% of patients receiving doxorubicin-cisplatin were predicted to be alive and disease free when adjusting for stage compared with 38% of patients receiving WAI. The stage-adjusted death stage was 0.68 (95% CI, 0.52 to 0.89; P<.01) favoring doxorubicin-cisplatin. Moreover, at 60 months and adjusting for stage, 55% of doxorubicin-cisplatin patients were predicted to be alive compared with 42% of WAI patients. Greater acute toxicity was seen with doxorubicin-cisplatin. Treatment probably contributed to the deaths of 8 patients (4%) on the doxorubicin-cisplatin arm and 5 patients (2%) on the WAI arm. |
1 |
6. Creutzberg CL, van Putten WL, Koper PC, et al. Survival after relapse in patients with endometrial cancer: results from a randomized trial. Gynecol Oncol. 2003;89(2):201-209. |
Experimental-Tx |
714 patients |
To determine the rates of local control and survival after relapse in patients with stage I endometrial cancer treated in the multicenter randomized PORTEC trial. |
The analysis was done by intention-to-treat. A total of 714 patients were evaluated. At a median follow-up of 73 months, 8-year actuarial locoregional recurrence rates were 4% in the RT group and 15% in the control group (P < 0.0001). The 8-year actuarial overall survival rates were 71 (RT group) and 77% (control group, P = 0.18). Eight-year rates of distant metastases were 10 and 6% (P = 0.20). The majority of the locoregional relapses were located in the vagina, mainly in the vaginal vault. Of the 39 patients with isolated vaginal relapse, 35 (87%) were treated with curative intent, usually with external RT and brachytherapy, and surgery in some. A complete remission (CR) was obtained in 31 of the 35 patients (89%), and 24 patients (77%) were still in CR after further follow-up. Five patients subsequently developed distant metastases, and 2 had a second vaginal recurrence. The 3-year survival after first relapse was 51% for patients in the control group and 19% in the RT group (P = 0.004). The 3-year survival after vaginal relapse was 73%, in contrast to 8 and 14% after pelvic and distant relapse (P < 0.001). At 5 years, the survival after vaginal relapse was 65% in the control group compared to 43% in the RT group. |
1 |
7. Creutzberg CL, Nout RA, Lybeert ML, et al. Fifteen-year
radiotherapy outcomes of the randomized PORTEC-1 trial for endometrial
carcinoma. Int J Radiat Oncol Biol Phys. 2011;81(4):e631-638. |
Experimental-Tx |
714 patients |
To evaluate the very long-term results of the randomized Post Operative Radiation Therapy in Endometrial Carcinoma (PORTEC)-1 trial for patients with Stage I endometrial carcinoma (EC), focusing on the role of prognostic factors for treatment selection and the long-term risk of second cancers. |
426 patients were alive at the date of analysis. The median follow-up time was 13.3 years. The 15-year actuarial locoregional recurrence (LRR) rates were 6% for EBRT vs. 15.5% for NAT (p < 0.0001). The 15-year overall survival was 52% vs. 60% (p = 0.14), and the failure-free survival was 50% vs. 54% (p = 0.94). For patients with high-intermediate risk criteria, the 15-year overall survival was 41% vs. 48% (p = 0.51), and the 15-year EC-related death was 14% vs. 13%. Most LRR in the NAT group were vaginal recurrences (11.0% of 15.5%). The 15-year rates of distant metastases were 9% vs. 7% (p = 0.25). Second primary cancers had been diagnosed over 15 years in 19% of all patients, 22% vs. 16% for EBRT vs. NAT (p = 0.10), with observed vs. expected ratios of 1.6 (EBRT) and 1.2 (NAT) compared with a matched population (p = NS). Multivariate analysis confirmed the prognostic significance of Grade 3 for LRR (hazard ratio [HR] 3.4, p = 0.0003) and for EC death (HR 7.3, p < 0.0001), of age >60 (HR 3.9, p = 0.002 for LRR and 2.7, p = 0.01 for EC death) and myometrial invasion >50% (HR 1.9, p = 0.03 and HR 1.9, p = 0.02). |
1 |
8. Yechieli R, Robbins JR, Schultz D, Munkarah A, Elshaikh MA.
Vaginal recurrence more than 17 years after hysterectomy and adjuvant treatment
for uterine carcinoma with successful salvage brachytherapy: a case report. Case Rep Oncol. 2011;4(1):242-245. |
Review/Other-Tx |
1 |
To report herein a successful salvage vaginal brachytherapy in a patient with endometrioid uterine carcinoma which recurred more than 17 years after initial treatment. |
The patient remained disease free until her death from unrelated causes 7 years later. |
4 |
9. Wylie J, Irwin C, Pintilie M, et al. Results of radical radiotherapy for recurrent endometrial cancer. Gynecol Oncol. 2000;77(1):66-72. |
Observational-Tx |
58 patients |
To determine the overall survival (OS) and local control (LC) achieved in patients developing a locoregional recurrence of endometrial carcinoma and to define those prognostic factors that predict for improved LC and OS. |
The median time to relapse from original diagnosis was 1.3 years (range 0.2-13.4 years). The actuarial 5- and 10-year OS was 53 and 41%, respectively. The respective results for LC were 65 and 62%. All end-points were measured from the time of relapse. The median total dose received was 81.5 Gy. Univariate analysis showed that favorable histological features at original diagnosis (<50% myometrial involvement, grade 1-2, P = 0.007) and Perez modified staging (P = 0.02) were significant predictors for OS. The Perez staging (P = 0.02) and size of recurrence (<2 cm versus >/=2 cm, P = 0.04) were predictors for LC. |
2 |
10. Robbins JR, Yechieli R, Laser B, Mahan M, Rasool N, Elshaikh
MA. Is time to recurrence after hysterectomy predictive of survival in patients
with early stage endometrial carcinoma? Gynecol
Oncol. 2012;127(1):38-42. |
Observational-Tx |
57 patients |
To determine the prognostic significance of time to recurrence (TTR) on overall survival (OS) and disease-specific survival (DSS) following recurrence in patients with stage I-II uterine endometrioid carcinoma. |
Median follow-up times were 54.8 months from hysterectomy and 19.8 months after recurrence. Median time to recurrence was 20.2 months. Twenty-eight (47%) patients had a recurrence<18 months after hysterectomy and 29 (53%) had a recurrence>/=18 months. Both groups were evenly matched regarding initial pathological features and adjuvant treatments. The median OS and DSS in patients with TTR<18 months was shorter than those with TTR>/=18 months, but not statistically significant (p=0.216). TTR did not impact outcomes after loco-regional recurrence, but for extrapelvic recurrence, a shorter TTR resulted in worse OS and DSS (p=0.03). On multivariate analysis, isolated loco-regional recurrence (HR 0.28, p=0.001) and salvage radiation therapy (HR 0.47, p=0.045) were statistically significant independent predictors of longer OS following recurrence. TTR as a continuous variable or dichotomized was not predictive of OS or DSS. |
2 |
11. Boruta DM 2nd, Gehrig PA, Fader AN, Olawaiye AB. Management of women with uterine papillary serous cancer: a Society of Gynecologic Oncology (SGO) review. [Review] [147 refs]. Gynecol Oncol. 115(1):142-53, 2009 Oct. |
Review/Other-Tx |
N/A |
To summarize the available literature concerning uterine papillary serous carcinoma in an effort to provide the clinician with information pertinent to its management. |
UPSC is morphologically and genetically different from EEC. Women often present with postmenopausal vaginal bleeding, but may also present with abnormal cervical cytology, ascites, or a pelvic mass. In some cases, the diagnosis may be made with endometrial biopsy, while in other cases it is not made until the time of definitive surgery. Metastatic disease is common and best identified via comprehensive surgical staging. Local and distant recurrences occur frequently, with extra-pelvic relapses reported most commonly. Optimal cytoreduction and adjuvant platinum/taxane-based chemotherapy appear to improve survival, while adjuvant radiotherapy may contribute to loco-regional disease control. |
4 |
12. Olawaiye AB, Boruta DM, 2nd. Management of women with clear cell endometrial cancer: a Society of Gynecologic Oncology (SGO) review. Gynecol Oncol. 2009;113(2):277-283. |
Review/Other-Tx |
N/A |
To explore the differences between clear cell and endometrioid endometrial cancer. In addition, it uses available evidence to determine the best approach to management. |
Clear cell histology is diagnosed in less than 6% of all endometrial cancers and its incidence increases with age. Diagnosis can be made using the same tests that are used in the diagnosis of other types of endometrial cancer. Clear cell histology is morphologically and genetically different from the more prevalent endometrioid endometrial cancer histology. It shares many similarities with clear cell neoplasms of the ovary and kidney. Comprehensive surgical staging is critical in order to plan appropriate postoperative management. Adjuvant pelvic and/or whole abdominal radiotherapy have not been shown to be clearly beneficial in women diagnosed with clear cell endometrial cancer. Adjuvant chemotherapy with cisplatinum, taxol and doxorubicin either in a doublet or triplet combination has demonstrated efficacy. |
4 |
13. Del Carmen MG, Boruta DM, 2nd, Schorge JO. Recurrent endometrial cancer. Clin Obstet Gynecol. 2011;54(2):266-277. |
Review/Other-Tx |
N/A |
To review the treatment options of surgery, radiation, hormonal therapy, cytotoxic chemotherapy, and biological agents for women with recurrent endometrial cancer. |
No results stated in the abstract. |
4 |
14. van Wijk FH, van der Burg ME, Burger CW, Vergote I, van Doorn HC. Management of recurrent endometrioid endometrial carcinoma: an overview. Int J Gynecol Cancer. 2009;19(3):314-320. |
Review/Other-Tx |
N/A |
To present an overview of the literature on the management of recurrent endometrial cancer, focusing on patients with histopathologic endometrioid type of tumors. |
The different treatment modalities are described, and a management recommendation scheme is presented. Indications for surgical treatment depend on resectability, site and size of the tumor, and performance status of the patient. Indications for radiotherapy depend on the site of the recurrence and also on the initial therapy received. When considering systemic treatment for patients with recurrent endometrial cancer, it is important to take into account the general health status and condition of the patient as well as which prior therapy the patient has received. The treatments of choice for patients with hormone-sensitive tumors (positive receptor levels, low-grade tumors, and long disease-free interval) are progestagens as first-line treatment and tamoxifen as second-line treatment. Patients with high-grade tumors, negative hormone receptor levels, and short treatment-free interval are best treated with chemotherapy. Paclitaxel, doxorubicin, and cisplatin are the most active combination therapy for these patients but with significant toxicity. In phase II studies, the combination therapy with paclitaxel and carboplatin seems to be as effective but less toxic and can be administered in outpatient clinic. The literature on the management of patients with recurrent endometrial cancer is discussed in detail. The different sites of recurrent disease (ie, local, regional, and/or distant) are evaluated separately; management recommendations are proposed, and alternative approaches are given. |
4 |
15. Ozen A, Falchook AD, Varia MA, Gehrig P, Jones EL. Effect of race and histology on patterns of failure in women with early stage endometrial cancer treated with high dose rate brachytherapy. Gynecol Oncol. 2015;138(2):429-433. |
Observational-Tx |
208 patients |
To examine patterns of failure for early stage EC patients treated with postoperative high dose rate brachytherapy. |
Median follow-up was 46.4 (range, 6.2-137.3) months. Thirteen (6.3%) patients developed with locoregional recurrent disease and 15 (7.2%) patients developed distant metastasis. Freedom from recurrence at 5 years was 88.6% for white patients and 60.5% for black patients (p=0.0093). Five year recurrence free survival (RFS) for white vs. black patients was 82.9% vs. 48.9% (p=0.0007). Five year overall survival (OS) was 86.8% for white patients and 59.5% for black patients (p=0.0023). Black patients with unfavorable histology treated with chemotherapy and vaginal brachytherapy had a 15% locoregional recurrence rate, more than double the rate of local recurrence compared to AA patients with endometrioid histology and white patients with any histology (6% locoregional recurrence rate). |
2 |
16. Kitajima K, Murakami K, Yamasaki E, et al. Performance of FDG-PET/CT in the diagnosis of recurrent endometrial cancer. Ann Nucl Med. 22(2):103-9, 2008 Feb. |
Observational-Dx |
30 patients; 2 reviewers |
To evaluate the accuracy of integrated PET and CT using FDG compared with PET alone, in the diagnosis of suspected endometrial cancer recurrence. |
Patient-based analysis showed: Sensitivity, specificity, and accuracy of PET/CT were 93% (14/15), 93% (14/15), and 93% (28/30), respectively. Sensitivity, specificity, and accuracy of PET were 80% (12/15), 80% (12/15), and 80% (24/30), respectively (P=0.479, 0.479, and 0.134, respectively). Integrated FDG-PET/CT is a useful complementary modality for providing good anatomic and functional localization of sites of recurrence during follow-up of patients with endometrial cancer. |
2 |
17. Sharma P, Kumar R, Singh H, et al. Carcinoma endometrium: role of 18-FDG PET/CT for detection of suspected recurrence. Clin Nucl Med. 2012;37(7):649-655. |
Observational-Dx |
101 patients |
To evaluate the role of 18-flurodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) in patients suspected to have recurrence of carcinoma endometrium. |
The mean age was 56.9+/-8.6 years. 18-FDG PET/CT was positive for recurrence in 51 (50.5%) patients and negative in 50 (49.5%). Locoregional disease was observed in 24 patients, metastatic disease was observed in 10, and 17 showed both locoregional and metastatic disease. The sensitivity, specificity, positive and negative predictive values, and accuracy of 18-FDG PET/CT were 88.9%, 93.6%, 94.1%, 88%, and 91%, respectively. 18-FDG PET/CT showed strong positive correlation with final diagnosis based on reference standard (kappa 0.823; P=0.0001). Compared to CI, 18-FDG PET/CT has much higher specificity (62% vs. 96.4%), and accuracy (76.3% vs. 92.1%), with comparable sensitivity (85.1% vs. 89.5%). |
3 |
18. Kadkhodayan S, Shahriari S, Treglia G, Yousefi Z, Sadeghi R. Accuracy of 18-F-FDG PET imaging in the follow up of endometrial cancer patients: systematic review and meta-analysis of the literature. Gynecol Oncol 2013;128:397-404. |
Meta-analysis |
11 studies |
To review the available literature on the accuracy of 18-F-FDG PET imaging in the follow up of the endometrial cancer patients and presented the results in systematic review and meta-analysis format. |
Eleven studies (541 patients in total) were included in the analysis. Pooled diagnostic indices (patient basis) for detection of overall recurrence were as follows: sensitivity 95.8% [92.2–98.1], specificity 92.5% [89.3–94.9], positive likelihood ratio (LR+) 9.53 [6.52–13.91], negative likelihood ratio (LR-) 0.075[0.044–0.128], and diagnostic odds ratio (DOR) 204 [91.97–453.5]. 18-F-FDG performance was better in studies conducted by PET/CT as compared to PET. The treatment plan changed in 22–35% of the studied patients |
Good |
19. Lalwani N, Dubinsky T, Javitt MC, et al. ACR Appropriateness Criteria(R) pretreatment evaluation and follow-up of endometrial cancer. Ultrasound Q. 2014;30(1):21-28. |
Review/Other-Tx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for endometrial cancer. |
N/A |
4 |
20. Jhingran A, Burke TW, Eifel PJ. Definitive radiotherapy for patients with isolated vaginal recurrence of endometrial carcinoma after hysterectomy. Int J Radiat Oncol Biol Phys. 2003;56(5):1366-1372. |
Observational-Tx |
91 patients |
To determine the outcome of patients after radical radiotherapy (RT) for isolated vaginal recurrence of endometrial carcinoma and to determine the clinical and pathologic predictors of outcome. |
The 2- and 5-year local control (LC) rate and overall survival rate was 82% and 75% and 69% and 43%, respectively. The median time from initial diagnosis of endometrial cancer to death from disease was 38 months. On univariate analysis, a dose to the relapse site of > or =80 Gy and EBRT plus brachytherapy vs. single-modality therapy were significant predictors of improved LC. On multivariate analysis, only the type of treatment correlated significantly with LC (p = 0.03). On univariate analysis, Grade 1 or 2 vs. Grade 3 tumor and EBRT plus brachytherapy vs. single-modality therapy were significant predictors of improved overall survival. |
2 |
21. Lin LL, Grigsby PW, Powell MA, Mutch DG. Definitive radiotherapy in the management of isolated vaginal recurrences of endometrial cancer. Int J Radiat Oncol Biol Phys. 2005;63(2):500-504. |
Observational-Tx |
50 patients |
To assess prognostic factors and overall survival after salvage radiotherapy for patients who had endometrial carcinoma and who experienced an isolated vaginal recurrence. |
The 5-year and 10-year disease-free and overall survivals were 68% and 55%, and 53% and 40%, respectively. On multivariate analysis, age (p = 0.0242), Grade 1 or 2 vs. Grade 3 tumor (p = 0.002), and size of recurrence (p < 0.001) were significant predictors of overall survival. All patients who had Grade 3 disease were dead by 3.6 years from the time of recurrence. Five patients experienced a Grade 3 or 4 complication. |
3 |
22. Nag S, Yacoub S, Copeland LJ, Fowler JM. Interstitial brachytherapy for salvage treatment of vaginal recurrences in previously unirradiated endometrial cancer patients. Int J Radiat Oncol Biol Phys. 2002;54(4):1153-1159. |
Experimental-Tx |
13 patients |
To evaluate whether interstitial brachytherapy can effectively salvage vaginal recurrence from endometrial carcinoma. |
The patients had initially presented with FIGO Stage I (n = 11) or III (n = 2) cancer. Vaginal recurrences were diagnosed at a mean interval of 27.5 months after hysterectomy (range 2-83). The patients were followed for a median of 60 months (range 15-105). Ten patients had recurrence at the vaginal apex and three had recurrence in the lower two-thirds of the vagina. The median time to recurrence was 22 months. The tumor size ranged from 1.5 to 6 cm (mean 2.2, median 2.5). Eleven of 13 patients received 45-50-Gy pelvic external beam radiotherapy, followed by a mean interstitial brachytherapy boost of 28.3 Gy (range 18-35). The 2 other patients received brachytherapy only of 40 Gy and 50 Gy, respectively. All tumors were locally controlled. Three (23%) of 13 patients had a relapse at distant sites (two in the paraaortic region and one in the liver). The overall 8-year actuarial disease-specific survival rate was 77%. Major (Grade 3 and 4) long-term morbidity occurred in 2 patients (15%) and included Grade 3 vaginal ulceration in 1 patient, and Grade 4 colovesical fistula requiring surgical intervention in 1 patient. Additional long-term morbidity included Grade 2 proctitis in 1 patient. |
2 |
23. Huh WK, Straughn JM, Jr., Mariani A, et al. Salvage of isolated vaginal recurrences in women with surgical stage I endometrial cancer: a multiinstitutional experience. Int J Gynecol Cancer. 2007;17(4):886-889. |
Observational-Tx |
69 patients |
To evaluate the treatment outcomes and risk factors of women with surgical stage I endometrial adenocarcinoma who were initially treated with surgery alone and subsequently developed isolated vaginal recurrences. |
Of the 69 patients, 10 (15%) were diagnosed with stage IA disease, 43 (62%) were diagnosed with stage IB disease, and 16 (23%) were diagnosed with stage IC disease. Patients diagnosed with grade 1 disease were 22 (32%), grade 2 disease were 26 (38%), and grade 3 disease were 21 (30%). Among women, 81% with isolated vaginal recurrences were salvaged with radiation therapy. The mean time to recurrence was 24 months, and the mean follow-up was 63 months. Among women, 18% died from subsequent recurrent disease. The 5-year overall survival was 75%. |
2 |
24. Jereczek-Fossa B, Badzio A, Jassem J. Recurrent endometrial cancer after surgery alone: results of salvage radiotherapy. Int J Radiat Oncol Biol Phys. 2000;48(2):405-413. |
Observational-Tx |
73 patients |
To assess the long-term results of salvage radiotherapy in previously nonirradiated endometrial cancer patients who developed local recurrence, and to evaluate the impact of patient- and treatment-related factors on treatment efficacy. |
Three- and 5-year overall survival rates were 33% and 25%, respectively. In the univariate analysis, lower stage of recurrent disease (p < 0.0005), combined EBRT and BRT (p = 0.027), higher total radiation dose (p = 0.031), and higher NTD (p = 0.006) were significantly correlated with better survival. In the multivariate analysis, only stage of recurrent disease (p < 0.005) and high total dose (p = 0.047) were independently correlated with better survival. Lower FIGO stage of recurrence (p = 0.023) and higher total dose (p = 0.005) were also independently correlated with longer time to progression, whereas higher radiotherapy dose was the only factor correlated with better local control (p = 0.029). |
2 |
25. Lee LJ, Damato AL, Viswanathan AN. Clinical outcomes following 3D image-guided brachytherapy for vaginal recurrence of endometrial cancer. Gynecologic Oncology. 131(3):586-92, 2013 Dec. |
Observational-Tx |
44 patients |
To evaluate clinical outcomes for women with recurrent endometrial cancer treated with 3D image-guided brachytherapy. |
Histologic subtypes were endometrioid (EAC, 33), papillary serous/clear cell (UPSC/CC, 5) and carcinosarcoma (CS, 6). The 2-year DFS/OS rates were 75%/89% for EAC and 11%/24% for UPSC/CC/CS (both p<0.01). On MVA, high tumor grade was associated with recurrence (HR 3.2 for grade 2, 9.6 for grade 3, p<0.01). The LF rate at 2 years was 4% for patients without versus 39% for those with prior RT (p=0.1). Patients who had prior RT received lower cumulative doses at recurrence (66.5 Gy vs. 74.4 Gy, p<0.01). The 2-year DFS/OS rates with and without prior RT were 26%/55% and 72%/80% (both p=0.1). Four patients (9%) experienced grade 3 late toxicity, including 3 of 13 (23%) in the re-irradiation setting and 1 of 31 (3%) with no prior radiotherapy. |
2 |
26. Lee LJ, Damato AL, Viswanathan AN. Clinical outcomes of high-dose-rate interstitial gynecologic brachytherapy using real-time CT guidance. Brachytherapy. 2013;12(4):303-310. |
Observational-Tx |
68 patients |
To evaluate clinical outcomes of CT-guided high-dose-rate (HDR) interstitial brachytherapy for primary and recurrent gynecologic cancer. |
Primary disease sites were endometrial (34), cervical (17), vaginal (11), ovarian (3), and vulvar (3). Median age was 61.5 years, and tumor size at diagnosis was 3.4cm. Median D90 and V100 were 73.6Gy and 87.5%, respectively; median D2cc for bladder, rectum, and sigmoid were 67.1, 64.6, and 53.7Gy, respectively. With a median followup of 17 months, actuarial rates of local control, progression-free survival, and overall survival at 2 years for all patients were 86%, 60%, and 64%, respectively. There were 9 grade 3 late toxicities (six gastrointestinal and three vulvovaginal). |
2 |
27. Hasbini A, Haie-Meder C, Morice P, et al. Outcome after salvage radiotherapy (brachytherapy +/- external) in patients with a vaginal recurrence from endometrial carcinomas. Radiother Oncol. 2002;65(1):23-28. |
Observational-Tx |
25 patients |
To evaluate the efficacy of vaginal brachytherapy (BT) combined or not with whole pelvic external radiotherapy (RT) for the treatment of patients with vaginal recurrences from endometrial cancer. |
Local control was achieved in 23 patients (92%). With a follow-up ranging from 4 to 154 months, 13 patients have died (ten due to metastasis, two of intercurrent disease and two due to local tumor progression) and ten patients are alive and disease free. The 3-year actuarial survival was 48%. Late radiation-related sequelae were observed in nine patients (mucous necrosis in one patient, moderate sclerosis in six patients) in an interval varying between 8 and 45 months. The majority of recurrences occurred in patients who had not previously received irradiation, which emphasizes the role of systematic prophylactic post-operative vaginal BT. Extra-vaginal extension (P < 0.001), the tumor size (P < 0.03) and the stage of initial disease (P < 0.01) appeared to have a significant impact on the prognosis. |
2 |
28. Sorbe B, Soderstrom K. Treatment of vaginal recurrences in endometrial carcinoma by high-dose-rate brachytherapy. Anticancer Res. 2013;33(1):241-247. |
Observational-Tx |
40 patients |
To evaluate the efficacy and safety of high-dose-rate brachytherapy alone or in combination with external pelvic irradiation in treatment of vaginal recurrences in endometrial carcinomas. Predictive and prognostic factors were also evaluated. |
The local control of vaginal recurrences treated with a combination of external beam therapy and brachytherapy was 92%. The local control rate was lower for external beam therapy-alone. In eleven patients (28%), a second recurrence occurred (five vaginal and six distant metastases). The overall 5-year survival rate was 50%. Age, FIGO grade and time from diagnosis to recurrence were the only independent and significant prognostic factors. Upfront external beam therapy was associated with a worse overall survival rate. Site of recurrence was significant only in univariate analysis. Late gastrointestinal toxicity (grade 3-4) was recorded in 11% of irradiated patients. |
2 |
29. Nag S, Martinez-Monge R, Copeland LJ, Vacarello L, Lewandowski GS. Perineal template interstitial brachytherapy salvage for recurrent endometrial adenocarcinoma metastatic to the vagina. Gynecol Oncol. 1997;66(1):16-19. |
Observational-Tx |
15 patients |
To evaluate the use of interstitial brachytherapy salvage of recurrent endometrial adenocarcinoma metastatic to the vagina. |
After a median follow-up of 47 months (range 14-81), the actuarial local control rate was 66.6%. The local control rate for patients treated with interstitial irradiation only was 64.3% and the local control rate for patients treated with interstitial irradiation + EBRT was 100%. Distant metastases occurred in 30.7% of the patients. Actuarial overall and disease-specific 5-year survival were 42.3 and 67.5%, respectively. Toxicity has been minimal, with 6 patients complaining of vaginal/rectal (RTOG) grade 1-3 complications (5 patients grade 1-2, 1 patient grade 3). |
2 |
30. Randall ME, Evans L, Greven KM, McCunniff AJ, Doline RM. Interstitial reirradiation for recurrent gynecologic malignancies: results and analysis of prognostic factors. Gynecol Oncol. 1993;48(1):23-31. |
Observational-Tx |
13 patients |
To evaluate the clinical utility of interstitial reirradiation (IRI) in patients with recurrent or second primary gynecologic malignancies, all of whom had previous RT, and to assess patient selection and treatment factors which contribute efficacy. |
Thirteen patients with recurrent or new primary gynecologic malignancies after previous radiation therapy (RT) underwent interstitial reirradiation (IRI) from July 1986 through December 1990. Mean and median ages were 63 and 70 years, respectively. Mean and median implanted volumes were 14.3 and 12 cc, respectively. Overall, 9/13 (69%) had complete responses to IRI and 6 (46%) continue to have no evidence of disease (NED) 24-71 months later (median follow-up, 59 months). Of 7 patients with recurrent cervical or new primary vaginal carcinoma, 5 (71%) remain free of disease 27-71 months (median, 58 months) after IRI. Of 6 patients with recurrent endometrial carcinomas, only 1 (16%) continues with NED 24 months after IRI. Patients with NED after IRI had a median disease-free interval prior to IRI of 100 months compared to 6 months in patients failing IRI. |
3 |
31. Mundt AJ, McBride R, Rotmensch J, Waggoner SE, Yamada SD, Connell PP. Significant pelvic recurrence in high-risk pathologic stage I--IV endometrial carcinoma patients after adjuvant chemotherapy alone: implications for adjuvant radiation therapy. Int J Radiat Oncol Biol Phys. 2001;50(5):1145-1153. |
Observational-Tx |
43 patients |
To evaluate the risk of pelvic recurrence in high-risk pathologic stage I--IV endometrial carcinoma patients after adjuvant chemotherapy alone. |
29 women (67.4%) relapsed. 17 (39.5%) recurred in the pelvis and 23 (55.5%) in extrapelvic sites. The 3-year actuarial pelvic recurrence rate was 46.5%. The most significant factors correlated with pelvic recurrence were cervical involvement (P=0.01) and adnexal (P=0.05) involvement. Of the 17 women who developed a pelvic recurrence, 8 relapsed in the vagina, 3 in the nonvaginal pelvis, and 6 in both. The 3-year vaginal and nonvaginal pelvic recurrence rates were 37.8% and 26%, respectively. The most significant factor correlated with vaginal pelvic recurrence was cervical involvement (P=0.0007). Deep myometrial invasion (P=0.02) and lymph nodal involvement (P=0.03) were both correlated with nonvaginal pelvic recurrence. 9/29 relapsed patients (31%) developed pelvic recurrence as their only (6) or first site (3) of recurrence. Factors associated with a higher rate of pelvic recurrence (as the first or only site) were cervical involvement and stage I--II disease. |
2 |
32. Poulsen MG, Roberts SJ. The salvage of recurrent endometrial carcinoma in the vagina and pelvis. Int J Radiat Oncol Biol Phys. 1988;15(4):809-813. |
Observational-Tx |
93 patients |
To analyze only those patients with locally recurrent disease in the pelvis, vaginal vault or lower 1/3 vagina to see what proportion was salvageable with subsequent treatment. |
There were 12 lower 1/3 vaginal recurrences, 24 vault recurrences and 57 pelvic recurrences from the 1005 patients treated between 1960 and 1976. Median time to recurrence was 30 months. Twenty-six patients had distant metastases also present at the time of recurrence in the sites mentioned above. Thirty-three percent of lower 1/3 vaginal recurrences, 12.5% of vault recurrences, and 5.3% of pelvic recurrences were salvaged with further treatment. The 10-year actuarial survival rates of isolated lower 1/3 vaginal, vaginal vault, and pelvic recurrences were 50%, 45%, and 24% |
2 |
33. Blecharz P, Brandys P, Urbanski K, Reinfuss M, Patla A. Vaginal and pelvic recurrences in stage I and II endometrial carcinoma--survival and prognostic factors. Eur J Gynaecol Oncol. 2011;32(4):403-407. |
Observational-Tx |
106 patients |
To analyze prognostic factors and treatment outcomes in 106 patients with Stage I and II endometrial carcinoma (EC) treated between 1980 and 2005 in the Center of Oncology, Maria Sklodowska-Curie Memorial Institute, Kracow, Poland, who developed vaginal or pelvic recurrences. |
The 5-year overall survival rate in the observed group was 17%. Five-year survival was 23.3% (14/60) for patients with KPS 60-70 vs 8.7% (4/46) with KPS 40-50, 25% (12/48) patients with Stage I EC vs 10.3% (6/58) with Stage II EC, and 34% (16/47) patients with vaginal recurrence vs 3.4% (2/59) with pelvic recurrences. |
3 |
34. Kuten A, Grigsby PW, Perez CA, Fineberg B, Garcia DM, Simpson JR. Results of radiotherapy in recurrent endometrial carcinoma: a retrospective analysis of 51 patients. Int J Radiat Oncol Biol Phys. 1989;17(1):29-34. |
Observational-Tx |
51 patients |
To analyze the Washington University experience in the treatment of locoregional recurrences of endometrial carcinoma. |
The 5- and 10-year overall actuarial survivals for all patients were 18 and 12.5%, respectively. The 5- and 10-year progression-free survivals of patients with isolated vaginal recurrences were 40% and 29%, respectively; the 5-year progression-free survival of patients with vaginal recurrence with pelvic extension was 20%. There were no survivors beyond 1.5 years among patients with pelvic recurrence (p = 0.02). All patients with simultaneous locoregional and distant failure were dead by 3.5 years. Stage at original diagnosis, time to relapse from primary treatment, histologic pattern, and grade of malignancy were prognosticators of survival. Five patients (10%) developed a total of ten radiation-related sequelae. |
2 |
35. Homesley HD, Filiaci V, Gibbons SK, et al. A randomized phase III trial in advanced endometrial carcinoma of surgery and volume directed radiation followed by cisplatin and doxorubicin with or without paclitaxel: A Gynecologic Oncology Group study. Gynecol Oncol. 2009;112(3):543-552. |
Experimental-Tx |
552 patients |
Treatment was randomized to compare RFS and toxicity between two chemotherapy regimens for the treatment of women with advanced stage endometrial carcinoma. |
Of 659 patients enrolled following surgery, 552 eligible patients were randomized to chemotherapy after irradiation. Accrual closed to stage IV patients in June, 2003. Approximately 80% completed 6 cycles of chemotherapy. Three deaths resulted from bowel complications and one death was due to renal failure. Hematologic adverse events, sensory neuropathy and myalgia, were more frequent and severe in the paclitaxel arm (P<0.01) which was confirmed by Quality of Life assessments. Percentage of patients alive and recurrence-free at 36 months was 62% for cisplatin and doxorubicin vs 64% for cisplatin and doxorubicin with paclitaxel. The hazard of recurrence or death relative to the cisplatin and doxorubicin arm stratified by stage is 0.90 (95% CI, 0.69 to 1.17, P=0.21, one-tail). However, in subgroup analysis, cisplatin and doxorubicin with paclitaxel was associated with a 50% reduction in the risk of recurrence or death among patients with gross residual disease (95% CI, 0.26 to 0.92). Stage, residual disease, histology/grade, positive para-aortic node and cytology, pelvic metastases and age were significantly associated with RFS. |
1 |
36. Miller D, Filiaci V, Fleming G, et al. Late-Breaking Abstract 1: Randomized phase III noninferiority trial of first line chemotherapy for metastatic or recurrent endometrial carcinoma: A Gynecologic Oncology Group study. Gynecol Oncol. 2012;125(3):771. |
Experimental-Tx |
1381 patients |
To determine if the combination of carboplatin and paclitaxel (TC) chemotherapy is clinically inferior to the combination of doxorubicin, cisplating, and paclitaxel (TAP) chemoterahpy with regard to survival, and to assess differences in toxicity profile, specifically neurotoxicity and infection between TAP and TC. |
Treatment was hematologically well tolerated, with only 7% of patients receiving TAP and 6% on TC experiencing neutropenic fever. Neurologic toxicity for those receiving TAP was 26% grade N1 sensory neuropathy compared with 19% in those receiving TC (pb.01). Common grade N2 toxicities more often (pb.01) reported with TAP included: Thrombocytopenia (23% v 12%), other hematologic (30% v 22%), vomiting (7% v 4%), diarrhea (6% v 2%), and metabolic (14% v 8%); whereas neutropenia (52% v 79%) was more often reported with TC. Study treatment was discontinued due to toxicity in 18% on TAP and 12% on TC. The 7 planned cycles were completed in 62% of those on TAP and 69% on TC (p=.01). The interim analysis adjusted 90% upper confidence limit for the death hazard ratio (HR) of TC relative to TAP was 1.16 and excludes the inferiority region bounded at 1.2. PFS (median TC v TAP, 14 v 14 months; HR=1.03) and OS (median TC v TAP, 32 v 38 months; HR=1.01) results for TC were not inferior to TAP. A homogeneity test suggests consistent treatment effects across strata defined by measurable/recurrent v primary disease and pelvic irradiation history (pN.1). |
2 |
37. Shirvani SM, Klopp AH, Likhacheva A, et al. Intensity modulated radiation therapy for definitive treatment of paraortic relapse in patients with endometrial cancer. Pract Radiat Oncol. 2013;3(1):e21-28. |
Observational-Tx |
27 patients |
To review the outcomes of patients treated with IMRT for unresected or incompletely resected paraortic recurrences of primary uterine cancer. |
Of the 27 patients, 19 (70%) had local control of paraortic disease after a median follow-up time of 25 months (range, 4-83 months). Two-year actuarial overall survival and progression-free survival rates were 63% and 53%, respectively. Five patients (19%) experienced severe late gastrointestinal toxic effects (grade 3-5). |
3 |
38. Dowdy SC, Mariani A, Cliby WA, et al. Radical pelvic resection and intraoperative radiation therapy for recurrent endometrial cancer: technique and analysis of outcomes. Gynecol Oncol. 2006;101(2):280-286. |
Observational-Tx |
25 patients |
To describe the technique and assess outcomes and morbidity following radical resection combined with intraoperative electron radiation therapy (IOERT) in patients with recurrent endometrial cancer. |
Treatment prior to referral included radiation in 56% and either a secondary surgery or chemotherapy in 48%. External radiation (EBRT) was administered in addition to IOERT in 84%. Radical procedures performed at the time of IOERT included resection of the pelvic sidewall en bloc with the obturator nerve, external iliac vein, psoas, iliacus, or obturator internus muscles, ureter, or boney ileum. Seven patients required exenteration in combination with resection of the pelvic sidewall. The median IOERT dose was 1500 cGy (range 1000-2500 cGy). Overall five-year survival was 47% vs. 71% for those with a gross total resection but close margins. Two patients with recurrences limited to the para-aortic area are alive without evidence of disease at 54 and 71 months. Proportional hazards modeling showed concurrent EBRT, tumor size after resection, grade, and age to be associated with improved survival. The most common complications were peripheral neuropathy, functional ureteral obstruction, and fistula formation. |
2 |
39. Choi CW, Cho CK, Yoo SY, et al. Image-guided stereotactic body radiation therapy in patients with isolated para-aortic lymph node metastases from uterine cervical and corpus cancer. Int J Radiat Oncol Biol Phys. 2009;74(1):147-153. |
Observational-Tx |
30 patients |
To evaluate the role of stereotactic body radiation therapy (SBRT) as a local treatment for isolated para-aortic lymph node (PALN) metastases originating from uterine cervical and corpus cancer. |
The 4-year OS rate was 50.1%, and the median survival time was not reached. The OS rate among symptomatic patients was significantly lower than that among asymptomatic patients (p = 0.002). The 4-year actuarial LC rate was 67.4%. Patients with a planning target volume of </=17 ml had significantly higher LC rates (p = 0.009). The 4-year DPFS rate was 45.0%, and the median time to disease progression was 32 months. Small planning target volume was a favorable prognostic factor (p = 0.043). Grade 3 or 4 complications requiring hospitalization were reported in 1 patient at 20 months after SBRT. |
2 |
40. Nout RA, Smit VT, Putter H, et al. Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): an open-label, non-inferiority, randomised trial. Lancet. 375(9717):816-23, 2010 Mar 06. |
Experimental-Tx |
427 patients |
To compare outcomes and adverse effects after vaginal brachytherapy and EBRT, and to establish optimum adjuvant treatment for patients with endometrial carcinoma of high-intermediate risk. |
At median follow-up of 45 months (range 18-78), 3 vaginal recurrences had been diagnosed after vaginal brachytherapy and 4 after EBRT. Estimated 5-year rates of vaginal recurrence were 1.8% (95% CI, 0.6-5.9) for vaginal brachytherapy and 1.6% (0.5-4.9) for EBRT (stage [HR] 0.78, 95% CI, 0.17-3.49; P=0.74). 5-year rates of locoregional relapse (vaginal or pelvic recurrence, or both) were 5.1% (2.8-9.6) for vaginal brachytherapy and 2.1% (0.8-5.8) for EBRT (HR 2.08, 0.71-6.09; P=0.17). 1.5% (0.5-4.5) vs 0.5% (0.1-3.4) of patients presented with isolated pelvic recurrence (HR 3.10, 0.32-29.9; p=0.30), and rates of distant metastases were similar (8.3% [5.1-13.4] vs 5.7% [3.3-9.9]; HR 1.32, 0.63-2.74; P=0.46). We recorded no differences in OS (84.8% [95% CI, 79.3-90.3] vs 79.6% [71.2-88.0]; HR 1.17, 0.69-1.98; P=0.57) or DFS (82.7% [76.9-88.6] vs 78.1% [69.7-86.5]; HR 1.09, 0.66-1.78; P=0.74). Rates of acute grade 1-2 gastrointestinal toxicity were significantly lower in the vaginal brachytherapy group than in the EBRT group at completion of RT (12.6% [27/215] vs 53.8% [112/208]). |
1 |
41. Bristow RE, Santillan A, Zahurak ML, Gardner GJ, Giuntoli RL, 2nd, Armstrong DK. Salvage cytoreductive surgery for recurrent endometrial cancer. Gynecol Oncol. 2006;103(1):281-287. |
Observational-Tx |
61 patients |
To determine the survival impact of salvage cytoreductive surgery, and other prognostic variables, among patients with recurrent endometrial cancer. |
Sixty-one patients were identified with endometrial cancer recurrence a median of 18.5 months after initial diagnosis. Median age at recurrence was 63 years, and the median post-recurrence follow-up time was 22.0 months. Thirty-five patients underwent salvage cytoreductive surgery and had a median survival time of 28.0 months, compared to 13.0 months for patients treated non-surgically (P < 0.0001). Complete cytoreduction (no gross residual) was achieved in 23/35 surgical patients (65.7%). The median EBL was 350 cc and 28.6% of patients received blood products. There were no peri-operative deaths; however, 31.4% of patients experienced minor morbidity. Patients undergoing complete salvage cytoreduction had a median post-recurrence survival time of 39.0 months, compared to 13.5 months for those patients with gross residual disease (P = 0.0005). On multivariate analysis, salvage surgery and residual disease status were significant and independent predictors of post-recurrence survival. |
2 |
42. Campagnutta E, Giorda G, De Piero G, et al. Surgical treatment of recurrent endometrial carcinoma. Cancer. 2004;100(1):89-96. |
Observational-Tx |
75 patients |
To present our standard surgical approach to abdominal and pelvic recurrences and demonstrate that, within well defined limits, surgery can be feasible and efficientin the treatment of patients with recurrent endometrial carcinoma. |
Fifty-six patients (74.7%) underwent optimal debulking. Major surgical complications were observed in 23 patients (30.7%). Only 1 postoperative death was observed, although the mortality rate for surgical complications after the postoperative period was 8%. Patients who underwent optimal debulking had a significantly better cumulative survival rate compared with patients who had residual disease (36% vs. 0% at 60 months; P < 0.05). Residual disease, chemotherapy after rescue surgery, and central pelvis-vagina as the only site of recurrence were associated significantly with survival. |
3 |
43. Awtrey CS, Cadungog MG, Leitao MM, et al. Surgical resection of recurrent endometrial carcinoma. Gynecol Oncol. 2006;102(3):480-488. |
Observational-Tx |
27 patients |
To determine the outcomes of non-exenterative secondary surgical resections in patients with recurrent endometrial cancer. |
Fifteen patients (56%) had disease limited to the retroperitoneum, 10 patients (37%) had intraperitoneal disease, and 2 patients (7%) had both intra- and retroperitoneal disease. Cytoreduction to <or=2 cm of residual disease was achieved in 18 patients (67%), while 9 patients (33%) had cytoreduction to residual disease >2 cm. There were no major perioperative complications or mortalities. The median hospital stay was 7 days (range, 1-18 days). Additional therapies included intraoperative radiation therapy in 9 patients (33%), radiation therapy in 12 patients (44%), and chemotherapy in 10 patients (37%). The median follow-up for the entire cohort was 24 months (range, 5-84 months). The median progression-free survival was 14 months (95% CI, 6-23), and the median disease-specific survival was 35 months (95% CI, 24-not reached). Size of residual disease was the only significant predictor for both progression-free and disease-specific survival. Patients with residual disease <or=2 cm had a median disease-specific survival of 43 months (95% CI, 35-not reached) compared with 10 months (95% CI, 7-29) for those with >2 cm residual (P = 0.01). |
2 |
44. Scarabelli C, Campagnutta E, Giorda G, et al. Maximal cytoreductive surgery as a reasonable therapeutic alternative for recurrent endometrial carcinoma. Gynecol Oncol. 1998;70(1):90-93. |
Observational-Tx |
20 |
To determine if maximal cytoreductive surgery could carry any benefit in pelvic and abdominal recurrent endometrial carcinoma. |
Complete macroscopic resection of tumor was feasible in 13 women (65%). R0 group women had a significant both progression-free (median reached at 9.1 months) and overall survival (median reached at 11.8 months) compared to R1 group women. There were 2 (10%) perioperative deaths. Eight women died of cancer, 5 in the R1 group and 3 in the R0 group. There were four intercurrent deaths in women still free from the disease. Local control of neoplasia was achieved in 84.6% of R0 women and their survival was affected mostly by distant recurrences or intercurrent deaths. Residual tumor at the end of surgery was the only significant variable to affect both progression-free and overall survival. |
2 |
45. Chi DS, Welshinger M, Venkatraman ES, Barakat RR. The role of surgical cytoreduction in Stage IV endometrial carcinoma. Gynecol Oncol. 1997;67(1):56-60. |
Observational-Tx |
55 patients |
To evaluate the impact of surgical cytoreduction in patients (pts) with Stage IV endometrial adenocarcinoma. |
Fifty-five patients who underwent surgery as part of their primary treatment for Stage IV endometrial carcinoma were identified. They were divided into three groups: Group I consisted of 24 pts (44%) who underwent optimal surgical cytoreduction (diameter of largest residual tumor nodule < or = 2 cm); Group II contained 21 pts (38%) who underwent suboptimal surgical cytoreduction (> 2 cm residual disease); Group III consisted of 10 pts (18%) who had unresectable carcinomatosis and had no cytoreduction at all. There were no statistically significant differences between the three groups with respect to median age at diagnosis, tumor grade, histologic subtype, or the presence of extra-abdominal metastases. The median survival rates for the three groups were I, 31 months; II, 12 months; and III, 3 months (P < 0.01). Within Group I, there was no statistically significant difference in survival between the 8 pts who were found at laparotomy to have metastatic disease < or = 2 cm and the 16 pts who initially had metastatic disease > 2 cm and were subsequently cytoreduced to optimal status. On multivariate analysis only the extent of surgical cytoreduction had prognostic significance on survival. |
2 |
46. Nezhat F, Prasad Hayes M, Peiretti M, Rahaman J. Laparoscopic radical parametrectomy and partial vaginectomy for recurrent endometrial cancer. Gynecol Oncol. 2007;104(2):494-496. |
Review/Other-Tx |
1 patient |
To describe a case of a second recurrence of endometrial cancer isolated to the vaginal apex that was treated with a laparoscopic radical parametrectomy and partial vaginectomy. |
Laparoscopic radical parametrectomy and partial vaginectomy may be an option for patients with small central recurrences of endometrial cancer. |
4 |
47. Cho JE, Liu C, Gossner G, Nezhat FR. Laparoscopy and gynecologic oncology. Clin Obstet Gynecol. 2009;52(3):313-326. |
Review/Other-Tx |
N/A |
To present the application of laparoscopy in cervical, endometrial, and ovarian cancer. |
No results stated in abstract. |
4 |
48. Lee YS, Lee TH, Koo TB, Cho YL, Park IS. Laparoscopic-assisted radical parametrectomy including pelvic and/or paraaortic lymphadenectomy in women after prior hysterectomy-three cases. Gynecol Oncol. 2003;91(3):619-622. |
Review/Other-Tx |
3 patients |
To report on the cases of two patients with invasive cervical cancer found after a simple hysterectomy and one patient with recurrent endometrial cancer in the vaginal stump. |
A laparoscopic radical parametrectomy including a pelvic and/or paraaortic lymphadenectomy is a viable technique for women with invasive cervical cancer or recurrent endometrial vaginal cancer after a prior hysterectomy. |
4 |
49. Barber HR, Brunschwig A. Treatment and results of recurrent cancer of corpus uteri in patients receiving anterior and total pelvic exenteration 1947-1963. Cancer. 1968;22(5):949-955. |
Review/Other-Tx |
36 patients |
To question whether further therapy in the form of exenteration should be offered to patients with recurrent or persistent disease. |
Of 36 patients receiving pelvic exenteration 5 or more years ago, seven received their initial treatment less than 1 year prior to treatment for recurrence and none survived more than 15 months. Of the 29 patients who were free of disease for at least 1 year after initial treatment and before receiving exenteration for recurrence, five lived 5 or more years. It is concluded that there is a limited place for pelvic exenteration in the treatment of recurrent endometrial cancer. |
4 |
50. Morris M, Alvarez RD, Kinney WK, Wilson TO. Treatment of recurrent adenocarcinoma of the endometrium with pelvic exenteration. Gynecol Oncol. 1996;60(2):288-291. |
Observational-Tx |
20 patients |
To reevaluate the role of pelvic exenteration in selected women with recurrent adenocarcinoma of the endometrium. |
he median patient age was 65 years (range 44-79 years). At most recent follow-up, 8 patients were alive and disease free, 2 were alive with disease, 6 had died of disease, and 4 had died of other causes. The median follow-up of living patients is 89 months. Twelve of 20 patients experienced major complications, the most common of which was neovaginal flap necrosis. Of the 20 patients, 1 patient (5%) died in 1963 of surgical complications. The Kaplan-Meier estimate of 5-year disease-free survival is 45%. |
3 |
51. Ferenschild FT, Vermaas M, Verhoef C, et al. Total pelvic exenteration for primary and recurrent malignancies. World J Surg. 2009;33(7):1502-1508. |
Observational-Tx |
69 patients |
To study preoperative morbidity and mortality, local recurrence, disease-free, and overall survival rates, and to analyze prognostic factors for local control or survival. |
The median follow-up was 43 (range, 1-196) months. Median duration of surgery was 448 (range, 300-670) minutes, median blood loss was 6,300 (range, 750-21,000) ml, and hospitalization was 17 (range, 4-65) days. Overall major and minor complication rates were 34% and 57%, respectively. The in-hospital mortality rate was 1%. A complete resection was possible in 75% of all patients, a microscopically incomplete resection (R1) in 16%, and a macroscopically incomplete resection (R2) in 9%. Five-year local control for primary locally advanced rectal cancer, recurrent rectal cancer, and cervical cancer was 89%, 38%, and 64%, respectively. Overall survival after 5 years for primary locally advanced rectal cancer, recurrent rectal cancer, and cervical cancer was 66%, 8%, and 45%. |
2 |
52. Barakat RR, Goldman NA, Patel DA, Venkatraman ES, Curtin JP. Pelvic exenteration for recurrent endometrial cancer. Gynecol Oncol. 1999;75(1):99-102. |
Observational-Tx |
44 patients |
To review our experience with pelvic exenteration performed in patients with recurrent endometrial adenocarcinoma from 1947 through 1994. |
A total of 44 patients were identified, with a mean age of 60 years (range 35-69 years). Primary therapy usually consisted of total abdominal hysterectomy with bilateral salpingo-oophorectomy, with most receiving either pre- or postoperative radiotherapy. Prior to exenteration, 10 of 44 (23%) patients had never received any form of radiotherapy. The median interval between initial surgery and exenteration was 28 months (range 2-189 months). The type of exenteration performed was total in 23 patients (52%), anterior in 20 patients (46%), and posterior in 1 patient. Major postoperative complications occurred in 35 patients (80%) and included urinary/intestinal tract fistulas, pelvic abscess, septicemia, pulmonary embolism, and cerebrovascular accident. Median survival for the entire group of patients was 10.2 months. Nine patients (20%) achieved long-term survival (>5 years). Pelvic exenteration for recurrent endometrial cancer is associated with a high operative morbidity and poor overall survival. |
2 |
53. de Wilt JH, van Leeuwen DH, Logmans A, et al. Pelvic exenteration for primary and recurrent gynaecological malignancies. Eur J Obstet Gynecol Reprod Biol. 2007;134(2):243-248. |
Observational-Tx |
42 patients |
To analyse the outcome of pelvic exenteration for gynaecological malignancies in a tertiary referral center, including post-operative in-hospital morbidity, long-term morbidity, disease free and overall survival rates. |
A pelvic exenteration was performed in 14 patients for primary and 28 patients for recurrent gynaecological cancers. In-hospital complications occurred in 19 patients (45%) of whom seven patients needed a reoperation (17%). Late complications occurred in 31 patients (75%); 21 reinterventions were performed (50%). Five-year disease free and overall survival was, respectively, 48 and 52%. Age, type of surgery, histology, localisation of the tumour, lateral wall involvement, completeness of resection and primary versus recurrent cancer were not identified as prognostic factors for recurrence or survival. |
2 |
54. Sharma S, Odunsi K, Driscoll D, Lele S. Pelvic exenterations for gynecological malignancies: twenty-year experience at Roswell Park Cancer Institute. Int J Gynecol Cancer. 2005;15(3):475-482. |
Observational-Tx |
48 patients |
To review the experience with pelvic exenterations for gynecological malignancies at our cancer institute. |
Charts of 48 women who underwent a pelvic exenteration between January 1980 and December 1999 were reviewed, and several outcomes were analyzed. Majority of patients had received prior radiation therapy. The median survival was 35 months, and the disease-free survival was 32 months. Mortality from the procedure was 4.2%. Early and late postoperative complication rates were 27% and 75%, respectively. Recurrence rate was 60%. Eight patients received intraoperative radiation. Median survival in this group was 11.3 vs 35 months (P = 0.003). Univariate analysis failed to show an association between type of pelvic exenteration, type of fecal and urinary diversion, outcome, need for reoperation, and recurrence. |
2 |
55. Roos EJ, Van Eijkeren MA, Boon TA, Heintz AP. Pelvic exenteration as treatment of recurrent or advanced gynecologic and urologic cancer. Int J Gynecol Cancer. 2005;15(4):624-629. |
Observational-Tx |
62 |
To determine morbidity, disease-free and overall survival after pelvic exenteration for gynecological and urologic cancer in the University Medical Center Utrecht from 1989 to 1999. |
The operative mortality was 1.6%. Seventy-five percent of the patients had postoperative complications of which ileus and urinary tract infection were the most common. Late complications occurred in 83% of the patients. Recurrent disease was observed in 38% of the women, whereas 50% had died on January 1, 2000. Five-years disease-free and overall survival were 42% (confidence interval [CI] +/- 14%) and 46% (CI +/- 14%), respectively. |
2 |
56. Burke TW, Stringer CA, Morris M, et al. Prospective treatment of advanced or recurrent endometrial carcinoma with cisplatin, doxorubicin, and cyclophosphamide. Gynecol Oncol. 1991;40(3):264-267. |
Experimental-Tx |
102 patients |
To present updated and final results concerning the effectiveness of cisplating, doxorubicin, and cyclophosphamide as a salvage combination. |
Of the 87 patients with measurable disease, 12 had a complete clinical response, while 27 had a partial clinical response, for an overall objective response rate of 45%. No differences in response rates between primary and recurrent disease patients were noted. Median time to response was 2.5 months with a median response duration of 4.8 months. Nonresponders included 33 patients with stable disease and 15 with progression. Median progression-free survival for all patients was 6 months. Dose escalation was possible in 25% of patients; however, 52% of patients required dose reductions during treatment. Clinically significant toxicities included neutropenia (65%), anemia (47%), emesis (21%), nephrotoxicity (17%), and neurotoxicity (4%). |
2 |
57. Gallion HH, Brunetto VL, Cibull M, et al. Randomized phase III trial of standard timed doxorubicin plus cisplatin versus circadian timed doxorubicin plus cisplatin in stage III and IV or recurrent endometrial carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol. 2003;21(20):3808-3813. |
Experimental-Tx |
169 patients ST arm; 173 patients CT arm |
To determine if circadian timed (CT) chemotherapy results in improved response, progression-free survival (PFS), overall survival (OS), and lower toxicity, when compared with standard timed (ST) chemotherapy. |
The objective response rate (complete responses plus partial responses) was 46% in the ST group compared with 49% in the CT group (P =.26, one tail). Median PFS and OS were 6.5 and 11.2 months, respectively, in the ST group; and 5.9 and 13.2 months, respectively, in the CT group (PFS: P =.31; OS: P =.21, one tail). Median total doses were 209 mg/m2 doxorubicin and 349 mg/m2 cisplatin in the ST group, versus 246 mg/m2 doxorubicin and 354 mg/m2 cisplatin in the CT group. Grade 3 or 4 leukopenia occurred in 73% of patients in the ST arm and in 63% of patients in the CT arm. There were eight treatment-related deaths. |
1 |
58. Muggia FM, Blessing JA, Sorosky J, Reid GC. Phase II trial of the pegylated liposomal doxorubicin in previously treated metastatic endometrial cancer: a Gynecologic Oncology Group study. J Clin Oncol. 2002;20(9):2360-2364. |
Experimental-Tx |
42 patients |
To determine whether pegylated liposomal doxorubicin (PLD) has antitumor activity in pretreated patients with persistent or recurrent endometrial carcinoma and to define the nature and degree of toxicity of PLD. |
Of 46 patients entered, 42 were assessable for response, as three were declared ineligible on central pathology review and one was not assessable for response. Forty had received prior chemotherapy, 11 hormonal therapy, and 29 radiation therapy. Doxorubicin had been given to 32 patients, carboplatin with paclitaxel to six, carboplatin to one, and fluorouracil to one. Four patients had partial responses lasting 1.1, 2.1, 3.3, and 5.4 months; the overall response rate was 9.5% (95% confidence interval, 2.7% to 22.6%). Three of these responses (in liver and in lymph node) occurred in patients who had progressed after doxorubicin with either paclitaxel or cisplatin. The median number of courses was 2.5 (range, one to 14). Toxicity was generally mild: only 25 patients experienced leukopenia, with a median WBC count of 2,900 (range, 800 to 3,900) at nadir. The only grade 4 toxicities were one episode each of esophagitis, hematuria, and vomiting. The median overall survival was 8.2 months. |
2 |
59. Pierga JY, Dieras V, Beuzeboc P, et al. Phase II trial of doxorubicin, 5-fluorouracil, etoposide, and cisplatin in advanced or recurrent endometrial carcinoma. Gynecol Oncol. 1997;66(2):246-249. |
Experimental-Tx |
20 patients |
To describe the preliminary results of a combination of adriamycin (doxorubicin), 5-fluorouracil, etoposide, and cisplating (AFEP) in a series of 20 patients as a first-line chemotherapy in advanced or recurrent endometrial carcinoma. |
From August 1992 to January 1996, 20 consecutive patients were treated with a monthly combination chemotherapy consisting of doxorubicin 30 mg/m2 i.v. Day 1, 5-fluorouracil 600 mg/m2 i.v. Days 1 to 3, etoposide 80 mg/m2 i.v. Days 1 to 3, and cisplatin 35 mg/m2 i.v. Days 1 to 3 (AFEP). All patients were evaluable for response and toxicity. Median age was 62 years (range 45-72). Two to eight cycles were delivered (median 5). Two of 20 patients had complete response and 7 of 20 had partial response. The objective response rate was 45% (CI 95%: 23-68%). The median survival duration was 17 months. The median progression-free survival was 8 months. Major toxic effect was myelosuppression: 75% of grade 3 and 4 leukopenia and 20% of grade 3 and 4 thrombocytopenia. Seven patients (35%) developed infection and 4 (20%) were hospitalized once or more for toxicity. |
2 |
60. Scudder SA, Liu PY, Wilczynski SP, et al. Paclitaxel and carboplatin with amifostine in advanced, recurrent, or refractory endometrial adenocarcinoma: a phase II study of the Southwest Oncology Group. Gynecol Oncol. 2005;96(3):610-615. |
Experimental-Tx |
47 patients |
To evaluate the response rate and progression free and overall survival of patients with advanced endometrial cancer treated with paclitaxel, carboplatin and amifostine. To evaluate the toxicity of amifostine when used in combination with carboplatin and paclitaxel. |
There were 4 CRs (8%) (2 confirmed, 2 unconfirmed) and 15 PRs (32%) (9 confirmed, 6 unconfirmed) for a total response rate of 40% (95% confidence interval [CI], 26% to 56%). The median progression-free survival (PFS) was 7 months (95% CI, 6-9 months) and a 6-month PFS rate of 64% (95% CI, 50% to 78%). The median overall survival was 14 months (95% CI, 12 to 17 months). Toxicity was tolerable. While 79% of patients developed Grade 3/4 neutropenia (30% Grade 3, 49% Grade 4), there were no episodes of Grade 4 febrile neutropenia and one episode of infection with grades 3-4 neutropenia. |
2 |
61. Thigpen JT, Blessing JA, DiSaia PJ, Yordan E, Carson LF, Evers C. A randomized comparison of doxorubicin alone versus doxorubicin plus cyclophosphamide in the management of advanced or recurrent endometrial carcinoma: A Gynecologic Oncology Group study. J Clin Oncol. 1994;12(7):1408-1414. |
Experimental-Tx |
276 patients |
To compare doxorubicin with or without cyclophosphamide in patients with advanced or recurrent endometrial carcinoma no longer amenable to therapy with surgery, radiotherapy, or progestins. |
Among 132 patients treated with doxorubicin alone, there were seven complete responses (5%), 22 partial responses (17%), 73 with stable disease (55%), and 30 with increasing disease within 2 months of study entry (23%). For the 144 patients who received the combination, there were 18 complete responses (13%), 25 partial responses (17%), 75 with stable disease (52%), and 26 with increasing disease (18%). The median progression-free interval for those patients who received doxorubicin alone was 3.2 months, while it was 3.9 months for those who received the combination. The median survival duration for doxorubicin patients was 6.7 months, while it was 7.3 months for the combination patients. None of the unadjusted estimates of treatment differences are statistically significant. Prognostic features that had an impact on outcome included one factor associated with an increased likelihood of response (presence of measurable lung metastases) and four features associated with a poorer survival (poor performance status [PS] of 2 or 3, high pathologic grade, and presence of liver metastases or other intraabdominal disease). If these features are taken into account in multivariate analyses, there is no statistically significant evidence for differences in response rates (relative odds of response, 1.58; P = .06, one-tailed test), and survival duration is slightly longer in the combination regimen (17% reduction in death rate; P = .048). |
1 |
62. Guckenberger M, Bachmann J, Wulf J, et al. Stereotactic body radiotherapy for local boost irradiation in unfavourable locally recurrent gynaecological cancer. Radiother Oncol. 2010;94(1):53-59. |
Observational-Tx |
19 patients |
To evaluate outcome of radiotherapy for locally recurrent cervical and endometrial cancer. |
After median follow-up of 22 months, 3-year overall survival was 34% with systemic progression the leading cause of death (7/10). Median time to systemic progression was 16 months. Three local recurrences resulted in a local control rate of 81% at 3 years. No correlation between survival, systemic or local control and any patient or treatment characteristic was observed. The rate of late toxicity>grade II was 25% at 3 years: two patients developed a grade IV intestino-vaginal fistula and one patient suffered from a grade IV small bowel ileus. |
2 |
63. Deodato F, Macchia G, Grimaldi L, et al. Stereotactic radiotherapy in recurrent gynecological cancer: a case series. Oncol Rep. 2009;22(2):415-419. |
Experimental-Tx |
11 patients (12 lesions) |
To analyze the results of our preliminary experience with extracranial stereotactic radiotherapy in locally or distantly recurrent gynecological tumors. |
Eleven patients (12 lesions), were included in the analysis. Stereotactic radiotherapy was delivered as first radiotherapy treatment (5 patients), or as retreatment (6 patients). Complete clinical response was achieved in 8/12 lesions (66.6%), while partial response was documented in 2/12 lesions (16.6%). With a median follow-up of 19 months (range, 2-37 months), 7 patients (63%) experienced local and/or distant progression of disease. The 2-year local progression-free survival was 81.8%, while the 2-year metastases-free survival was 54.4%. The 2-year overall survival was 63.6%. Acute and late toxicities were grade 2 or less. There was no difference in quality of life scores between the data collected before extracranial stereotactic radiotherapy and at first follow-up evaluation. |
2 |
64. Aghajanian C, Sill MW, Darcy KM, et al. Phase II trial of bevacizumab in recurrent or persistent endometrial cancer: a Gynecologic Oncology Group study. J Clin Oncol. 2011;29(16):2259-2265. |
Experimental-Tx |
52 patients |
To assess the activity and tolerability of single-agent bevacizumab in recurrent or persistent endometrial cancer (EMC). |
Fifty-six patients were enrolled. Fifty-two patients were eligible and evaluable. Median age was 62 years, and prior treatment consisted of one or two regimens in 33 (63.5%) and 19 (36.5%) patients, respectively. Twenty-nine patients (55.8%) received prior radiation. Adverse events were consistent with those expected with bevacizumab treatment. No GI perforations or fistulae were seen. Seven patients (13.5%) experienced clinical responses (one complete response and six partial responses; median response duration, 6.0 months), and 21 patients (40.4%) survived progression free for at least 6 months. Median PFS and overall survival times were 4.2 and 10.5 months, respectively. Suggested associations were observed between high VEGF-A and adjusted hazard of death or tumor response when evaluated in tumor/plasma or plasma, respectively. |
2 |
65. Oza AM, Elit L, Tsao MS, et al. Phase II study of temsirolimus in women with recurrent or metastatic endometrial cancer: a trial of the NCIC Clinical Trials Group. J Clin Oncol. 2011;29(24):3278-3285. |
Experimental-Tx |
60 patients (33 in Group A; 27 in Group B) |
To investigate the efficacy of temsirolimus in patients with locally advanced, recurrent, and/or metastatic carcinoma of the endometrium |
In the chemotherapy-naive group, 33 patients received a median of four cycles (range, one to 23 cycles). Of the 29 patients evaluable for response, four (14%) had an independently confirmed partial response and 20 (69%) had stable disease as best response, with a median duration of 5.1 months (range, 3.7 to 18.4 months) and 9.7 months (range, 2.1 to 14.6 months). Only five patients (18%) had progressive disease. In the chemotherapy-treated group, 27 patients received a median of three cycles (range, one to six cycles). Of the 25 patients evaluable for response, one (4%) had an independently confirmed partial response, and 12 patients (48%) had stable disease, with a median duration of 4.3 months (range, 3.6 to 4.9 months) and 3.7 months (range, 2.4 to 23.2 months). PTEN loss (immunohistochemistry and mutational analysis) and molecular markers of PI3K/Akt/mTOR pathway did not correlate with the clinical outcome. |
2 |
66. Decruze SB, Green JA. Hormone therapy in advanced and recurrent endometrial cancer: a systematic review. Int J Gynecol Cancer. 2007;17(5):964-978. |
Review/Other-Tx |
2471 patients (5 RCTs; 29 phase II studies) |
To identify which populations should be considered for hormone interventions. |
In previously untreated patients with grade 1 (G1) or G2 tumors, the response rate for progestogens and the progression-free survival is in the range of 11-56% and 2.5-14 months, respectively. Higher response rates are seen in progesterone receptor-positive cases. Phase II studies comprise the majority of the data and many are of poor quality. There was considerable heterogeneity in patient selection, prior treatment, and type of regimen, and meta-analysis was not possible. G3 or G4 toxicity was less than 5%. |
4 |
67. Dellinger TH, Monk BJ. Systemic therapy for recurrent endometrial cancer: a review of North American trials. Expert Rev Anticancer Ther. 2009;9(7):905-916. |
Review/Other-Tx |
N/A |
To discuss the developments of systemic therapy in recurrent endometrial cancer, focusing on North American trials, in particular those documenting recent progress in new drug developments, as well as the future of individualized treatment regimens. |
No results stated in abstract. |
4 |
68. Rose PG, Brunetto VL, VanLe L, Bell J, Walker JL, Lee RB. A phase II trial of anastrozole in advanced recurrent or persistent endometrial carcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2000;78(2):212-216. |
Experimental-Tx |
23 patients |
To evaluate anastrozole in recurrent endometrial carcinoma. |
Twenty-three patients were entered on this trial. On central pathology review, 9 of them had grade 2 and 14 had grade 3 tumors. One to 24 courses (median: 1) of therapy were administered. Two partial responses were noted (9%; 90% confidence interval 3 to 23%). Two additional patients had short-term stable disease. With the exception of 1 case of venous thrombosis, the toxicity profile was mild. Median durations of progression-free survival and overall survival are 1 and 6 months, respectively. |
2 |
69. McMeekin DS, Gordon A, Fowler J, et al. A phase II trial of arzoxifene, a selective estrogen response modulator, in patients with recurrent or advanced endometrial cancer. Gynecol Oncol. 2003;90(1):64-69. |
Experimental-Tx |
34 patients |
To determine response rate and evaluate toxicity of LY353381 (arzoxifene) in patients with recurrent or advanced endometrial cancer (EC). |
From February 1999 through April 2001, 37 patients were entered of whom 34 received treatment. Efficacy was evaluated for the 29 patients who received at least 4 weeks of therapy and at least one tumor response assessment. Safety was assessed in all 34 patients who received any drug. Thirty patients were defined as progestagen sensitive, and 4 patients were defined as progestagen failures. Twenty-six patients were ER+, and 22 were PR+. Nine (1 CR + 8 PR) of 29 patients responded (31%, CI 25-51%), with a median duration of response of 13.9 months. All 9 responses occurred in progestagen-sensitive patients. Two additional patients (one from each progestagen cohort) had stable disease for >or=6 months. The median progression-free interval was 3.7 months (CI 1.9-6.6 months) for all 29 patients. Toxicity was minimal with no grade 3-4 toxic effects, and 9 patients had only grade 1-2 toxic effects (7 grade 1, 2 grade 2). Hot flashes were the most common toxic effect and, in all 3 reported cases, were grade 1. |
2 |
70. Piura B, Rabinovich A, Apel-Sarid L, Shaco-Levy R. Splenic metastasis from endometrial carcinoma: report of a case and review of literature. Arch Gynecol Obstet. 2009;280(6):1001-1006. |
Review/Other-Tx |
1 |
To describe only the 12th case of splenic metastasis from endometrial carcinoma and review pertinent literature. |
A 58-year-old woman had surgery and radiotherapy for stage IIB endometrial carcinoma. Eighteen months later, PET scan discovered a hypermetabolic splenic mass and two hypermetabolic lung nodules. Spleen biopsy showed metastasis from endometrial carcinoma. Chemotherapy with six cycles of cyclophosphamide, adriamycin and cisplatin effected a partial response of the splenic and lung metastasis. After few months, however, splenectomy was performed because of substantial growth of the spelnic metastasis and it confirmed that the splenic metastasis was of endometrial origin and solitary in the peritoneal cavity. After splenectomy, the patient received chemotherapy with six cycles of paclitaxel. To date, 6 months after splenectomy, she is alive with no intraperitoneal disease and with few stable lung metastases. |
4 |
71. Tangjitgamol S, Levenback CF, Beller U, Kavanagh JJ. Role of surgical resection for lung, liver, and central nervous system metastases in patients with gynecological cancer: a literature review. Int J Gynecol Cancer. 2004;14(3):399-422. |
Review/Other-Tx |
N/A |
To review the published literature, regarding surgical management of metastatic disease in patients with gynecological cancer. |
Some prognostic factors in the patients with metastatic lesions from these three different cancers were found in common. Favorable prognostic factors for a prolonged survival were good performance status of the patients, long disease-free interval, absence of other systemic disease, and the resectability, preferably with a clear margin. These factors should be considered as the criteria for surgery. In well-selected patients, survival could be extended from the surgical procedure with minimal complications. Other types of treatment such as radiation therapy or chemotherapy could also be given in conjunction with surgery, depending on tumor type and disease status of the primary cancer, other systemic diseases, and residual metastatic lesions after surgery. |
4 |
72. Salama JK, Milano MT. Radical irradiation of extracranial oligometastases. J Clin Oncol. 2014;32(26):2902-2912. |
Review/Other-Tx |
N/A |
No abstract available. |
No abstract available. |
4 |
73. Higginson DS, Morris DE, Jones EL, Clarke-Pearson D, Varia MA. Stereotactic body radiotherapy (SBRT): Technological innovation and application in gynecologic oncology. Gynecol Oncol. 2011;120(3):404-412. |
Review/Other-Tx |
N/A |
To provide an introduction and review of stereotactic body radiotherapy with regard to its use in gynecologic malignancies, and to present preliminary results from our experience for the purpose of illustrating the range of SBRT applications in gynecologic oncology. |
Six case series are published that report results of SBRT for gynecologic malignancies. Sixteen gynecologic patients have been treated with SBRT at our institution. Treatment sites include pelvic and periaortic nodes (9 patients), oligometastatic disease (2), and cervical or endometrial primary tumors when other conventional external radiation or brachytherapy techniques were unsuitable (5). Preliminary follow-up at a median of 11 months (range, 0.3-33 months) demonstrates 79% locoregional control, 43% distant failure, and 50% overall survival. |
4 |
74. Baschnagel AM, Mangona VS, Robertson JM, Welsh RJ, Kestin LL, Grills IS. Lung metastases treated with image-guided stereotactic body radiation therapy. Clin Oncol (R Coll Radiol). 2013;25(4):236-241. |
Experimental-Tx |
32 patients (47 lung metastases) |
To evaluate outcomes after treatment with image-guided stereotactic body radiation therapy (SBRT) using daily online cone beam computed tomography for malignancies metastatic to the lung. |
The median follow-up was 27.6 months (7.6-57.1 months). The 1, 2 and 3 year actuarial local control rates for all treated lesions were 97, 92 and 85%, respectively. Two patients with colorectal primaries (four lesions in total) had local failure. The median overall survival was 40 months. The 1, 2 and 3 year overall survival from the time of SBRT completion was 83, 76 and 63%, respectively. There were no grade 4 or 5 toxicities. Grade 3 toxicities (one instance of each) included pneumonitis, dyspnoea, cough, rib fracture and pain. |
2 |
75. Lo SS, Lutz ST, Chang EL, et al. ACR Appropriateness Criteria (R) spinal bone metastases. J Palliat Med. 2013;16(1):9-19. |
Review/Other-Tx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition. |
No results stated in abstract. |
4 |
76. Nag S, Erickson B, Parikh S, Gupta N, Varia M, Glasgow G. The American Brachytherapy Society recommendations for high-dose-rate brachytherapy for carcinoma of the endometrium. Int J Radiat Oncol Biol Phys. 2000;48(3):779-790. |
Review/Other-Tx |
N/A |
To develop recommendations for use of high-dose-rate (HDR) brachytherapy in patients with endometrial cancer. |
The ABS endorses the National Comprehensive Cancer Network (NCCN) guidelines for indications for radiation therapy for patients with endometrial cancer and the guidelines on HDR quality assurance of the American Association on Physicists in Medicine (AAPM). The ABS made specific recommendations for HDR applicator selection, insertion techniques, target volume definition, dose fractionation, and specifications for postoperative adjuvant vaginal cuff therapy, for vaginal recurrences, and for medically inoperable primary endometrial cancer patients. The ABS recommends that applicator selection should be based on patient and target volume geometry. The dose prescription point should be clearly specified. The treatment plan should be optimized to conform to the target volume whenever possible while recognizing the limitations of computer optimization. Suggested doses were tabulated for treatment with HDR alone, and in combination with external beam radiation therapy (EBRT), when applicable. For intravaginal brachytherapy, the largest diameter applicator should be selected to ensure close mucosal apposition. Doses should be reported both at the vaginal surface and at 0.5-cm depth irrespective of the dose prescription point. For vaginal recurrences, intracavitary brachytherapy should be restricted to patients with nonbulky (< 0.5-cm thick) disease. Patients with bulky (> 0.5-cm thick) recurrences should be treated with interstitial techniques. For medically inoperable patients, an appropriate applicator that will allow adequate irradiation of the entire uterus should be selected. |
4 |
77. Elshaikh MA, Yashar CM, Wolfson AH, et al. ACR appropriateness Criteria(R) advanced stage endometrial cancer. Am J Clin Oncol. 2014;37(4):391-396. |
Review/Other-Tx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for advanced stage endometrial cancer. |
N/A |
4 |