Non-exenterative surgical management of recurrent endometrial carcinoma Journal Article


Authors: Moukarzel, L. A.; Braxton, K. F.; Zhou, Q. C.; Pedra Nobre, S.; Iasonos, A.; Alektiar, K. M.; Tew, W. P.; Abu-Rustum, N. R.; Leitao, M. M. Jr; Chi, D. S.; Mueller, J. J.
Article Title: Non-exenterative surgical management of recurrent endometrial carcinoma
Abstract: Objective: To examine the role of non-exenterative secondary cytoreductive surgery (SCS) compared with non-surgical treatments and identify predictors of improved survival for patients with recurrent endometrial cancer (EC). Methods: All patients undergoing primary surgical management for EC 1/1/2009–12/31/2017 who subsequently developed recurrence were retrospectively identified. Survival was determined from date of diagnosis of first recurrence to last follow-up and estimated using Kaplan-Meier method. Differences in survival were analyzed using Log-rank and Wald tests, based on Cox Proportional Hazards model. Results: Among 376 patients with recurrent EC, median time to recurrence was 14.3 months (range, 0.2–102.2), post-recurrence median survival 29 months, median follow-up 29.2 months (range, 0–116). Sixty-one patients (16.2%) received SCS, 257 (68.4%) medical management (MM) (chemotherapy and/or radiation therapy), 32 (8.5%) hormonal therapy, 26 (6.9%) no further therapy. Patients selected for SCS were younger, had more endometrioid histology, more stage I disease at initial diagnosis, no residual disease after primary surgery, longer interval to first recurrence or progression, and the longest OS (57.6 months) (95% CI, 33.3–not reached). On multivariate analysis SCS was an independent predictor of improved survival. Among the 61 SCS patients, age < 70 at time of initial diagnosis, and endometrioid histology, were associated with improved post-relapse survival univariately (p = 0.008, 0.03, respectively). Conclusions: While MM was the most common treatment for first recurrence of EC, patients selected for surgery demonstrated the greatest survival benefit even after controlling for tumor size, site, histology, stage, time to recurrence. Careful patient selection and favorable tumor factors likely play a major role in improved outcomes. Surgical management should be considered whenever feasible in medically eligible patients, with additional consideration given to our suggested criteria. © 2021 Elsevier Inc.
Keywords: chemotherapy; endometrial cancer; surgical cytoreduction; radiation therapy; recurrent endometrial cancer
Journal Title: Gynecologic Oncology
Volume: 162
Issue: 2
ISSN: 0090-8258
Publisher: Elsevier Inc.  
Date Published: 2021-08-01
Start Page: 268
End Page: 276
Language: English
DOI: 10.1016/j.ygyno.2021.05.020
PUBMED: 34090704
PROVIDER: scopus
PMCID: PMC8319948
DOI/URL:
Notes: Article -- Export Date: 1 September 2021 -- Source: Scopus
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MSK Authors
  1. Dennis S Chi
    589 Chi
  2. Kaled M Alektiar
    286 Alektiar
  3. Mario Leitao
    434 Leitao
  4. Qin Zhou
    169 Zhou
  5. Alexia Elia Iasonos
    254 Iasonos
  6. William P Tew
    197 Tew
  7. Jennifer Jean Mueller
    95 Mueller