PDF herunterladen
CC BY 4.0 · Rev Bras Ginecol Obstet 2021; 43(01): 041-045
DOI: 10.1055/s-0040-1721352
Original Article
Gynecological Endoscopy/Oncology

Efficacy of Endometrial Cancer Follow-up Protocols: Time to Change?

Amina Lubrano 
1   Department of Gynecology and Obstetrics, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
,
Virginia Benito 
1   Department of Gynecology and Obstetrics, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
,
Beatriz Pinar 
2   Depatment of Radiotherapy, Hospital Dr. Negrin, Las Palmas de Gran Canaria, Spain
,
Fernando Molano 
3   Department of Medical Oncology, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
,
Laureano Leon 
4   Department of Pathology, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
› Institutsangaben
› Weitere Informationen
   Lizenzen und Reprints

Abstract

Objective The aim of the present study was to analyze relapse rates and patterns in patients with endometrial cancer with the aim of evaluating the effectiveness of current follow-up procedures in terms of patient survival, as well as the convenience of modifying the surveillance strategy.

Methods Retrospective descriptive study including all patients diagnosed with endometrial cancer relapse at the Department of Gynecology and Obstetrics of the Complejo Hospitalario Insular-Materno Infantil de Canarias, between 2005 and 2014.

Results Recurrence was observed in 81 patients (10.04% of the sample); 66.7% of them suffered relapse within 2 years and 80.2% within 3 years after the termination of the primary treatment; 41.9% showed distant metastases while the rest corresponded to local-regional (40.7%) or ganglionar (17.4%) relapse; 42% of these were symptomatic; 14 patients showed more than 1 site of relapse. Relapse was detected mainly through symptoms and physical examination findings (54.3%), followed by elevated serum marker levels (29.6%), computed tomography (CT) images (9.9%) and abnormal vaginal cytology findings (6.2%). No differences in global survival were found between patients with symptomatic or asymptomatic relapse.

Conclusion Taking into account that the recurrence rate of endometrial cancer is low, that relapse occurs mainly within the first 3 years post-treatment and that symptom evaluation and physical examination are the most effective follow-up methods, we postulate that a modification of the current model of hospital follow-up should be considered.

Keywords

endometrial cancer relapse - follow-up - survival

Contributors

All authors contributed with the project and data interpretation, the writing of the article, the critical review of the intellectual content, and with the final approval of the version to be published.




Publikationsverlauf

Eingereicht: 29. Juni 2020

Angenommen: 28. September 2020

Artikel online veröffentlicht:
29. Januar 2021

© 2021. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Sociedad Española de Oncología Médica. Las cifras del cáncer en España: Depósito Legal: M-3266–2020 [Internet]. 2020 [cited 2020 Jan 15]. Available from: https://seom.org/seomcms/images/stories/recursos/Cifras_del_cancer_2020.pdf
    PubMedSuche in Google Scholar
  • 2 Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68 (06) 394-424
    CrossrefPubMedSuche in Google Scholar
  • 3 Morrow CP, Bundy BN, Kurman RJ, Creasman WT, Heller P, Homesley HD, Graham JE. Relationship between surgical-pathological risk factors and outcome in clinical stage I and II carcinoma of the endometrium: a Gynecologic Oncology Group study. Gynecol Oncol 1991; 40 (01) 55-65
    CrossrefPubMedSuche in Google Scholar
  • 4 Rubinstein EB, Miller WL, Hudson SV, Howard J, O'Malley D, Tsui J. et al. Cancer Survivorship Care in Advanced Primary Care Practices: A Qualitative Study of Challenges and Opportunities. JAMA Intern Med 2017; 177 (12) 1726-1732
    CrossrefPubMedSuche in Google Scholar
  • 5 Sartori E, Pasinetti B, Chiudinelli F, Gadducci A, Landoni F, Maggino T. et al. Surveillance procedures for patients treated for endometrial cancer: a review of the literature. Int J Gynecol Cancer 2010; 20 (06) 985-992
    CrossrefPubMedSuche in Google Scholar
  • 6 Hunn J, Tenney ME, Tergas AI, Bishop EA, Moore K, Watkin W. et al. Patterns and utility of routine surveillance in high grade endometrial cancer. Gynecol Oncol 2015; 137 (03) 485-489
    CrossrefPubMedSuche in Google Scholar
  • 7 Fung-Kee-Fung M, Dodge J, Elit L, Lukka H, Chambers A, Oliver T. Cancer Care Ontario Program in Evidence-based Care Gynecology Cancer Disease Site Group. Follow-up after primary therapy for endometrial cancer: a systematic review. Gynecol Oncol 2006; 101 (03) 520-529
    CrossrefPubMedSuche in Google Scholar
  • 8 Iavazzo C, Gkegkes ID, Vrachnis N. Early recurrence of early stage endometrioid endometrial carcinoma: possible etiologic pathways and management options. Maturitas 2014; 78 (03) 155-159
    CrossrefPubMedSuche in Google Scholar
  • 9 Colombo N, Creutzberg C, Amant F, Bosse T, González-Martin A, Ledermann J. et al; ESMO-ESGO-ESTRO Endometrial Consensus Conference Working Group. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: diagnosis, treatment and follow-up. Ann Oncol 2016; 27 (01) 16-41
    CrossrefPubMedSuche in Google Scholar
  • 10 Salani R, Khanna N, Frimer M, Bristow RE, Chen LM. An update on post-treatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncology (SGO) recommendations. Gynecol Oncol 2017; 146 (01) 3-10
    CrossrefPubMedSuche in Google Scholar
  • 11 Morice P, Levy-Piedbois C, Ajaj S, Pautier P, Haie-Meder C, Lhomme C. et al. Value and cost evaluation of routine follow-up for patients with clinical stage I/II endometrial cancer. Eur J Cancer 2001; 37 (08) 985-990
    CrossrefPubMedSuche in Google Scholar
  • 12 Carrara L, Gadducci A, Landoni F, Maggino T, Scambia G, Galletto L. et al. Could different follow-up modalities play a role in the diagnosis of asymptomatic endometrial cancer relapses?: an Italian multicentric retrospective analysis. Int J Gynecol Cancer 2012; 22 (06) 1013-1019
    CrossrefPubMedSuche in Google Scholar
  • 13 Gadducci A, Cosio S, Fanucchi A, Cristofani R, Genazzani AR. An intensive follow-up does not change survival of patients with clinical stage I endometrial cancer. Anticancer Res 2000; 20 (3B): 1977-1984
    PubMedSuche in Google Scholar
  • 14 Sartori E, Laface B, Gadducci A, Maggino T, Zola P, Landoni F, Zanagnolo V. Factors influencing survival in endometrial cancer relapsing patients: a Cooperation Task Force (CTF) study. Int J Gynecol Cancer 2003; 13 (04) 458-465
    CrossrefPubMedSuche in Google Scholar
  • 15 Otsuka I, Uno M, Wakabayashi A, Kameda S, Udagawa H, Kubota T. Predictive factors for prolonged survival in recurrent endometrial carcinoma: Implications for follow-up protocol. Gynecol Oncol 2010; 119 (03) 506-510
    CrossrefPubMedSuche in Google Scholar
  • 16 Novetsky AP, Kuroki LM, Massad LS, Hagemann AR, Thaker PH, Powell MA. et al. The utility and management of vaginal cytology after treatment for endometrial cancer. Obstet Gynecol 2013; 121 (01) 129-135
    CrossrefPubMedSuche in Google Scholar
  • 17 Erikson C, Salsberg E, Forte G, Bruinooge S, Goldstein M. Future supply and demand for oncologists : challenges to assuring access to oncology services. J Oncol Pract 2007; 3 (02) 79-86
    CrossrefPubMedSuche in Google Scholar
  • 18 Rutledge TL, Kano M, Guest D, Sussman A, Kinney AY. Optimizing endometrial cancer follow-up and survivorship care for rural and other underserved women: Patient and provider perspectives. Gynecol Oncol 2017; 145 (02) 334-339
    CrossrefPubMedSuche in Google Scholar
  • 19 Beaver K, Williamson S, Sutton C, Hollingworth W, Gardner A, Allton B. et al. Comparing hospital and telephone follow-up for patients treated for stage-I endometrial cancer (ENDCAT trial): a randomised, multicentre, non-inferiority trial. BJOG 2017; 124 (01) 150-160
    CrossrefPubMedSuche in Google Scholar
  • 20 Trial between two follow up regimens with different test intensity in endometrial cancer treated patients (TOTEM) [Internet]. 2018 [cited 2019 Dec 20]. Available from: https://clinicaltrials.gov/ct2/show/NCT00916708
    PubMedSuche in Google Scholar
  • 21 Ezendam NPM, de Rooij BH, Kruitwagen RFPM, Creutzberg CL, van Loon I, Boll D. et al. ENdometrial cancer SURvivors' follow-up carE (ENSURE): Less is more? Evaluating patient satisfaction and cost-effectiveness of a reduced follow-up schedule: study protocol of a randomized controlled trial. Trials 2018; 19 (01) 227
    CrossrefPubMedSuche in Google Scholar
  • 22 Jones JM, Ferguson S, Edwards E, Walton T, McCurdy N, Howell D. Experiences of care delivery: endometrial cancer survivors at end of treatment. Gynecol Oncol 2012; 124 (03) 458-464
    CrossrefPubMedSuche in Google Scholar