Early-Stage Endometrial Cancer: Recurrence Pattern and Survival Analysis from a Tertiary Cancer Centre in South India

Abstract

The incidence of endometrial cancer is rising in India possibly due to the change in lifestyle and urbanization. Recent years have also shown a change in the adjuvant therapy for endometrial cancer. We evaluated the pattern of recurrence and survival of stage I and II carcinoma endometrium treated at our institution during a 5-year period. This was a single-institution retrospective analysis where all patients with early (Stage I and II) endometrial cancers treated from January 2004 to December 2008 were included. Data were retrieved from the hospital electronic medical records and hospital-based cancer registry. Details regarding the disease, initial treatment, follow-up, recurrence, and present status of the patient were collected. During the study period, 103 women with early endometrial cancer were identified. Patients were classified into low-risk, low-intermediate risk (LIR), high-intermediate risk (HIR), and high-risk (HR) groups according to the risk stratification used by the PORTEC study group. There were no recurrences in the low-risk group, whereas 9 % of LIR, 13.7 % of HIR, and 66 % of high-risk group recurred. The recurrence pattern was also distinctive between the groups with LIR having more vault recurrences, HIR and HR groups having distant recurrences. The local recurrences were salvageable whereas the distant recurrences were not. Overall and disease-free survival were 96.35 and 86.6 %, respectively. Endometrial carcinoma is mostly detected in early stages and has an excellent prognosis. Risk stratification is a prognostic indicator and also deciding factor in offering adjuvant therapy. Majority of uterus confined disease falls under intermediate risk group. Recurrences in LIR are locoregional and are salvageable with RT, while recurrences in HIR and HR are distant and not salvageable. EBRT with VBT improved DFS in both LIR and HIR groups when compared with no adjuvant treatment.