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

Virginia Benito,Laureano Leon,Fernando Molano,Amina Lubrano,Beatriz Pinar

doi:10.1055/s-0040-1721352

Abstract

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. 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. 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. 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.

Highlights

The incidence of cancer in Spain is rising
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
At the moment of diagnosis, these patients were 67.72 years old on average; and the FIGO classification of the initial tumor was: stage I in 41 patients (50.6%), stage II in 12 patients (14.8%), stage III in 22 patients (27.2%) and stage IV in 6 patients (7.4%); 70.3% (57 patients) had type-1 endometrial adenocarcinoma and 29.7% (24 patients) had type-2 endometrial adenocarcinoma; 28.4% (23 patients) had been initially treated with surgery only, while the rest of them had received adjuvant treatment depending on their risk group

Summary

Introduction

42 Efficacy of Endometrial Cancer Follow-up Protocols Lubrano et al. Breast, colorectal and endometrial are most frequently associated with long-term survival. Survival is known to be closely related to disease stage, with local disease associated with > 95% survival at 5 years.[3] Given that endometrial cancer is the most common gynecological neoplasm and that most patients present with early-stage disease, the amount of patients to be followed-up after treatment is rather high. The objective of post-treatment follow-up protocols has been to diagnose possible treatment-associated complications and detect relapse as soon as possible. Other goals related to long-term follow-up are emerging, for example, control of delayed toxicity, management of physical consequences, rehabilitation and promotion of health and healthy habits. The goal is to improve the quality of life of survivors, as well as to help them retake their social, familial and working life.[4]

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Discussion

Conclusion