Is there a role for routine imaging in Type 2 endometrial cancer surveillance? A retrospective review of method of detection of recurrent disease (495)

Abstract

<b>Objectives:</b> National Comprehensive Cancer Network guidelines recommend symptom and exam-based surveillance of all endometrial cancers after remission, regardless of the staging and histology of the carcinoma. Similarly, "Choosing Wisely" discourages routine imaging. Our primary objective was to identify the first method of detection of recurrence in the highest risk Type II endometrial cancers and, secondarily, to examine patterns of disease recurrence in this population. <b>Methods:</b> We conducted a retrospective chart review of all patients diagnosed with Type II endometrial cancer from January 2014 through March 2019 at a large academic institution. Type II endometrial cancers were classified by histology (grade 3 endometrioid, serous, clear cell, carcinosarcoma, and poorly differentiated) and pathologic stage. Patient characteristics and disease and treatment information were abstracted from the medical record. At our institution, standard surveillance consists of quarterly visits with exams, with some patients receiving routine imaging and CA-125 levels based on their elevated risk of recurrence. Among patients with recurrence, we identified the first method of detection of recurrence and sites of recurrence. All patients were followed for a minimum of two years. We calculated descriptive statistics, presenting data as percent, median (interquartile range), or mean (± standard deviation). <b>Results:</b> We identified 180 patients with Type II endometrial cancer, with 49 (22%) recurrences. The mean age at diagnosis was 68 years. The cohort was primarily White (68%) and African American (20%). Approximately 50% were stage I, 9% stage II, 28% stage III, and 12% stage IV at diagnosis. Patient characteristics and symptoms at presentation and surgery were similar between the total cohort and recurrence sub-population. The median time of follow-up for the entire cohort was 3.6 years (IQR: 2.2-4.8 years). Recurrence was first detected with routine imaging in 50%, followed by symptoms in 37%, while the minority of patients were diagnosed with CA-125 levels (10%) and routine physical exam (2%). The most common site of recurrence was in the lung (49%), followed by the peritoneum (28%). The median time from the initial diagnosis to recurrence was 1.4 years (IQR: 0.91-2.0 years). For patients with recurrences, 77% were identified within two years from initial diagnosis, while 10% were identified more than three years after recurrence. <b>Conclusions:</b> Recurrence of Type II endometrial cancer was most commonly first detected by routine imaging in approximately one- half of patients, followed by symptoms in 37%. CA-125 and routine physical exam detected the minority of recurrences. Further studies examining the role of imaging to surveil these high-risk, high-grade endometrial cancer patients are needed to evaluate if earlier detection with routine imaging translates into better cancer outcomes, particularly in light of newly approved systemic therapy options.