Vaginal vault recurrences of endometrial cancer in non-irradiated patients — Radiotherapy or surgery

Abstract

BackgroundThe treatment of locally recurrent endometrial cancer is based on limited evidence. The standard treatment is radiotherapy (RT) which is effective for local control and the effect has been documented in prospective studies. Investigations of surgical treatment (ST) of recurrences are few and limited to previously irradiated patients or patients with advanced disease. Investigation of surgical treatment for isolated vaginal vault recurrence is practically nonexistent. The aim of this study is to evaluate the efficacy of RT and ST in a non-irradiated group with recurrent endometrial cancer limited to the vaginal vault. MethodsPatients treated for recurrent endometrial cancer at Odense University Hospital, Denmark between 2003 and 2012 were identified, n=118. Thirty-three patients had an isolated vaginal vault recurrence and were treated with either RT, ST or both.Re-recurrence rates and survival rates were calculated at 2year follow-up using Fishers exact test. ResultsTwenty-six patients were treated with RT, 5 with ST, 2 with both. The mean (SD) follow-up-time was 4.4years (2.99) (RT) and 3.9years (0.90) (ST). Two year re-recurrence rates were 40% (RT) (95 CI 9.2–48%) and 0% (ST) (95 CI 0–60%). Two-year survival rates were 83% (RT) (95 CI 71–100%) and 100% (ST) (95 CI 40–100%) ST had one re-recurrence at 2.3years. ConclusionThis study indicates that ST is an appropriate treatment for locally recurrent endometrial cancer. Our study involves a limited number of patients and is made retrospectively, therefore prospective and ideally randomized trials evaluating both survival and complications are warranted.