Vaginalrezidiv nach Primärtherapie des Endometriumkarzinoms im Stadium FIGO I* - Langzeitbeobachtungen der Freiburger Behandlungsjahrgänge 1969 - 1990 -

Abstract

Objective. To investigate the prevalence of vaginal recurrence, as defined by Perez and Carmel 1982, after endometrial cancer. We wanted to know whether vaginal relapse depends on initial treatment, risk factors such as depth of infiltration, orading and histological subtype. The results of second line therapy after relapse are demonstrated. Materials and Methods: 2521 patients treated for endometrial cancer at a tertiary reference center (Freiburg university women's hospital) between 1970 and 1990 were identified. Of those 1864 patients had FIGO stage I disease. In a retrospective analysis with a mean follow-up of more than 12 years, time to and type of recurrence were studied in relation to initial treatment and high risk factors (rare subtypes, grading 3 and deep myometrial infiltration. Results: 1732 patients were available for follow-up, 0.9% of the patients had a relapse limited to the vagina, in 1% a combined vaginal-pelvic wall relapse was diagnosed. Together 1.9% of the patients suffered a vaginal recurrence. The rate was highest for women, who had undergone surgery only (7.8%) and lowest for those, who had received adjuvant brachytherapy after surgery (0.5%), Myometrial infiltration, high grading and rate histological subtypes have only limited influence on the oc currence of vaginal relapse. These factors appear to be more strongly associated with pelvic wall recurrence and distant metastasis. A restriction of adjuvant brachytherapy to patients presenting with risk factors would miss the larger proportion of patients, who will later develop a relapse. Median survival after therapy for isolated vaginal relapse was 5.7 years, whereas after combined vaginal-pelvic recurrence only 1.6 years. Condusion: Radiotherapy after hysterectomy can limit the rate of vaginal relapse to 1,9%. Secondline therapy of the isolated vaginal recurrence can yield excellent results with a 5-year survival rate of 51.6%, supporting an aggressive therapentic approach in this situation.