Early Endometrial Carcinoma Research Articles

Intracavitary vaginal brachytherapy in early stage endometrial carcinoma - impact on sexual function

Intracavitary vaginal brachytherapy in early stage endometrial carcinoma - impact on sexual function

Why Routine Clinical Follow-up for Patients With Early-Stage Endometrial Cancer Is Not Always Necessary

Objective This study aimed to examine the existing methods of follow-up in women who have undergone treatment of early endometrial carcinoma in South Wales and to assess if they are appropriate. Design This study used a retrospective analysis of follow-up data. Setting This study was performed in the Virtual Gynaecological Oncology Centre, South Wales, United Kingdom. Sample This study sample is composed of 552 women. Methods Data regarding follow-up were collected retrospectively from patient case notes and computerized data systems. Data were analyzed using the Pearson χ2 test, Cox proportional hazard regression analysis, and Kaplan-Meier curves. Main Outcome Measures This study aimed to determine whether routine follow-up was beneficial in detecting disease recurrence and whether outcome was influenced by routine follow-up. Results Between January 1, 2000, and December 31, 2010, 552 women were treated for early stage endometrial carcinoma. The 5-year survival was 81%, and the 5-year progression-free survival was 77%. Of these 552 women, 81 (15%) developed a disease recurrence; the majority (61/81 [75%]) recurred within 3 years. The median survival was 35 months compared with 47 months in patients who did not develop a recurrence. Of the 81 patients, 73 (90%) were symptomatic and only 5 patients were truly asymptomatic at follow-up. The most important and significant prognostic factor was “recurrent disease” with overall survival (hazard ratio, 2.20; P Conclusions Routine follow-up for early endometrial cancer is not beneficial for patients because most were symptomatic at the time of detection. It does not significantly improve the outcome. We propose altering the follow-up time regimen and adopting alternative follow-up strategies for women in South Wales.

Staging laparotomy for endometrial cancer in a patient with situs inversus totalis: A case report.

Situs inversus is a rare congenital anomaly in which the organs are transposed from their normal site to the opposite side of the body. To the best of our knowledge, this is the first study of staging laparotomy performed in a patient with endometrial carcinoma and situs inversus totalis (SIT). This study presents a patient with early endometrial carcinoma with SIT who underwent staging laparotomy. Total abdominal hysterectomy with bilateral salphingoophorectomy, omentectomy and pelvic para-aortic lymph node dissection was successfully performed without additional blood loss and time. The number of retrieved lymph nodes was 47. No abnormal course of blood vessels except for the right/left inversion was found. The postoperative course was favorable and the patient was discharged eight days after surgery.

Age-adjusted Charlson comorbidity index is a prognostic factor in patients with early-stage uterine carcinoma: A study with 1132 patients

Objectives: The impact of competing medical comorbidity on survival endpoints in women with early stage endometrial carcinoma (EC) is not well studied. The study goal was to use a validated comorbidity scoring system to determine its impact on recurrence-free (RFS), disease-specific (DSS), and overall survival (OS) in patients with early-stage EC.

Can Body Mass Index Influence the Outcome of a Laparoscopic Hysterectomy?

Objective: The purpose of this study was to evaluate differences in outcomes on the basis of body mass index (BMI) in patients undergoing laparoscopic hysterectomy. Design: The study was a retrospective analysis. Methods: All cases of laparoscopic hysterectomy performed from May 2008 to May 2012 for benign, microinvasive cervical, early endometrial, and occult ovarian carcinoma were reviewed. There were 347 patients analyzed by BMI. As proposed by the World Health Organization classification system of obesity, patients were categorized by BMI. Ideal BMI was defined as being between 18.5 and 24.9 kg/m2, overweight was defined as having a BMI between 25 and 29.9 mg/m2, and obesity was defined as having a BMI ≥30 kg/m2. Laparoscopic surgery was completed successfully in 338 patients, and 9 patients had their surgery converted to laparotomy for findings at the surgery, not for complications relating to the surgery, and, therefore, were excluded from the analysis. Results: Mean age was 51.1 years in the ideal group, 50.45 in the overweight group, and 55.49 in the obese group. The patients' ages ranged in all the samples between 31 and 94 years (p<0.003). Mean operating time was 105.5 minutes, mean blood loss was 252 mL, and mean length of hospital stay was 2.4 days. There was not a significant difference among the three groups. Total major complication rate was 3.7% and early postoperative complication rate was 5. There was not a significant difference among the three groups. Urologic injury was present in 0.6% of all patients. Conclusions: Laparoscopic hysterectomy is feasible and safe, resulting in short hospital stay, minimal blood loss, and minimal operating time for patients in all BMI groups. The laparoscopic approach may extend the benefits of minimally invasive hysterectomy to the very obese, for whom abdominal surgery poses serious risk. (J GYNECOL SURG 30:74)

Survival Rate of Early Stage Endometrioid Adenocarcinoma of Endometrium Treated at Srinagarind Hospital

To evaluate the survival outcome of early stage endometrioid adenocarcinoma of the endometrium with risk factors for locoregional recurrence treated with combined pelvic external beam radiotherapy (EBRT) and vaginal brachytherapy (VBT) after comprehensive surgery. Post-operative radiotherapy by pelvic EBRT and VBT for early stage endometrioid endometrial carcinoma resulted in excellent pelvic control with acceptable complications. This study showed no significant relationships between age, stage, histologic grade and LVSI and overall survival rate. The 5-year overall survival rate (OS) of early stage endometrioid type of endometrial carcinoma was 85.7%. Acute toxicity occurred in 38.1% of the patients, all of whom were grade 1 or 2. Total late toxicity developed in 42.9% of study group, in which 36.99% of them were grade 1-2 and 4.76% were grade 3-4. Post-operative radiotherapy by pelvic EBRT and VBT is acceptable for early stage endometrioid endometrial carcinoma, independent of age, stage, histologic grade and LVSI.

Why Routine Clinical Follow-up for Patients With Early Stage Endometrial Cancer Is Not Always Necessary: A Study on Women in South Wales

This study aimed to examine the existing methods of follow-up in women who have undergone treatment of early endometrial carcinoma in South Wales and to assess if they are appropriate. This study used a retrospective analysis of follow-up data. This study was performed in the Virtual Gynaecological Oncology Centre, South Wales, United Kingdom. This study sample is composed of 552 women. Data regarding follow-up were collected retrospectively from patient case notes and computerized data systems. Data were analyzed using the Pearson χ test, Cox proportional hazard regression analysis, and Kaplan-Meier curves. This study aimed to determine whether routine follow-up was beneficial in detecting disease recurrence and whether outcome was influenced by routine follow-up. Between January 1, 2000, and December 31, 2010, 552 women were treated for early stage endometrial carcinoma. The 5-year survival was 81%, and the 5-year progression-free survival was 77%. Of these 552 women, 81 (15%) developed a disease recurrence; the majority (61/81 [75%]) recurred within 3 years. The median survival was 35 months compared with 47 months in patients who did not develop a recurrence. Of the 81 patients, 73 (90%) were symptomatic and only 5 patients were truly asymptomatic at follow-up. The most important and significant prognostic factor was "recurrent disease" with overall survival (hazard ratio, 2.20; P < 0.001; 95% confidence interval, 1.75-2.65) and progression-free survival (hazard ratio, 2.52; P < 0.001; 95% confidence interval, 2.09-2.95). "Asymptomatic recurrence" was not an independent predictor of outcome. Routine follow-up for early endometrial cancer is not beneficial for patients because most were symptomatic at the time of detection. It does not significantly improve the outcome. We propose altering the follow-up time regimen and adopting alternative follow-up strategies for women in South Wales.

Combination of Diane-35 and Metformin to Treat Early Endometrial Carcinoma in PCOS Women with Insulin Resistance

Background: Young women with polycystic ovary syndrome (PCOS) have a high risk of developing endometrial carcinoma. There is a need for the development of new medical therapies that can reduce the need for surgical intervention so as to preserve the fertility of these patients. The aim of the study was to describe and discuss cases of PCOS and insulin resistance (IR) women with early endometrial carcinoma while being co-treated with Diane-35 and metformin.Methods: Five PCOS-IR women who were scheduled for diagnosis and therapy for early endometrial carcinoma were recruited. The hospital records and endometrial pathology reports were reviewed. All patients were co-treated with Diane-35 and metformin for 6 months to reverse the endometrial carcinoma and preserve their fertility. Before, during, and after treatment, endometrial biopsies and blood samples were obtained and oral glucose tolerance tests were performed. Endometrial pathology was evaluated. Body weight (BW), body mass index (BMI), follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone (TT), sex hormone-binding globulin (SHBG), free androgen index (FAI), insulin area under curve (IAUC), and homeostasis model assessment of insulin resistance (HOMA-IR) were determined.Results: Clinical stage 1a, low grade endometrial carcinoma was confirmed before treatment. After 6 months of co-treatment, all patients showed normal epithelia. No evidence of atypical hyperplasia or endometrial carcinoma was found. Co-treatment resulted in significant decreases in BW, BMI, TT, FAI, IAUC, and HOMA-IR in parallel with a significant increase in SHBG. There were no differences in the FSH and LH levels after co-treatment.Conclusions: Combined treatment with Diane-35 and metformin has the potential to revert the endometrial carcinoma into normal endometrial cells in PCOS-IR women. The cellular and molecular mechanisms behind this effect merit further investigation.

Total laparoscopic modified radical hysterectomy with lymphadenectomy for endometrial cancer compared with laparotomy

This is the first report to determine the feasibility and safety of total laparoscopic modified radical hysterectomy (TLMRH) in the treatment of presumed stage I endometrial cancer. This was a retrospective study of 132 consecutive patients who underwent surgery for early endometrial cancer. Thirty-nine patients underwent TLMRH and bilateral salpingo-oophorectomy (BSO), and 93 had a total abdominal extrafascial hysterectomy and BSO. Lymphadenectomy was performed in 87 patients. The groups were compared for epidemiological and clinical characteristics, surgical outcomes, hospital stay, lymph nodes harvested, and intraoperative and postoperative complications. The patients in the TLMRH group had less blood loss (42.9 ± 76.3 vs 236.8 ± 186.6 mL, P < 0.0001), a similar number of lymph nodes removed (32.3 ± 13.1 vs 28.0 ± 11.9, P = 0.15), less need for analgesia and a shorter hospital stay (9.3 ± 2.5 vs 14.6 ± 12.6 days, P = 0.009) but longer operations (321.1 ± 65.9 vs 262.6 ± 75.0 min, P < 0.0001) than those treated by laparotomy. In our study, we had no conversions from laparoscopy to laparotomy. No major complications occurred in the TLMRH group. The patients who underwent TLMRH had less intense postoperative pain than patients treated by laparotomy. The median length of vaginal cuff removed was 12.0 ± 4.1 mm in the TLMRH group, and was 5.6 ± 6.6 mm in the laparotomy group (P < 0.0001). No patients demonstrated recurrence in either of the groups after a median follow-up of 48.5 months (range, 1-84). TLMRH is a safe and reliable alternative to open surgery in the management of early endometrial carcinoma, with a significantly reduced hospital stay and complications.

Small endometrial carcinoma 10 mm or less in diameter: clinicopathologic and histogenetic study of 131 cases for early detection and treatment

Natural history and clinicopathologic features of early endometrial carcinoma are not evident. Its knowledge is essential to make up strategies for prevention, early detection, and treatment of endometrial carcinoma. Especially it is important to know pathways of endometrial carcinogenesis and frequency of endometrial carcinomas arising from endometrial hyperplasia. Clinicopathologically 131 patients with endometrial carcinoma measuring ≤10 mm in diameter (“small endometrial carcinoma”) were studied to get useful information for early diagnosis, treatment, and histogenesis. The entire endometrium of surgically removed uterus was step-cut and examined. The patients were, on average, 5 years younger than the controls whose carcinomas measure >10 mm (P < 0.0001). Of the 131 patients, 20% were asymptomatic although only 5% of the controls were asymptomatic (P < 0.0001). Seventy-six percent had the carcinomas located in the upper third section of the uterine corpus. Macroscopically 44% of the tumors were flat and 56% were elevated. Incidence of nodal and ovarian metastases were <1%. Forty percent of “small endometrial carcinomas” were associated with endometrial hyperplasia and 60% were not. It is logical to believe that there are two pathways of endometrial carcinogenesis: carcinomas occurring from hyperplasia (40%) and carcinomas occurring from normal endometrium (60%). As hyperplasia-carcinoma sequence is not a main route, we cannot probably prevent carcinomas only by treatment of hyperplasia. Effort must be focused on detecting early de novo carcinomas. As most “small endometrial carcinomas” arise in the upper third of the corpus, careful endometrial sampling there is important for early detection.

The importance of adjuvant chemotherapy and pelvic radiotherapy in high-risk early stage endometrial carcinoma

ObjectiveTo determine the impact of a policy change in which women with high-risk early stage endometrioid endometrial cancer (EEC) received adjuvant chemoradiotherapy. MethodsThis is a population-based retrospective cohort study of British Columbia Cancer Registry patients diagnosed from 2008 to 2012 with high-risk early stage EEC, who received adjuvant chemoradiotherapy after primary surgery. High-risk early stage was defined as the presence of two or more high-risk uterine factors: grade 3 tumor, more than 50% myometrial invasion, and/or cervical stromal involvement. Adjuvant therapy consisted of 3 or 4cycles of carboplatin and paclitaxel chemotherapy, followed by pelvic radiotherapy. Sites and rate of recurrence were compared to a historical cohort diagnosed from 2005 to 2008 in which none of the patients received adjuvant chemoradiotherapy. Five-year progression-free and overall survival rates were calculated. ResultsThe study includes 55 patients. All patients except for 2 received at least 3cycles of chemotherapy. All patients received pelvic radiotherapy except for 2 who received brachytherapy only. Median follow-up was 27months (7–56months). Four patients (7.3%) recurred, including three with distant recurrence only and one with both a pelvic and paraaortic nodal recurrence. The historical cohort had a 29.4% recurrence rate, and therefore the hazard ratio for recurrence was 0.27 (95% CI 0.02–4.11). Five-year progression-free and overall survival rates were 88.6% and 97.3%, respectively. ConclusionPatients with high-risk early stage endometrial carcinoma treated with adjuvant chemoradiotherapy have a low rate of recurrence compared to those not receiving such therapy.

Fertility outcomes of patients with early stage endometrial carcinoma

Three to five percent of endometrial carcinoma patients are younger than 40 years and may desire fertility. Conservative treatment can be employed in these cases. We aimed to review treatment outcomes of patients who were diagnosed with endometrial carcinoma and who wanted to preserve their fertility. We reviewed nine patients who were diagnosed with early stage endometrial carcinoma and wanted to spare their fertility. The patients were followed up at Baskent University Adana Research Center from January 2004 to December 2011. In all patients the carcinoma presented as polyps, which were resected by hysteroscopy. After being informed about both surgical and medical therapies, four patients preferred surgery and five preferred medical treatment. The mean number of in vitro fertilization trials after conservative treatment was 3.25. One woman, who was on medroxyprogesterone acetate, delivered a healthy term baby from a fresh cycle. Another woman, who was on dydrogesterone, got pregnant from a thawing cycle, which later ended up in a missed abortus. Of all the patients who chose medical treatment, three had surgery at the end. One woman developed an ovarian tumor during the follow-up; one woman had a recurrence of endometrial carcinoma on dilatation and curettage for missed abortus and one woman tried in vitro fertilization several times and could not get pregnant, thus decided to have surgery. Two women had stage IA endometrial carcinoma and one had stage IIB ovarian carcinoma. Conservative treatment of endometrial carcinoma is safe in most cases. However, patients should be well-informed about the risks of conservative treatment because delaying definitive treatment sometimes worsens the prognosis.

Pregnant rate and pregnancy-relating factors of patients with early endometrial carcinoma and severe atypical hyperplasia of endometrium after fertility-preserving treatment by progestin

To summarize the pregnant rate of patients with early endometrial carcinoma and severe atypical hyperplasia after fertility-preserving treatment and analyze their pregnancy-relating factors. Endometrial curettage was used to evaluate the therapy response of endometrium after every 3 months of administration of high-dose progestin as fertility-sparing treatment for 51 patients with stage I endometrial carcinoma or severe endometrial atypical hyperplasia from Jun. 1996 to Jan. 2010. Individualized maintained treatment was given to patients after achieving complete remission of the endometrium. Pregnant results and pregnancy-relating factors were analyzed retrospectively. The median age of all the 51 patients was 29 years old. Forty-five (88%, 45/51) achieved complete response. Of the 34 cases who desired to conceive after complete response, 16 of them had 22 pregnancies, the pregnant rate was 47% (16/34); and 12 women obtained healthy live birth baby, the fertility rate was 35% (12/34). The pregnant rate of patients at age >35 or ≤ 35 was 0/2 and 50% (16/32) respectively (P > 0.05). The pregnant rate of patients with or without infertility was 40% (8/20) and 8/14, with endometrial cancer or severe atypical hyperplasia was 40% (10/25) and 6/9, respectively (all P > 0.05). The pregnant rate of patients who received in vitro fertilization-embryo transfer, ovulation promotion, or no treatment was 7/7, 6/16 and 3/11 respectively (P < 0.01). Fertility-preserving treatment for early endometrial cancer and severe atypical hyperplasia with high-dose progestin could achieve higher response rate. Assisted reproductive technologies could significantly increase the chance of conception.

Impact of Body Mass Index on Tumor Recurrence and Survival for Patients with Early Stage Endometrial Carcinoma after Adjuvant HDR Vaginal Cuff Brachytherapy

Increasing body mass index (BMI) is associated with increased prevalence of endometrial carcinoma (EC). We sought to investigate the significance of BMI as a prognostic factor for tumor recurrence and survival in women with early stage endometrial carcinoma who were treated with adjuvant HDR vaginal cuff brachytherapy. In our prospectively-maintained database of patients with endometrial cancer, we identified 141 patients who underwent surgical staging between 1990 and 2010 for FIGO stage I-II and received adjuvant high-dose-rate vaginal cuff brachytherapy. Their medical records were retrospectively reviewed in this IRB-approved study. Height and weight data were available at time of hysterectomy from which BMI was calculated (<30, ≥30 - <38 and ≥38). Following a univariate analysis, multivariable modeling was done using Cox regression analysis. Median followup was 48 months (range 13-245), median age was 62 years (range 39-91) and median BMI is 33.7 (range 19.7 - 63.6). There were 126 patients (89.4%) with endometrioid histology, 96 patients (68%) with stage IA, 38 patients 27% with stage IB and 7 (5%) with stage II. Median brachytherapy dose was 37.5 Gy to the surface of a vaginal cylinder in 5 fractions. Only 13 patients (9.2%) received adjuvant chemotherapy. There were only 6 patients with recurrences including only one patient with isolated vaginal cuff recurrence. Due to small number of events and based on exploratory analysis, body mass index (as a continuous variable or categorical) was not a significant predictor of recurrence-free, or disease-specific survival. BMI ≥38 and older age were the only independent predictor of OS (p=0.02 and <0.001, respectively). Five-year recurrence-free, disease-specific and overall survival for the study cohort was 93.2%, 96.3% and 89%, respectively. In our study, vaginal cuff control was excellent with vaginal brachytherapy. Body mass index was not a predictor of tumor recurrence or disease-specific survival in patients with early stage endometrial carcinoma who underwent surgical staging followed by adjuvant vaginal cuff HDR brachytherapy.

Long-Term Clinical Outcome of Women with Stage I-II Endometrial Adenocarcinoma after Adjuvant Intravaginal High-Dose-Rate Brachytherapy Alone

Vaginal cuff brachytherapy is proven to be an effective and well tolerated adjuvant radiation treatment modality after hysterectomy in women with early stage endometrial carcinoma. However, there remains paucity of data in regards to long-term clinical outcome endpoints. In this IRB-approved retrospective study, 141 women with 2009 FIGO stage I-II endometrial adenocarcinoma were identified. All patients underwent hysterectomy followed by adjuvant intravaginal HDR brachytherapy. Various prognostic factors were analyzed using Cox proportional hazards regression. All patients underwent hysterectomy between 1990 and 2010 with at least one year followup after hysterectomy. Median followup was 48 months (range 13-245). Median age at diagnosis for the study cohort was 62 years (range of 39 to 91). Ninety-six patients (68.1%), 38 patients (27%), and 7 patients (5%) had stages IA, IB, and II endometrial adenocarcinoma, respectively. One hundred twenty-six patients (89.4%) had endometrioid carcinoma. The median number of lymph nodes sampled was 10 (range of 5-68). Peritoneal cytology was negative for malignant cells in all patients. All patients received adjuvant high-dose-rate vaginal brachytherapy through single channel vaginal cylinder. Median brachytherapy surface dose was 37.5 Gy in 5 fractions to the upper 3-4 cm of the vagina. Thirteen patients (9.2%) had adjuvant platinum-based chemotherapy. None of the patients reported more than grade 1 vaginal toxicity according to common toxicities criteria version 3.0. Only 6 patients (4.3%) were diagnosed with tumor recurrence including only one patient with an isolated vaginal recurrence. Five-year relapse-free, disease-specific, and overall survival rates were 93.2%, 96.3% and 89%, respectively. Due to small number of recurrences and based on exploratory analysis, there were no significant predictors of relapse-free or disease-specific survival. As expected, age as a continuous variable was the only variable that was a significant predictor of overall survival (p<0.001). Our results suggest that vaginal cuff brachytherapy alone provides excellent long-term control in patients with early stage endometrial carcinoma after surgical staging. The treatment is very well tolerated with minimal patient-reported side effects.

Optimal Active Length of Vaginal Cuff High-Dose-Rate Brachytherapy in the Adjuvant Treatment of Endometrial Cancer: A University of Louisville Experience

and received adjuvant high-dose-rate vaginal cuff brachytherapy. Their medical records were retrospectively reviewed in this IRB-approved study. Height and weight data were available at time of hysterectomy from which BMI was calculated (!30, $30 -!38 and $38). Following a univariate analysis, multivariable modeling was done using Cox regression analysis. Results: Median followup was 48 months (range 13-245), median age was 62 years (range 39-91) and median BMI is 33.7 (range 19.7 63.6). There were 126 patients (89.4%) with endometrioid histology, 96 patients (68%) with stage IA, 38 patients 27% with stage IB and 7 (5%) with stage II. Median brachytherapy dose was 37.5 Gy to the surface of a vaginal cylinder in 5 fractions. Only 13 patients (9.2%) received adjuvant chemotherapy. There were only 6 patients with recurrences including only one patient with isolated vaginal cuff recurrence. Due to small number of events and based on exploratory analysis, body mass index (as a continuous variable or categorical) was not a significant predictor of recurrence-free, or disease-specific survival. BMI $38 and older age were the only independent predictor of OS (p50.02 and!0.001, respectively). Five-year recurrence-free, disease-specific and overall survival for the study cohort was 93.2%, 96.3% and 89%, respectively. Conclusions: In our study, vaginal cuff control was excellent with vaginal brachytherapy. Body mass index was not a predictor of tumor recurrence or disease-specific survival in patients with early stage endometrial carcinoma who underwent surgical staging followed by adjuvant vaginal cuff HDR brachytherapy.

Surgical Staging of Early Stage Endometrial Cancer: Comparison Between Laparotomy and Laparoscopy.

BackgroundThe aim of the present study was to compare the laparotomy (LT) and laparoscopy (LS) in patients who undergone surgical staging for early stage endometrium cancer.MethodsRetrospective data were collected and analyzed for amount of intraoperative bleeding, complication rates, total resected and laterality specific number of lymph nodes and duration of operation in patients operated with either LT or LS.ResultsSeventy-nine stage I endometrium cancer patients were found to be eligible for the trial purposes: 58 (73.4%) treated by LT and 21 (26.6%) treated by LS. The number of lymph nodes was similar in LT (8.9 ± 5.3) and LS (9.2 ± 4.8) (P = 0.8). In LT group, there was no difference in the number of lymph nodes between the right and left sides (10 ± 5.8 and 8.7 ± 4.8 respectively, P = 0.19); in LS group, the number of lymph nodes resected from the right side was higher than the left side (9.8 ± 5 and 7 ± 3.5 respectively, P = 0.039). The amount of intraoperative bleeding and hospitalization period were significantly higher in LT group. Seventy-nine patients had a median follow-up of 30 months. The two groups were similar for disease-free survival (P = 0.46, log rank test).ConclusionsThere was no significant difference between the two methods in terms of number of total resected lymph nodes. In early stage endometrial carcinoma, LS has provided adequate staging and similar survival rates with LT.

Is time to recurrence after hysterectomy predictive of survival in patients with early stage endometrial carcinoma?

Purpose/objective(s)To determine the prognostic significance of time to recurrence (TTR) on overall survival (OS) and disease-specific survival (DSS) following recurrence in patients with stage I–II uterine endometrioid carcinoma. Materials/methodsAfter IRB approval, we retrospectively identified 57 patients with recurrent endometrioid carcinoma who were initially treated for FIGO 1988 stages I–II between 1987 and 2009. The Kaplan–Meier approach and Cox regression analysis were used to estimate OS and DSS following recurrence and identify factors impacting outcomes. ResultsMedian follow-up times were 54.8months from hysterectomy and 19.8months after recurrence. Median time to recurrence was 20.2months. Twenty-eight (47%) patients had a recurrence <18months after hysterectomy and 29 (53%) had a recurrence ≥18months. Both groups were evenly matched regarding initial pathological features and adjuvant treatments. The median OS and DSS in patients with TTR<18months was shorter than those with TTR≥18months, but not statistically significant (p=0.216). TTR did not impact outcomes after loco-regional recurrence, but for extrapelvic recurrence, a shorter TTR resulted in worse OS and DSS (p=0.03). On multivariate analysis, isolated loco-regional recurrence (HR 0.28, p=0.001) and salvage radiation therapy (HR 0.47, p=0.045) were statistically significant independent predictors of longer OS following recurrence. TTR as a continuous variable or dichotomized was not predictive of OS or DSS. ConclusionsIn our study, the prognostic impact of time to recurrence was less important than the site of recurrence. While not prognostic for the entire cohort or for patients with loco-regional recurrence, TTR<18months was associated with shorter OS and DSS after extrapelvic recurrence.

Prognostic role of indoleamine 2,3-dioxygenase in endometrial carcinoma

ObjectiveIndoleamine-2,3-dioxygenase (IDO) suppresses the function of T-lymphocytes and is an important immune escape mechanism for cancer. Therefore, it is to be expected that IDO influences prognosis of cancer patients. This study aimed to investigate the prognostic role of IDO expression in a large cohort of endometrial carcinoma (EC) patients. MethodsA tissue microarray containing primary EC tissue of 355 patients treated in a single institution was used to evaluate IDO expression. Expression of IDO was associated with clinicopathological characteristics, survival and previously determined numbers of CD8+ and Foxp3+ T-lymphocytes. ResultsIDOhigh expression was associated with lower numbers of intratumoral CD8+ T-lymphocytes (p=0.031). Next to well-known prognostic parameters, IDOhigh expression was independently associated with poor disease specific survival in the general cohort of EC patients (HR 2.62, 95% C.I. 1.48–4.66, p=0.001) and among patients with early stage EC (HR 3.06, 95% C.I. 1.10–8.54, p=0.032). ConclusionOur results show that IDO expression is associated with poor survival. This provides evidence that further research into the use of IDO blocking agents in cancer treatment is valid where it might be a promising new therapeutic strategy.

Survival after radiation therapy for early-stage endometrial carcinoma: The Oslo study revisited after up to 43 years of follow-up.

5008 Background: There is an ongoing debate regarding the benefit of radiation in patients with early stage endometrial carcinoma. Data on long time risk conferred by radiation is scarce. This study is a long-term follow-up on survival and secondary cancers of a previously published randomized study (Aalders J. et al., Obstet Gynecol 1980; 56: 419-27). Methods: Between 1968 and 1974, 568 patients with endometrial cancer FIGO stage I primarily treated with abdominal hysterectomy and bilateral salpingo-oophorectomy were included in the study. Patients were postoperatively randomized to receive either vaginal radium brachytherapy followed by external pelvic radiation 40 Gy (N=288) or brachytherapy alone (N=280). Survival data and data on incident secondary cancers were obtained by individual linkage to the Registry of Statistics Norway and Cancer Registry of Norway. By the end of follow-up at 1 November 2011, 45 (7.9%) patients were still alive. We used Cox proportional hazards model to estimate hazard ratios (HR) with 95% confidence intervals (95% CI). We also conducted analyses stratified by age groups. Results: After median 21 (range 0-43.4) years of follow-up there was no significant difference in overall survival or relapse free survival between treatment arms with HR of 1.12 (95% CI: 0.95-1.33) and HR 0.88 (95% CI: 0.55-1.40), respectively. Patients treated with external radiation had significantly lower risk of developing locoregional relapse (p&lt;0.001). However, women younger than 60 years had a significant poorer survival after external radiation (HR 1.36; 95% Cl: 1.06-1.76). In this patient group the risk of secondary cancer was significantly increased (HR 1.9; 95% CI: 1.23-3.03). Conclusions: We observed no survival benefit of external pelvic radiation in early stage endometrial carcinoma. In women younger than 60 years, pelvic radiation decreased survival, probably due to increased risk of subsequent second neoplasms. Adjuvant external radiotherapy cannot be recommended to this patient group. Those who have received such treatment might eventually benefit from prolonged post treatment surveillance with respect to secondary cancer.