Highlights
- •Context of recurrence drives treatment options to include combination approaches.
- •Surveillance and survivorship should be tailored for endometrial cancer patients.
- •Fertility and ovarian preservation can be considered for select patients.
- •Primary radiation is reasonable for patients who are not surgical candidates.
Abstract
In 2014, the Society of Gynecologic Oncology's Clinical Practice Committee published
a clinical update reviewing the treatment of women with endometrial cancer. At that
time, there had been significant advances in the diagnosis, work-up, surgical management,
and available treatment options allowing for more optimal care of affected women.
This manuscript, Part II in a two-part series, includes specific recommendations on
treatment of recurrent disease, post treatment surveillance and survivorship, considerations
for younger women, and special situations. Part I covered histopathology and molecular
pathology, risk factors, presentation and diagnostic approach, surgical approach and
adjuvant therapy.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gynecologic OncologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Survival after relapse in patients with endometrial cancer: results from a randomized trial.Gynecol. Oncol. 2003; 89: 201-209
- A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study.Gynecol. Oncol. 2004; 92: 744-751
- Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): an open-label, non-inferiority, randomised trial.Lancet. 2010; 375: 816-823
- American Brachytherapy Society recurrent carcinoma of the endometrium task force patterns of care and review of the literature.Brachytherapy. 2017; 16: 1129-1143
- Management of nodal recurrences of endometrial cancer with IMRT.Gynecol. Oncol. 2015; 139: 40-46
- Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC Study Group. Post-operative radiation therapy in endometrial carcinoma.Lancet. 2000; 355: 1404-1411
- Definitive radiotherapy for patients with isolated vaginal recurrence of endometrial carcinoma after hysterectomy.Int. J. Radiat. Oncol. Biol. Phys. 2003; 56: 1366-1372
- Results of radical radiotherapy for recurrent endometrial cancer.Gynecol. Oncol. 2000; 77: 66-72
- Clinical outcomes following 3D image-guided brachytherapy for vaginal recurrence of endometrial cancer.Gynecol. Oncol. 2013; 131: 586-592
- Definitive salvage for vaginal recurrence of endometrial cancer: the impact of modern intensity-modulated-radiotherapy with image-based HDR brachytherapy and the interplay of the PORTEC 1 risk stratification.Radiother. Oncol. 2014; 113: 126-131
- Toward four-dimensional image-guided adaptive brachytherapy in locally recurrent endometrial cancer.Brachytherapy. 2014; 13: 554-561
- Pelvic exenterations for advanced and recurrent endometrial cancer: clinical outcomes of 40 patients.Int. J. Gynecol. Cancer. 2016; 26: 716-721
- Survival after pelvic exenteration for uterine malignancy: a National Cancer Data Base study.Gynecol. Oncol. 2016; 143: 472-478
- Pelvic exenteration for recurrent endometrial cancer.Gynecol. Oncol. 1999; 75: 99-102
- Pelvic exenteration for recurrent endometrial adenocarcinoma: a retrospective multi-institutional study about 21 patients.Int. J. Gynecol. Cancer. 2014; 24: 880-884
- Salvage cytoreductive surgery for recurrent endometrial cancer.Gynecol. Oncol. 2006; 103: 281-287
- Cytoreductive surgery for isolated para-aortic lymph node recurrence of endometrial cancer: report of four cases and a review of the literature.Eur. J. Gynaecol. Oncol. 2014; 35: 535-538
- Science. 2017; 357 (Ott PA, J Clin Oncol 2017; 35:2535–2541 Efficacy of Pembrolizumab in Patients With Noncolorectal High Microsatellite Instability/Mismatch Repair-Deficient Cancer: Results From the Phase II KEYNOTE-158 Study): 409-413
- J. Clin. Oncol. 2019 Nov 4; ([Epub ahead of print] PMID: 31682550)JCO1902105https://doi.org/10.1200/JCO.19.02105
- Safety and Antitumor Activity of Pembrolizumab in Advanced Programmed Death Ligand 1–Positive Endometrial Cancer, Obstetrical & Gynecological Survey.73(1). January 2018: 26-27https://doi.org/10.1097/01.ogx.0000527579.58363.20
- Lenvatinib plus pembrolizumab in patients with advanced endometrial cancer: an interim analysis of a multicentre, open-label, single-arm, phase 2 trial.Lancet Oncol. 2019 May; 20 (Epub 2019 Mar 25.): 711-718https://doi.org/10.1016/S1470-2045(19)30020-8
- Phase II trial of alternating courses of megestrol acetate and tamoxifen in advanced endometrial carcinoma: a Gynecologic Oncology Group study.Gynecol. Oncol. 2004; 92: 10-14
- Phase II study of medroxyprogesterone acetate plus tamoxifen in advanced endometrial carcinoma: a Gynecologic Oncology Group study.Gynecol. Oncol. 2004; 92: 4-9
- A phase II trial of anastrozole in advanced recurrent or persistent endometrial carcinoma: a Gynecologic Oncology Group study.Gynecol. Oncol. 2000; 78: 212-216
- The activity of letrozole in patients with advanced or recurrent endometrial cancer and correlation with biological markers - a study of the National Cancer Institute of Canada Clinical Trials Group.Int. J. Gynecol. Cancer. 2004; 14: 650-658
- Phase II Study of Everolimus and Letrozole in Patients with Recurrent Endometrial Carcinoma.J. Clin. Oncol. 2015; 33: 930
- GOG 3007, a randomized phase II (RP2) trial of everolimus and letrozole (EL) or hormonal therapy (medroxyprogesterone acetate/tamoxifen, PT) in women with advanced, persistent or recurrent endometrial carcinoma (EC): a GOG Foundation study.Gynecol. Oncol. 2018; 149: 2
- ZoptEC: Phase III randomized controlled study comparing zoptarelin with doxorubicin as second line therapy for locally advanced, recurrent, or metastatic endometrial cancer (NCT01767155).J. Clin. Oncol. 2018; 36
- Endometrial cancer: molecular markers and management of advanced stage disease.Gynecol. Oncol. 2018 Sep; 150 (Epub 2018 May 27): 569-580https://doi.org/10.1016/j.ygyno.2018.05.01529843906
- Randomized phase II trial of carboplatin-paclitaxel (CP) compared to carboplatin-paclitaxel-bevacizumab (CP-B) in advanced (stage III-IV) or recurrent endometrial cancer: The MITO END-2 trial.J. Clin. Oncol. 2015; 33
- Phase II trial of the pegylated liposomal doxorubicin in previously treated metastatic endometrial cancer: a Gynecologic Oncology Group Study.J. Clin. Oncol. 2002; 20: 2360-2364
- Randomized phase II trial of carboplatin-paclitaxel versus carboplatin-paclitaxel-trastuzumab in uterine serous carcinomas that overexpress human epidermal growth factor receptor 2/neu.J. Clin. Oncol. 2018; 36: 2044-2051
- Endometrial cancer surveillance adherence reduces utilization and subsequent costs.Gynecol. Oncol. 2017 Sep; 146 (Epub 2017 Jul 19): 514-518https://doi.org/10.1016/j.ygyno.2017.06.02428734496
- An update on post-treatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncology (SGO) recommendations.Gynecol. Oncol. 2017 Jul; 146 (Epub 2017 Mar 31): 3-10https://doi.org/10.1016/j.ygyno.2017.03.02228372871
- Improving quality and decreasing cost in gynecologic oncology care.Society of gynecologic oncology recommendations for clinical practice.Gynecol. Oncol. 2015; 137: 280-284
- Recurrence patterns and surveillance for patients with early stage endometrial cancer.Gynecol. Oncol. 2011 Nov; 123 (Epub 2011 Aug 5. PMID: 21820709): 205-207https://doi.org/10.1016/j.ygyno.2011.07.014
- Is cytologic screening an effective surveillance method for detection of vaginal recurrence of uterine cancer?.Obstet. Gynecol. 2006 Jan; 107: 71-76
- Obesity-related endometrial cancer: an update on survivorship approaches to reducing cardiovascular death.BJOG. 2016 Jan; 123: 293-298https://doi.org/10.1111/1471-0528.1368426841334
- Interventions for weight reduction in obesity to improve survival in women with endometrial cancer.Cochrane Database Syst. Rev. 2018; 2 (PMID 29388687)https://doi.org/10.1002/14651858.CD012513.pub2
- A review of the challenges faced in the conservative treatment of young women with endometrial carcinoma and risk of ovarian cancer.Gynecol. Oncol. 2009 Dec; 115 (Epub 2009 Sep 15. PMID: 19758691): 504-509https://doi.org/10.1016/j.ygyno.2009.08.011
- Prognostic factors for uterine cancer in reproductive-aged women.Obstet. Gynecol. 2007 Mar; 109 (PMID: 17329517): 655-662https://doi.org/10.1097/01.AOG.0000255980.88205.15
- Molecular classification defines outcomes and opportunities in young women with endometrial carcinoma.Gynecol. Oncol. 2019 Jun; 153 (Epub 2019 Mar 25. PMID: 30922603): 487-495https://doi.org/10.1016/j.ygyno.2019.03.098
- ProMisE on the horizon: molecular classification of endometrial cancer in young women.Gynecol. Oncol. 2019 Jun; 153 (PMID: 31151551): 465-466https://doi.org/10.1016/j.ygyno.2019.05.001
- Risk factors for young premenopausal women with endometrial cancer.Obstet. Gynecol. 2005 Mar; 105 (PMID: 15738027): 575-580https://doi.org/10.1097/01.AOG.0000154151.14516.f7
- Risk of endometrial, ovarian and breast cancer in women with polycystic ovary syndrome: a systematic review and meta-analysis.Hum. Reprod. Update. 2014 Sep-Oct; 20 (Epub 2014 Mar 30. PMID: 24688118; PMCID: PMC4326303): 748-758https://doi.org/10.1093/humupd/dmu012
- Risk of cancer among women with polycystic ovary syndrome: a Danish cohort study.Gynecol. Oncol. 2015 Jan; 136 (Epub 2014 Nov 20. PMID: 25451694): 99-103https://doi.org/10.1016/j.ygyno.2014.11.012
- Prospective determination of prevalence of lynch syndrome in young women with endometrial cancer.J. Clin. Oncol. 2007 Nov 20; 25 (Epub 2007 Oct 9): 5158-5164https://doi.org/10.1200/JCO.2007.10.859717925543
- ACOG practice bulletin no. 147: lynch syndrome.Obstet. Gynecol. 2014 Nov; 124 (PMID: 25437740): 1042-1054https://doi.org/10.1097/01.AOG.0000456325.50739.72
- Young patients with endometrial cancer: how many could be eligible for fertility-sparing treatment?.Gynecol. Oncol. 2009 Sep; 114 (Epub 2009 Jun 27. (PMID: 19560801)): 448-451https://doi.org/10.1016/j.ygyno.2009.05.038
- Comparison of D&C and office endometrial biopsy accuracy in patients with FIGO grade 1 endometrial adenocarcinoma.Gynecol. Oncol. 2009 Apr; 113 (Epub 2009 Jan 23): 105-108https://doi.org/10.1016/j.ygyno.2008.12.01719167049
- Transvaginal ultrasound versus magnetic resonance imaging for preoperative assessment of myometrial infiltration in patients with endometrial cancer: a systematic review and meta-analysis.J. Gynecol. Oncol. 2017 Nov; 28 (PMID: 29027404; PMCID: PMC5641536): e86https://doi.org/10.3802/jgo.2017.28.e86
- Endometrial cancer: a review and current management strategies: part II.Gynecol. Oncol. 2014 Aug; 134 (Epub 2014 Jun 11. PMID: 24929052): 393-402https://doi.org/10.1016/j.ygyno.2014.06.003
- Steroid receptors and clinical outcome in patients with adenocarcinoma of the endometrium.Am. J. Obstet. Gynecol. 1988 Apr; 158 (PMID: 2966586): 796-807https://doi.org/10.1016/0002-9378(88)90075-0
- Combined medroxyprogesterone acetate/levonorgestrel-intrauterine system treatment in young women with early-stage endometrial cancer.Am. J. Obstet. Gynecol. 2013 Oct; 209 (e1–4) (Epub 2013 Jun 19. PMID: 23791687): 358
- Long-term oncologic and reproductive outcomes in young women with early endometrial cancer conservatively treated: a prospective study and literature update.Int. J. Gynecol. Cancer. 2016 Nov; 26 (PMID: 27654262): 1650-1657https://doi.org/10.1097/IGC.0000000000000825
- Oncologic and reproductive outcomes with progestin therapy in women with endometrial hyperplasia and grade 1 adenocarcinoma: a systematic review.Gynecol. Oncol. 2012 May; 125 (Epub 2012 Jan 11): 477-482https://doi.org/10.1016/j.ygyno.2012.01.00322245711
- Oral progestogens vs levonorgestrel-releasing intrauterine system for endometrial hyperplasia: a systematic review and metaanalysis.Am. J. Obstet. Gynecol. 2010 Dec; 203 (e1–10) (PMID: 20934679): 547
- Efficacy of oral or intrauterine device-delivered progestin in patients with complex endometrial hyperplasia with atypia or early endometrial adenocarcinoma: a meta-analysis and systematic review of the literature.Gynecol. Oncol. 2012; 125: 263-270
- Does hormonal therapy for fertility preservation affect the survival of young women with early-stage endometrial cancer?.Cancer. 2017 May 1; 123 (Epub 2016 Dec 27. PMID: 28026855): 1545-1554https://doi.org/10.1002/cncr.30529
- Obstetric outcomes of pregnancy after conservative treatment of endometrial cancer: case series and literature review.Taiwan J. Obstet. Gynecol. 2011 Mar; 50 (PMID: 21482377): 62-66https://doi.org/10.1016/j.tjog.2009.10.006
- Outcomes after fertility-sparing management in young women with early endometrial cancer.Obstetr. Gynecol. January 2013; 121(1): 136-142
- Long-term health consequences of premature or early menopause and considerations for management.Climacteric. 2015; 18 (Epub 2015 Apr 7. PMID: 25845383; PMCID: PMC4581591): 483-491https://doi.org/10.3109/13697137.2015.1020484
- Ovarian involvement in endometrioid adenocarcinoma of uterus.Gynecol. Oncol. 2015 Sep; 138: 532-535
- Kang SB; Korean Gynecologic Oncology Group. Ovarian preservation during the surgical treatment of early stage endometrial cancer: a nation-wide study conducted by the Korean Gynecologic Oncology Group.Gynecol. Oncol. 2009 Oct; 115 (Epub 2009 Jul 26. PMID: 19635630): 26-31https://doi.org/10.1016/j.ygyno.2009.06.041
- Outcomes of ovarian preservation in a cohort of premenopausal women with early-stage endometrial cancer: a Korean Gynecologic Oncology Group study.Gynecol. Oncol. 2013 Nov; 131 (Epub 2013 Aug 29. PMID: 23994534): 289-293https://doi.org/10.1016/j.ygyno.2013.08.024
- Fertility preservation in young women with epithelial ovarian cancer.Cancer. 2009; 115: 4118-4126https://doi.org/10.1002/cncr.24461
- Survival impact of ovarian preservation on women with early-stage endometrial cancer: a systematic review and meta-analysis.Int. J. Gynecol. Cancer. 2017 Jan; 27 (PMID: 27922977): 77-84https://doi.org/10.1097/IGC.0000000000000857
- Coexisting ovarian malignancy in young women with endometrial cancer.Obstet. Gynecol. 2005 Oct; 106 (PMID: 16199623): 693-699https://doi.org/10.1097/01.AOG.0000172423.64995.6f
Wright, Jason D Take 'em or leave 'em: Management of the ovaries in young women with endometrial cancer.Gynecol. Oncol., 131, 2, 287–288.
- Prophylactic surgery to reduce the risk of gynecologic cancers in the Lynch syndrome.N. Engl. J. Med. 2006; 354: 261-269
- Synchronous occult cancers of the endometrium and fallopian tube in an MSH2 mutation carrier at time of prophylactic surgery.Gynecol. Oncol. 2008; 111: 575-578
- Gynecologic Oncology Group Study. Randomized double-blind trial of estrogen replacement therapy versus placebo in stage I or II endometrial cancer: a Gynecologic Oncology Group Study.J. Clin. Oncol. 2006 Feb 1; 24 (PMID: 16446331): 587-592https://doi.org/10.1200/JCO.2005.02.8464
- Management of menopausal symptoms in women with gynecologic cancers.Gynecol. Oncol. August 2017; 146: 427-435
- Hormone replacement therapy in gynecologic cancer survivors: why not?.Gynecol. Oncol. August 2011; : 447-454
- Effects of hormone replacement therapy on the rate of recurrence in endometrial cancer survivors: a meta-analysis.Eur. J. Cancer. 2014 Jun; 50 (Epub 2014 Mar 28. PMID: 24685478): 1628-1637https://doi.org/10.1016/j.ejca.2014.03.006
- Prospective assessment of lymphatic dissemination in endometrial cancer: a paradigm shift in surgical staging.Gynecol. Oncol. April 2008; 109: 11-18
- Utility of PET/CT to evaluate retroperitoneal lymph node metastasis in high-risk endometrial cancer: results of ACRIN 6671/GOG 0233 trial.Radiology. 2017 May; 283 (Epub 2017 Jan 3. PMID: 28051912; PMCID: PMC5410939): 450-459https://doi.org/10.1148/radiol.2016160200
- The management of inoperable stage I endometrial cancer using intracavitary brachytherapy alone: a 20-year institutional review.Brachytherapy. 2009 Jul-Sep; 8 (Epub 2009 Feb 20. PMID: 1923078): 278-283https://doi.org/10.1016/j.brachy.2008.11.006
- European Organisation for Research and Treatment of Cancer, Gynaecological Cancer Group (EORTC-GCG). Systemic review: radiation therapy alone in medical non-operable endometrial carcinoma.Eur. J. Cancer. 2016 Sep; 65 (Epub 2016 Aug 5. PMID: 27501506): 172-181https://doi.org/10.1016/j.ejca.2016.07.005
- Image-guided tandem and cylinder brachytherapy as monotherapy for definitive treatment of inoperable endometrial carcinoma.Gynecol. Oncol. 2017; 147: 302-308
- Consensus statement for brachytherapy for the treatment of medically inoperable endometrial cancer.Brachytherapy. 2015; 14: 587-599
Article info
Publication history
Published online: January 12, 2021
Accepted:
December 19,
2020
Received:
August 13,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
