Metastatic Endometrial Tumors: The Experience of a Single Institution

Background: In patients with recurrent or metastatic endometrial tumours, cure is unlikely unless the recurrence is limited to an isolated resectable lesion. Aim: We aimed to review the incidence and management of metastatic or recurrent endometrial cancer in our centre from August 2010 till August 2013. Patients and Methods: Patients’ notes and electronic records were reviewed. Results: A total of 237 patients with endometrial tumours were managed in our centre in that period. Eight patients (3.4%) had metastasis at initial presentation. Two hundred and twenty nine patients had early stages disease (I-III), 13 of them (5.7%) developed recurrence on follow-up. They were initially treated with total abdominal hysterectomy and bilateral salpingo-ophrectomy, followed by adjuvant pelvic radiotherapy in 9 patients (69%). Two of them had-in addition-adjuvant chemotherapy. Four patients (31%) had no indications for adjuvant treatment. On further follow-up, 10 of the 13 patients (76.9%) developed distant metastasis and 3 (23.1%) had isolated vaginal recurrences. The median time to recurrence was 9.5 months (range 1-16 months). Overall, endometriod adenocarcinoma was the most common histological subtype (71.5%) among patients with metastatic or recurrent disease. Other subtypes included clear cell (9.5%), endometrial stromal tumour (9.5%) and carcinosarcoma (9.5%). Carboplatin and paclitaxel (CP) was the most commonly used palliative regimen (58.8%). Complete response to CP regimen was obtained in 33.3%, partial response in 22.3% and stable disease in 33.3%. Other regimens included Doxorubicin and ifosfamide (AI) or hormonal treatment (progestogens or aromatase inhibitors). Patients with isolated vaginal recurrence were treated with combination of pelvic irradiation and brachytherapy. The median progression free and overall survival durations were 9 months and 17 months respectively. Conclusion: Patients with recurrent or metastatic endometrial cancer have different tumour behaviours and pattern. Treatment should-therefore-be tailored to each patient. Distant metastasis is the most common pattern of recurrence in high risk patients; hence the role of adjuvant chemotherapy should be further evaluated. Ongoing randomized studies will-further clarify that role.