Date of Award

9-11-2009

Document Type

Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Susan Higgins

Abstract

OUTCOMES OF TREATMENT FOR VAGINAL RECURRENCES OF ENDOMETRIAL CANCER. Tejaswini K. More (sponsored by Dr. Susan Higgins). Department of Therapeutic Radiology, Yale University, School of Medicine, New Haven, CT. The purpose of this study was to assess treatment outcomes for vaginal recurrences of endometrial cancer following total abdominal hysterectomy and bilateral salpingo-opherectomy (TAH-BSO). We hypothesized that poor survival after salvage treatment for disease recurrence is associated with the following factors: age, primary tumor stage, primary tumor grade, prolonged time to treatment initiation after diagnosis of recurrence, recurrence size greater than 2 cm, recurrence location in the lower third of the vaginal vault, and histopathologic features of lymphovascular space invasion, deep myometrial invasion, and endocervical involvement. We reviewed the records of all patients treated for endometrial adenocarcinoma at Yale New Haven Hospital between January 1994 and December 2007. Twenty patients initially treated with TAH-BSO (± adjuvant therapy) developed recurrent disease involving the vagina and received definitive therapy. FIGO staging for initial disease ranged from IA - IIIC. Treatment of recurrent disease consisted of vaginal brachytherapy (VB) and pelvic external-beam radiotherapy (EBRT) for 14 patients, VB alone for 2 patients, pelvic EBRT alone for 1 patient, and a combination of chemotherapy and surgery for 3 patients. Median follow-up from diagnosis of recurrence was 2.2 years. The median time from initial treatment to disease recurrence was 24 months (range: 6105 months). At last follow-up, 11 of 20 (55%) patients were alive and free of disease. Two-year and five-year cumulative local control rates were 79 and 61%, respectively. Two-year and five-year overall survival were 77 and 68%. Two-year and five-year disease-free survival rates were 74 and 57%, respectively. Clinical and pathologic factors associated with poor outcome included age at diagnosis, nuclear grade, stage and endocervical involvement of the primary tumor. We conclude that local failure following TAH-BSO (± adjuvant therapy) carries a poor prognosis. In our cohort, local control of isolated vaginal recurrences of endometrial carcinoma corresponds to trends in overall survival, suggesting that primary treatment for recurrence must be aggressive. Furthermore, we observed a significant number of local recurrences at greater than two years after initial treatment, emphasizing the need for long-term surveillance following treatment.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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