From the Guidelines
For a patient with pT1bN0M0 endometrial cancer after surgery and radiation therapy including HDR brachytherapy, routine imaging surveillance is not recommended in the absence of symptoms. The recommended approach is clinical surveillance with regular physical examinations, including pelvic examinations, every 3-6 months for the first 2-3 years, then every 6 months for years 3-5, and annually thereafter. Imaging should be performed only if there are concerning symptoms or physical examination findings that suggest recurrence, as the sensitivity and detection rate of imaging methods such as computed tomography scans are low, ranging from 0-20% 1. Most recurrences in endometrial cancer present with symptoms such as vaginal bleeding, pelvic pain, or constitutional symptoms, with symptoms being the method of detection in 41-83% of cases 1. The pT1b stage indicates tumor invasion into the inner half of the myometrium but not beyond, which carries a relatively good prognosis after appropriate treatment with surgery and radiation. Resources are better utilized by focusing on thorough clinical assessment and prompt investigation of new symptoms rather than scheduled routine imaging, as the impact of surveillance on outcomes is based predominantly on retrospective studies and expert opinions 1. Some studies have reported high sensitivity and specificity of positron emission test–computed tomography (PET-CT) scans for detecting recurrence, but its use for routine screening has not been well studied and is limited by high cost 1. Key points to consider in the surveillance approach include:
- Clinical surveillance with regular physical examinations
- Imaging only in the presence of concerning symptoms or physical examination findings
- Focus on thorough clinical assessment and prompt investigation of new symptoms
- Limited role of routine imaging in asymptomatic patients with early-stage endometrial cancer.
From the Research
Imaging Surveillance for pT1bN0M0 Endometrial Cancer
Background
The management of endometrial cancer involves surgical staging with adjuvant therapy guided by risk factors. For patients with pT1bN0M0 endometrial cancer who have undergone surgery and radiation therapy (RT) including high-dose rate (HDR) brachytherapy, the recommended imaging surveillance approach is not well-defined.
Surveillance Imaging
- The clinical benefit of surveillance imaging in endometrial cancer remains undefined 2.
- A retrospective study evaluated the positive predictive value (PPV) of surveillance imaging in endometrial cancer and found a PPV of 57.7% 2.
- The study suggested that surveillance imaging detects a significant number of recurrences in patients with high-risk endometrial cancer at a reasonable cost related to the overall risk 2.
Imaging Modalities
- Computed tomography (CT), positron emission tomography-computed tomography with 2-deoxy-2-[18F]fluoro-d-glucose (PET-CT), magnetic resonance imaging (MRI), and bone scans are commonly used imaging modalities for surveillance 2.
- The choice of imaging modality depends on the individual patient's risk factors and clinical presentation.
Frequency and Duration of Surveillance
- The frequency and duration of surveillance imaging are not well-established 2.
- A study suggested that well-designed prospective imaging trials are warranted to assess the clinical benefit of surveillance imaging 2.
Local Control and Survival
- Reirradiation including interstitial HDR brachytherapy is a promising option for vaginal recurrences of endometrial cancer after prior radiation, with a high rate of local control and acceptable toxicity 3.
- The overall crude local control rate was 87%, and the 3-year overall survival was 56% 3.
- Salvage IMRT plus 3-dimensional image-based HDR brachytherapy shows excellent tumor control and minimal morbidity for vaginal recurrence of endometrial cancer 4.