Outcome and Survival in Women Diagnosed with Early Stage Endometrial Intraepithelial Carcinoma: The Role of Adjuvant Therapy
JG Lake, KZ Hanley, MB Mosunjac. Emory University School of Medicine, Atlanta, GA; Emory University Hospital, Atlanta, GA
Background: Endometrial intraepithelial carcinoma (EIC) is characterized by surface glandular involvement of the endometrium and or endometrial polyp by tumor cells resembling papillary serous carcinoma. EIC often presents with extrauterine disease at the time of diagnosis, despite the absence of myoinvasion. Therefore full staging is recommended in women diagnosed with EIC. The overall survival of patients with early stage EIC (pT1a) is reported to range from 64-95%.The role of adjuvant treatment in setting of such limited disease is controversial. The aim of this retrospective study is to compare the outcome and survival of women receiving adjuvant therapy (control group) for early stage EIC with those treated with surgery alone (study group).
Design: The pathology electronic database was searched for uterine EIC (TNM stage pT1a, N0,M0). The tumor size extent and location was documented. Patients with adverse prognostic findings were excluded. Histologic type, grade and tumor stage were confirmed. Follow up clinical data was searched for tumor recurrence, type of adjuvant therapy if any, and survival. Results were analyzed using the Kaplan-Meier method.
Results: A total of 16 patients were identified (9 control, 7 study). EIC was limited to an endometrial polyp (10), involved an endometrial polyp and background endometrium (3), and the endometrial surface only (3). The adjuvant treatment in the control group consisted of chemotherapy (4), radiation (4) and chemoradiation (1). Follow-up was 10-62 months. The survival in both group was 100%, the disease free survival was 100% in the study group. One patient from the control group recurred, therefore the disease free survival was 93.7% in that group.
Conclusions: While complete surgical staging in patients diagnosed with EIC is essential, the role of adjuvant therapy in pT1a EIC is controversial. The current standard of care is administration of toxic adjuvant therapy and long-term surveillance. Even though the numbers in this study are small, they suggest a role for watchful waiting in pT1a EIC patients who have been fully staged. Patients with poor performance status, advanced age and small tumor size may be treated with surgery alone, if optimal cytoreduction and full staging can be accomplished.
Category: Gynecologic & Obstetrics
Wednesday, March 24, 2010 9:30 AM
Poster Session V # 125, Wednesday Morning