Successful salvage treatment of recurrent endometrial cancer with bulky central tumor and extensive lymph node metastasis. A case report

Recurrent endometrial cancer with both local and distant metastasis is very difficult to treat. A 55-year-old endometrial adenocarcinoma patient with bulky central recurrences and pelvic and inguinal lymph node metastases underwent laparotomy and paraaortic, pelvic and inguinal lymphadenectomy followed by concurrent chemoradiation (with cisplatin) to the paraaortic and inguinal lymph nodes as well as the whole pelvis. Neck and mediastinal lymph node metastasis emerged during treatment. Neck-node radiation and epirubicin was added followed by paclitaxel and carboplatin. Complete remission was achieved. Ten months later, isolated central re-recurrence happened and total pelvic exenteration was performed. The patient has survived without further recurrence for more than five years after the exenteration. Therefore, a multimodality approach with a combination of radical resection (even pelvic exenteration), radiotherapy and chemotherapy could be offered to well-selected patients with recurrent endometrial cancer despite out-of-field progression during therapy and in-field local failure to initial salvage treatment.

Endometrial cancer; Lymph node metastasis; Recurrence; Chemoradiation; Exenteration

[1] Aalders J.G.,A beler V.,K olstad P.: "Recurrent adenocarcinoma of the endometrium: a clinical and histological study of 379 patients". Gynecol. Oneal., 1984, 17, 85.

[2] Sears J.D., Greven K.M., Hoen H.M., Randall M.E.: "Prognostic factors and treatment outcomes for patients with locally recurrent endometrial cancer". Cancer. 1994, 74, 1303.

[3] Wylie J., Irwin C., Pintilie M., Levin W., Manchu! L., Milosevic M. et al.: "Results of radical radiotherapy for recurrent endometrial cancer". Gynecol. Oneal., 2000, 77, 66.

[4] Morris M., Alvarez R.D., Kinney WK., Wilson T.O.: "Treatment of recurrent adenocarcinoma of the endometrium with pelvic exenteration". Gynecol. Oneal., 1996, 60, 288.

[5] Barakat R.R., Goldman N.A., Patel D.A., Venkatraman E.S., Curtin J.P.: "Pelvic exenteration for recurrent endometrial cancer". Gynecol. Oneal., 1999, 75, 99.

[6] Jeyarajah A.R., Gallagher CJ., Blake P.R.: "Long-term follow-up of gonadotrophin-releasing hormone analog treatment for recurrent endometrial cancer". Gynecol. Oneal., 1996, 63, 4 7.

[7] Moore T.D., Phillips P.H., Nerenstone S.R., Cheson B.D.: "Systemic treatment of advanced and recurrent endometrial carcinoma: current status and future directions". J. Clin. Oneal., 1991, 6, 1071.

[8] Ball H.G., Blessing J.A., Lentz S.S., Mutch D.G.: "A phase II trial of paclitaxel in patients with advanced or recurrent adenocarcinoma of the endometrium: a Gynecologic Oncology Group study". Gynecol. Oneal., 1996, 62, 278.

[9] Woo H.L., Swenerton K.D., Hoskins P.J.: "Taxol is active in platinum- resistant endometrial adenocarcinoma". Am. J. Clin. Oneal., 1996, 19, 290.

[10] Hoskins P.J., Swenerton K.D., Pike J.A., Wong F., Lim P., Acquino-Parsons C. et al.: "Paclitaxel and carboplatin, alone or with irradiation, in advanced or recurrent endometrial cancer: a phase II study". J. Clin. Oneal., 2001, 19, 4048.

[11] Scarabelli C., Campagnutta E., Giorda G., DePiero G., Sopracordevole F., Quaranta M. et al.: "Maximal cytoreductive surgery as a reasonable therapeutic alternative for recurrent endometrial cancer". Gynecol. Oneal., 1998, 70, 90.