The value of gynecological cancer follow-up: a 15-year single institutional experience

Purpose of Investigation: A routine follow-up is standard medical practice in patients treated for gynecological cancer. The aim of this study was to compare the survival differences between asymptomatic and symptomatic patients at the time of relapse. Materials and Methods: Retrospective cohort analysis. Results: All women diagnosed and treated for vulvar (n=78), cervical (n=289), endometrial (n=453), and ovarian cancer (n=261) between 2001 and 2015 were included in this study. The median survival time after recurrence between symptomatic and asymptomatic patients was in vulvar cancer (27 vs. 22 months, p = 0.181), in cervical cancer (10 vs. 13 months, p = 0.123), in endometrial cancer (19 vs. 30 months, p = 0.265) and in ovarian cancer (19 vs. 18 months, p = 0.861). Conclusions: There was no survival difference between asymptomatic and symptomatic patients at the time of relapse. Follow-up may become effective if the procedures are adapted to other aims of routine practice (e.g. psychosocial care and monitoring adverse effects of treatment).

Follow-up; Survival; Cancer; Endometrial; Ovarian; Cervical; Vulvar; Recurrence

[1] Vistad I., Moy B.W., Salvesen H.B., Liavaag A.H.: “Follow-up routines in gynecological cancer – time for a change? ”. AOGS, 2011, 90, 707.

[2] Conte P., Gadducci A., Pignata S., Scambia G.: “Linee guida. Tumori dell’ovaio”. Available at: https://sigo.it/wp-content/uploads/ 2015/10/nove16321.pdf

[3] Dansk Selskab for Obestetrik og Gynaekologi (Denmark), 2012. Available at: www.dgc.eu.com/fundanemt/files/filer/DGC_retnings linier_for_cervix_revideret20jan2007.pdf

[4] Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (Germany) AWMF online-Leitlinien-FRAME-Version 2010. Available at: http://www.awmf.org/orgleitlinien/detail/II/032- 034.html

[5] ESMO (European society for Medical Oncology) 2011-Guidelines, 2012. Available at: http://www.annonc.oxfordjournals.org/content/ 20/suppl.4/iv29.full.

[6] Zola P., Macchi C., Cibula D., et al.: “Follow-up in Gynecological Malignancies: A State of Art”. Int. J. Gynecol. Cancer. 2015, 25, 1151.

[7] Benedet J.L., Bender H., Jones H. 3rd., Ngan H.Y., Pecorelli S.: “FIGO staging classifications and clinical practice guidelines in the management of gynecologic cancers. FIGO Committee on Gynecologic Oncology”. Int. J. Gynaecol. Obstet. 2000, 70, 209.

[8] Pecorelli S.: “Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium”. Int. J. Gynaecol. Obstet., 2009, 105, 103.

[9] Dahl L., Wittrup I., Petersen L.K., Blaakaer J, Væggemose U.: “Paradoxes of follow-up – health professionalsʼ views on follow-up after surgical treatment in gynecological cancer”. Acta Oncol., 2015, 54, 194.

[10] Vistad I., Cvancarova M., Salvesen H.B.: “Follow-up of gynecological cancer patients after treatment – the views fo European experts in gynecologic oncology”. Acta Obstet. Gynecol. Scand. 2012, 91, 1286.

[11] Maggino T., Landoni F., Sartori E., Zola P., Gadducci A., Alessi C., et al.: “Patterns of recurrence in patients with squamous cell carcinoma of the vulva”. Cancer, 2000, 89, 116.

[12] Cheng X., Zang R., Wu X., Li Z, Cai S, Zhang Z.: “Recurrence patterns and prognostic factors in Chinese patients with squamous cell carcinoma of the vulva treated with primary surgery”. Int. J. Gynecol. Cancer, 2009, 19, 158.

[13] Woolderink J.M., de Bock G.H., de Hullu J.A., Davy M.J., van der Zee A.G., Mourits M.J., et al.: “Patterns and frequency of recurrences of squamous cell carcinoma of the vulva”. Gynecol. Oncol., 2006, 103, 293.

[14] Rhodes C.A., Cummins C., Shafi M.I.: “The management of squamous cell vulval cancer: a population based retrospective study of 411 cases”. Br. J. Obstet. Gynaecol. 1998, 105, 200.

[15] Nordin A., Abang Mohammed K., Naik R., de Barros Lopes A,, Monaghan J.: “Does long-term follow-up have a role for node negative squamous carcinoma of the vulva? The Gateshead experience”. Eur. J. Gynaecol. Oncol., 2001, 22, 36.

[16] de Hullu J.A., Hollema H., Lolkema S., Boezen M., Boonstra H., Burger M.P., et al.: “Vulvar carcinoma. The price of less radical surgery”. Cancer, 2002, 95, 2331.

[17] Stehman F.B., Bundy B.N., Ball H., Clarke-Pearson D.L.: “Sites of failure and times to failure in carcinoma of the vulva treated conservatively: a Gynecologic Oncology Group study”. Am. J. Obstet. Gynecol., 1996, 174, 1128.

[18] Monk B.J., Tewari K.S.: “Invasive cervical cancer”. In: DiSaia P.J., Creasman W.T. Clinical Gynecologic Oncology. St. Louis (MO): Mosby, 2002, 54.

[19] Morice P., Deyrolled C., Rey A., Atallah D., Pautier P., Camatte S., et al.: “Value of routine follow-up procedures for patients with stage I/II cervical cancer treated with combined surgery-radiation therapy”. Ann. Oncol., 2004, 15, 218.

[20] Bodurka-Bevers D., Morris M., Eifel P.J., Levenback C., Bevers M.W., Lucas K.R., Wharton J.T.: “Post therapy surveillance of women with cervical cancer: an outcomes analysis”. Gynecol. Oncol. 2000, 78, 187.

[21] Duyn A., Van Eijkeren M., Kenter G., Zwinderman K., Ansink A.: “Recurrent cervical cancer: detection and prognosis”. Acta Obstet. Gynecol. Scand., 2002, 81, 351.

[22] Ansink A., de Barros Lopes A., Naik R., Monaghan J.M.: “Recurrent stage IB cervical carcinoma: evaluation of the effectiveness of routine follow-up surveillance”. Br. J. Obstet. Gynaecol. 1996, 103, 1156.

[23] Stehman F.B., Bundy B.N., DiSaia P.J., Keys H.M., Larson J.E., Fowler W.C.: “Carcinoma of the cervix treated with radiation therapy. I. A multi-variate analysis of prognostic variables in the Gynecologic Oncology Group”. Cancer, 1991, 67, 2776.

[24] Burghardt E.: “Surgical Gynecologic Oncology”. New York, NY: Thieme Medical Publishers Inc., 1993, 185.

[25] Zola P., Fuso L., Mazzola S., Gadducci A., Landoni F., Maggino T., Sartori E.: “Follow-up strategies in gynecological oncology: searching appropriateness”. Int. J. Gynecol. Cancer, 2007, 17, 1186.

[26] Mabuchi S., Isohashi F., Maruoka S., Hisamatsu T., Takiuchi T., Yoshioka Y., Kimura T.: “Post-treatment follow-up procedures in cervical cancer patients previously treated with radioterapy”. Arch. Gynecol. Obstet., 2012, 286, 179.

[27] Reddoch J.M., Burke T.W., Morris M., Tornos C., Levenback C., Gershenson D.M., et al.: “Surveillance for recurrent endometrial carcinoma: development of a follow-up scheme”. Gynecol. Oncol., 1995, 59, 221.

[28] Berchuck A., Anspach C., Evans A.C., Soper J.T., Rodriguez G.C., Dodge R., et al.: “Postsurgical surveillance of patients with FIGO stage I/II endometrial carcinoma”. Gynecol. Oncol. 1995, 59, 20.

[29] Owen P., Duncan I.D.: “Is there any value in long-term follow-up of women treated for endometrial cancer? ”. Br. J. Obstet. Gynaecol., 1996, 103, 710.

[30] Salvesen H.B., Akslen L.A., Iversen T., Iversen O.E.: “Recurrence of endometrial carcinoma and the value of routine follow-up”. Br. J. Obstet. Gynaecol., 1997, 104, 1302.

[31] Agboola O.O., Grunfield E., Coyle D., Perry G.A.: “Costs and benefits of routine follow-up after curative treatment for endometrial cancer”. CMAJ, 1997, 157, 879.

[32] Shumsky A.G., Stuart G.C., Brasher P.M., Nation J.G., Robertson D.I., Sangkarat S.: “An evaluation of routine follow-up of patients treated for endometrial carcinoma”. Gynecol. Oncol., 1994, 55, 229.

[33] Tjalma W.A., van Dam P.A., Makar A.P., Cruickshank D.J.: “The clinical value and the cost-effectiveness of follow-up in endometrial cancer patients”. Int. J. Gynecol. Cancer, 2004, 14, 931.

[34] Lajer H., Jense M.B., Kilsmark J., Albæk J., Svane D., Mirza M.R., et al.: “The value of gynecologic cancer follow-up”. Int. J. Gynecol. Cancer, 2010, 20, 1307.

[35] Gadducci A., Cosio S., Fanucchi A., Cristofani R., Genazzani A.R.: “An intensive follow-up does not change survival of patients with clinical stage I endometrial cancer”. Anticancer Res., 2000, 20, 1977.

[36] Morice P., Levy-Piedbois C., Ajaj S., Pautier P., Haie-Meder C., Lhomme C., et al.: “Value of cost evaluation of routine follow-up for patients with clinical stage I/II endometrial cancer”. Eur. J. Can- cer, 2001, 37, 985.

[37] Smith C.J., Heeren M., Nicklin J.L., Perrin L.C., Land R., Crandon A.J., Obermair A.: “Efficacy of routine follow-up in patients with recurent uterine cancer”. Gynecol. Oncol., 2007, 107, 124.

[38] Fung-Kee-Fung M., Dodge J., Elit L., Lukka H., Chambers A., Oliver T., Cancer Care Ontario Program in Evidence-based Care Gynecology Cancer Disease Site Group: “Follow-up after primary therapy for endometrial cancer: a systematic review”. Gynecol. Oncol., 2006, 101, 520.

[39] Carrara L., Gadducci A., Landoni F., Maggino T., Scambia G., Galletto L., et al.: “Could different follow-up modalities play a role in the diagnosis of asymptomatic endometrial cancer relapse? ”. Int. J. Gynecol. Cancer, 2012, 22, 1013.

[40] Gadducci A., Cosio S., Zola P., Landoni F., Maggino T., Sartori E.: “Surveillance procedures for patients treated for epitelial ovarian cancer: a review of the literature”. Int. J. Gynecol. Cancer, 2007, 17, 21.

[41] Petruželka L., Fischerová D., Novotný J.: “Chemoterapie”. In: Cibula D., Petruželka L. Onkogynekologie. Praha: Grada Publishing, 2009, 544.

[42] Gadducci A., Fuso L., Cosio S., et al.: “Are surveillance procedures of clinical benefit for patients treated for ovarian cancer? A retrospective Italian multicentric study”. Int. J. Gynecol. Cancer, 2009, 19, 367.

[43] Chan K.K., Tam K.F., Tse K.Y., Ngan HY.: “The role of regular physical examination in the detection of ovarian cancer recurrence”. Gynecol. Oncol., 2008, 110, 158.

[44] Tanner E.J., Chi D.S., Eisenhauer E.L., Diaz-Montes T.P., Santillan A., Bristow R.E.: “Surveillance for the detection of recurrent ovarian cancer: survival impact of lead-time bias? ” Gynecol. Oncol., 2010, 117, 336.

[45] Geurts S., de Vegt F., van Altena A., Tjan-Heijnen V.C., Massuger L.F., Adang E.M., et al.: “Impact of routine follow-up examination on life expectacy in ovarian cancer patients”. Int. J. Gynecol. Oncol., 2012, 22, 1150.

[46] Gadducci A., Cosio S., Conte P.F., Genazzani A.R.: “Consolidation and maintenance treatments for patients with advanced epithelial ovarian cancer in complete response after first-line chemotherapy: a review of the literature”. Crit. Rev. Oncol. Hematol., 2005, 55, 153.

[47] von Georgi R., Schubert K., Grant P., Münstedt K.: “Post-therapy surveillance and after-care in ovarian cancer”. Eur. J. Obstet. Gynecol. Reprod. Biol., 2004, 114, 228.

[48] Rustin G.J.S., van der Burg M.E.L., Griffin C.L., Guthrie D., Lamont A., Jayson G.C., et al.: “Early versus delayed treatment of relapsed ovarian cancer (MRC OV05/EORTC55955): a randomised trial”. Lancet, 2010, 376, 1155.

[49] Geurts S.M.E.., van Altena A.M., de Vegt F., Tjan-Heijnen V.C., Massuger L.F., van Dijck J.A., Verbeek A.L.: “No supportive evidence for clinical benefit of routine follow-up in ovarian cancer: a Dutch multicenter study”. Int. J. Gynecol. Cancer, 2011, 21, 647.

[50] Verheijen R.H.M., Cibula D., Zola P., Reed N.: “Cancer antigen 125: lost of follow-up? A European Society of Gynecological Oncology. Consensus Statement”. Int. J. Gynecol. Cancer, 2012, 22, 170.