POSTSURGICAL SURVEILLANCE OF PATIENTS WITH FIGO STAGE I II ENDOMETRIAL ADENOCARCINOMA/

Objective: To examine the effect of postsurgical surveillance on survi val of patients with FIGO stage I/II endometrial adenocaricinoma. Meth ods: We examined the records of 354 patients who underwent primary sur gical therapy for FIGO stage I/II endometrial adenocarcinoma. In patie nts who developed recurrent disease, we determined whether symptoms or signs of disease were present at recurrence and whether there was evi dence of disease on Pap smear or chest radiograph. Results: Among the 354 patients in this study, 44 (12%) developed recurrent disease. Site s of recurrence included 12 (27%) isolated vaginal, 12 (27%) pelvis wi th vagina or abdomen, 4 (10%) isolated lung, 13 (29%) pelvic/abdominal with other distant sites, and 3 (7%) other distant sites. At diagnosi s of recurrence 61% of patients had symptoms related to their cancer, 68% had physical exam findings suggestive of recurrence, and 84% had s ymptoms and/or signs. Findings consistent with recurrent cancer were d etected by Pap smear in 25% and on chest radiograph in 20%. Among the 44 patients who developed recurrent disease, 8 (18%) remain alive with out evidence of disease, including 6/12 (50%) with isolated vaginal di sease and 2/34 (6%) with other patterns of recurrent disease (P = 0.01 ). Among the 12 patients with isolated vaginal recurrence, 1/3 (33%) i n whom recurrent disease was diagnosed by Pap smear alone was salvaged compared to 5/9 (56%) who had symptoms or signs of vaginal recurrence . None of the three patients in whom an abnormal chest radiograph was the only evidence of recurrence survived. Conclusions: Because of the low recurrence rate of FIGO stage I/II endometrial cancer and the pauc ity of effective second-line treatment, surveillance Pap smears and ch est radiographs appear to have little impact on survival. Although few asymptomatic potentially curable recurrences were detected due to sur veillance examinations, the value of psychological reassurance associa ted with a normal examination is difficult to quantitate. (C) 1995 Aca demic Press, Inc.