MAXIMAL CYTOREDUCTIVE SURGERY AS A REASONABLE THERAPEUTIC ALTERNATIVEFOR RECURRENT ENDOMETRIAL CARCINOMA

Objective. The objective was to determine if maximal cytoreductive sur gery could carry any benefit in pelvic and abdominal recurrent endomet rial carcinoma. Methods. Twenty women at their first large pelvic or a bdominal recurrence from endometrial carcinoma were treated with maxim al cytoreductive surgery. Women were classified as R1 (residual tumor) or RO (no residual tumor) by tumor left at the end of surgery. Adjuva nt postoperative therapy was undertaken upon clinical judgement. Progr ession-free, overall, and cancer-related survivals were analyzed with the product-limit method and compared with the log-rank test. The Cox regression model was used to study the variables involved in progressi on-free and overall survival. Results. Complete macroscopic resection of tumor was feasible in 13 women (65%). RO group women had a signific ant both progression-free (median reached at 9.1 months) and overall s urvival (median reached at 11.8 months) compared to R1 group women. Th ere were 2 (10%) perioperative deaths. Eight women died of cancer, 5 i n the R1 group and 3 in the RO group. There were four intercurrent dea ths in women still free from the disease. Local control of neoplasia w as achieved in 84.6% of RO women and their survival was affected mostl y by distant recurrences or intercurrent deaths. Residual tumor at the end of surgery was the only significant variable to affect both progr ession-free and overall survival. Conclusion. Intensive surgery is a v alid treatment option in women with large pelvic or abdominal recurren ce from endometrial carcinoma. Tumor can be completely resected and lo cal control of the disease can be achieved in most of the patients, al though survival could be affected by distant recurrence and intercurre nt deaths. (C) 1998Academic Press.