Management of recurrent endometrial carcinoma

Management of recurrent endometrial carcinoma has traditionally focused on providing targeted adjuvant therapy in select groups of patients based on their risk factors. Major progress has been made over the last two decades in identifying these clinical-pathological risk factors, which has led to the classification of patients into different risk groups. Patients with high-risk factors are generally treated with adjunctive radiation therapy immediately following surgery to minimize the incidence of recurrence. Those patients identified as low-risk generally receive no further treatment. Patients with intermediate-risk factors are individualized either to receive adjunctive therapy or not to receive further therapy based on institutional bias. Review of the literature suggests this traditional treatment strategy may reduce local recurrence, but fails to improve overall survival. Further studies to identify molecular based biomarkers may improve current classification of risk factors and the selection of patients for adjunctive therapy. Once the recurrence takes place, loco-regional disease can be treated with radiation therapy with reasonable success. Targeted radiotherapy and several cytotoxic chemotherapeutic agents are effective in the treatment of systemic recurrent disease. Hormonal therapy has also been demonstrated to be useful in selected group of patients for palliative purpose. The current areas of controversy and debate include the efficacy of adjunctive therapy, mode of therapy, timing of therapy, and issues related to surgical staging of patients as required by the current FIGO staging system.