Isolated Vaginal Recurrence of Endometrioid Endometrial Carcinoma

Endometrioid endometrial carcinoma (EEC) is the most common type of endometrial carcinoma. A small subset recurs exclusively in the vagina. Data on this group remain limited due to its low incidence and study heterogeneity, combining different histologies and recurrence sites. We describe 20 patients with isolated vaginal recurrence of EEC, focusing on tumor characteristics, treatment, time to recurrence, and outcomes. Vaginal recurrences occurred between 2015 and 2024. Patients with positive margins at primary surgery or persistent disease were excluded. Medical records and slides were reviewed. Median time to vaginal recurrence was 2 yr (range, <1->16 yr), with 85% occurring within 4 yr. Most recurrences were unifocal and at the vaginal apex, and all retained the primary tumor grade. High-grade EEC recurred 19 months earlier than low-grade (P=0.0227). Time to vaginal recurrence was not associated with other tumor features or postsurgical management. Complete remission was achieved in 65% of evaluable patients; among complete responders, 82% received radiotherapy (RT) alone. Second vaginal-only recurrences were uncommon (10%), and half were successfully salvaged. Five-year overall survival (OS) after primary tumor diagnosis was 89% (95% CI: 75%-100%) and after vaginal recurrence was 84% (95% CI: 66%-100%). Median follow-up after recurrence was 3.7 yr (95% CI: 1.0-5.7 yr). OS was associated with FIGO stage (P<0.0001) and lymphovascular invasion (P=0.0081). Five-year postrecurrence disease-free survival (PR-DFS) was 68% and was shorter in high-grade tumors (P=0.043) and in patients receiving adjuvant RT (P=0.013).