Treatment failure in endometrial carcinoma

Endometrial carcinoma has been regarded as one of the more curable gynecologic malignancies. Clinical stage, grade, and depth of myometrial invasion are well-established prognostic variables. We examined the clinical course of 520 patients with endometrial carcinoma treated at Walter Reed Army Medical Center and the Naval Hospital, Bethesda, Maryland, between January 1, 1960 and December 31,1982. Life table 5-year survivals for stages la, Ib, II, III, and IV were 89, 92, 77, 27, and 0%, respectively. Compared with patients with grade 1 endometrial adenocarcinomas, significant decreases in survival were noted for patients with grade 2 or 3 endometrial, papillary endometrioid, serous papillary, and clear-cell tumors. There were six treatment-related deaths (1.2%). Thirty-eight patients (7.3%) developed recurrent disease, with a median time to recurrence of 15 months and a median survival of 21 months. Two of 11 patients with pelvic recurrence were salvaged by radiotherapy, whereas none of 27 patients with distant failure survived. Sixteen advanced-stage patients (3.1%) with persistent disease had a median survival of 4.5 months. Patients with advanced disease or unfavorable histologic subtypes responded poorly to conventional therapy. Current salvage treatments are largely ineffective. Combined-modality therapy and systemic adjuvant therapy should be prospectively evaluated in high-risk patient subgroups.