Outcomes Following Salvage Radiation Therapy for Recurrent Endometrial Cancer in Patients with No Prior Adjuvant Therapy – An Institutional Review

Abstract Objective Following definitive surgery, women with early-stage, low-risk endometrial cancer are observed. However, some will require salvage radiotherapy for recurrence. The purpose of this study was to evaluate our experience using salvage radiation for recurrent endometrial cancer in patients who did not receive upfront adjuvant therapy. Methods Twenty-eight women with endometrial cancer who had undergone initial definitive hysterectomy without adjuvant therapy developed isolated local and/or regional recurrence and were treated with salvage radiation in our department from 2004-2018. Salvage radiation included whole pelvic radiation, vaginal brachytherapy, or both. Patient and tumor characteristics, treatment details, and toxicities were recorded and analyzed. Results The median time to first recurrence was 1.7 years. First recurrences consisted of local recurrence in twenty-three patients, regional recurrence in four, and both in one. The median times from hysterectomy to first recurrence, local and regional, were 1.2 and 4.0 years, respectively. All patients underwent salvage radiation for management of their first recurrence. The median total equivalent dose in 2 Gy fractions (EQD210) for this treatment was 67.6 Gy (37.5 – 81.8 Gy). Two second recurrences occurred following salvage treatment, both local recurrence, at 6.5 and 13.5 months after radiation. The 2-year rates of local control, disease-free survival, and overall survival were 93%, 80%, and 88%, respectively. Treatment was well-tolerated, with low rates of GI and GU toxicity. Conclusions In this group of patients, salvage radiotherapy for local and/or regional recurrence of endometrial cancer resulted in excellent control with low rates of acute and chronic toxicities.