Treatment of pulmonary recurrences in patients with endometrial cancer

Objective: To assess the treatment and outcome of patients with endometrial cancer following isolated pulmonary relapse. Methods: Between 1984 and 1996, 82 of 1109 patients undergoing surgery for primary endometrial cancer experienced a primary pulmonary recurrence, 28 of which were solitary. Median follow up of censored patients after isolated pulmonary recurrence was 159 months. Results: Grade 1/2 disease, pulmonary nodule size < 2 cm, and the presence of estrogen receptors (ER) were significant (p < 0.05) predictors of improved disease specific survival (DSS) in the 28 patients with an isolated lung recurrence. Median DSS for the 11 patients with grade 1/2 tumors and pulmonary nodules measuring ≤ 2 cm was 98 months. Treatment with hormonal therapy, surgery, or combination therapy was not predictive of survival after recurrence. In contrast, median DSS for patients treated with chemotherapy was 14 months vs. 28 months for those treated with other modalities (p = 0.04). Median DSS was 28 months for patients treated with hormonal therapy compared to 18 months for those who underwent surgical resection (p = NS). Conclusion: Patients with grade 1/2 endometrial cancer and isolated pulmonary recurrences measuring less than 2 cm have appreciable median DSS, 98 months in this series. Treatment with chemotherapy appears to be associated with poor outcomes, but this finding was likely to be confounded by indication. Compared to treatment with hormonal therapy, thoracotomy was not associated with a survival advantage. Although potentially confounded by selection bias, these data suggest that initial hormonal therapy may offer the greatest risk/benefit ratio for patients with low grade isolated pulmonary failures.