Up-to-date ACR recommendations available for managing patients with recurrent endometrial cancer

Noting that endometrial cancer (EC) is the most common cancer of the female reproductive organs, an expert panel reports that it has developed and refined ACR appropriateness criteria on the management of patients with recurrent EC across its most common clinical variants.

The report was lead-authored by Mohamed Elshaikh, MD, of Henry Ford Health System in Detroit. It was published online July 8 in the American Journal of Clinical Oncology.

Reviewing the literature, the authors scrutinized 77 references cited in the ACR’s Appropriateness Criteria Management of Recurrent Endometrial Cancer document published from 1968 to 2015.

“Although there are references that report on studies with design limitations, 49 well designed or good quality studies provide good evidence,” they write in their summary of evidence.

In women with EC, tumor recurrences tend to occur in the two- to three-year period following surgical staging. Management of recurrence with this cancer poses significant challenges, Elshaikh et al. write, as no randomized controlled trials have been published to determine optimal management in this group of patients.

Hence the convening of the expert panel with ACR’s blessing.

In general, the authors point out, curative management can include radiation therapy, surgical resection, chemotherapy, hormonal treatment or any combination of these modalities.

As for imaging, when recurrence is suspected, “a complete restaging workup should include at least computed tomography (CT) with contrast of the abdomen and pelvis,” they write. “If a patient is unable to have CT with contrast, then magnetic resonance imaging, ideally with gadolinium, should be considered as an alternative.”

The authors note that the role of FDG-PET/CT for imaging endometrial cancer remains controversial—despite the highly accurate performance of the modality for detecting nodal recurrences in numerous trials. Elshaikh and team cite a recent meta-analysis with over 500 patients that showed a sensitivity of 95.8 percent and specificity of 92.5 percent with FDG-PET in detecting recurrent EC.

“In combining available medical literature and expert opinions, this manuscript may serve as an aid for other practitioners in the appropriate management of women with recurrent EC,” the authors conclude in their abstract.

AJCO publisher Wolters Kluwer has posted, for free, a PDF of the full report as a revised version of the related ACR guidelines