title: Efficacy of routine follow-up in patients with recurrent uterine cancer.
abstract: OBJECTIVE
  To evaluate the efficacy of routine follow-up in patients with recurrent uterine cancer.
  
  
  METHODS
  In a single institution study, a total of 2637 patients were treated curatively for uterine cancer from 1990 to 2006. A total of 438 patients experienced disease recurrence. Data for detailed analysis were available from 280 of the 438 patients. Prior to the diagnosis of recurrence, all patients had regular follow-up and were investigated through internal examination, vaginal vault cytology and imaging. Overall survival (OS) was the main study endpoint and was calculated from recurrence diagnosis to death or date censored.
  
  
  RESULTS
  Clinical and histopathological features as well as patterns of recurrence were similar in symptomatic and asymptomatic patients. Eighty-one patients (28.9%) were diagnosed with asymptomatic recurrence while 199 patients (71.1%) presented with symptomatic recurrence. The overall survival probability at 5 years was 41.0% and 28.9% respectively for asymptomatic and symptomatic patients (log-rank p=0.013). Those patients with stage 1 or 2 tumors of endometrioid type were found to have an overall survival probability at 5 years of 38.0% and 25.7% respectively for asymptomatic and symptomatic recurrence (log-rank p=0.05). The absence of symptoms did not impact on the outcome of patients with stage 3 tumors or tumors of non-endometrioid type.
  
  
  CONCLUSIONS
  While patients at low/intermediate risk of recurrence may benefit from intensive follow-up including internal examinations, routine vaginal vault cytology and imaging, high-risk patients might gain more from an alternate follow-up strategy with emphasis on imaging in conjunction with symptom education.
authors.affiliation: Queensland Centre for Gynecological Cancer, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Smith
authors.forename: Monique
authors.initials: M
authors.lastname: Heeren
authors.forename: James L
authors.initials: JL
authors.lastname: Nicklin
authors.forename: Lewis C
authors.initials: LC
authors.lastname: Perrin
authors.forename: Russell
authors.initials: R
authors.lastname: Land
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Crandon
authors.forename: Andreas
authors.initials: A
authors.lastname: Obermair
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018269:Carcinoma, Endometrioid / Q000628:therapy*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D014594:Uterine Neoplasms / Q000628:therapy*