title: Vaginal vault recurrences of endometrial cancer in non-irradiated patients - Radiotherapy or surgery.
abstract: BACKGROUND
  The treatment of locally recurrent endometrial cancer is based on limited evidence. The standard treatment is radiotherapy (RT) which is effective for local control and the effect has been documented in prospective studies. Investigations of surgical treatment (ST) of recurrences are few and limited to previously irradiated patients or patients with advanced disease. Investigation of surgical treatment for isolated vaginal vault recurrence is practically nonexistent. The aim of this study is to evaluate the efficacy of RT and ST in a non-irradiated group with recurrent endometrial cancer limited to the vaginal vault.
  
  
  METHODS
  Patients treated for recurrent endometrial cancer at Odense University Hospital, Denmark between 2003 and 2012 were identified, n = 118. Thirty-three patients had an isolated vaginal vault recurrence and were treated with either RT, ST or both. Re-recurrence rates and survival rates were calculated at 2 year follow-up using Fishers exact test.
  
  
  RESULTS
  Twenty-six patients were treated with RT, 5 with ST, 2 with both. The mean (SD) follow-up-time was 4.4 years (2.99) (RT) and 3.9 years (0.90) (ST). Two year re-recurrence rates were 40% (RT) (95 CI 9.2-48%) and 0% (ST) (95 CI 0-60%). Two-year survival rates were 83% (RT) (95 CI 71-100%) and 100% (ST) (95 CI 40-100%) ST had one re-recurrence at 2.3 years.
  
  
  CONCLUSIONS
  This study indicates that ST is an appropriate treatment for locally recurrent endometrial cancer. Our study involves a limited number of patients and is made retrospectively, therefore prospective and ideally randomized trials evaluating both survival and complications are warranted.
authors.affiliation: Department of Obstetrics and Gynecology, Odense University Hospital, Denmark.
authors.forename: Hordur Alexander
authors.initials: HA
authors.lastname: Hardarson
authors.affiliation: Department of Obstetrics and Gynecology, Odense University Hospital, Denmark.
authors.forename: Lene Nyhøj
authors.initials: LN
authors.lastname: Heidemann
authors.affiliation: Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Denmark.
authors.forename: René
authors.initials: R
authors.lastname: dePont Christensen
authors.affiliation: Department of Obstetrics and Gynecology, Odense University Hospital, Denmark.
authors.forename: Ole
authors.initials: O
authors.lastname: Mogensen
authors.affiliation: Department of Obstetrics and Gynecology, Odense University Hospital, Denmark.
authors.forename: Kirsten M
authors.initials: KM
authors.lastname: Jochumsen
keywords: Cancer; Endometrial; Radiotherapy; Recurrence; Surgery; Vault