To evaluate the need of new therapeutic strategies by analysis of initial failure site in advanced staged endometrial carcinoma and the spread pattern in recurrent endometrial cancer.

This retrospective study was undertaken in an attempt to identify initial failure sites and spread patterns in patients with endometrial carcinoma. A retrospective clinicopathologic review of 301 patients treated from 1995 to 2003 at Seoul Asan Medical Center was performed. Especially our study was focused on the 59 women with advanced stage and 26 patients with recurrence. All Patients with advanced stage underwent total hysterectomy, bilateral salpingo- oophorectomy and pelvic and/or paraaortic lymphadenectomy. Postoperative adjuvant therapy was given to the patients with the risk factors of recurrence.

Of the 301patients, 296 had no evidence of residual disease after initial treatment and 5 had confirmed residual disease. Of the301 patients, 26 (8.6%) suffered recurrence. The recurrence rates for stage I, II, III, and IV were 1.3% (3/222), 0% (0/0), 38.7% (19/49), and 40% (4/10), respectively. Of the 26 patients who recurred, 4 (15.4%) experienced local failure, 15 (57.6%) had distant failure without peritoneal spread, and 7 (26.9%) had distant failure with peritoneal spread. In distant failure, the incidence of peritoneal spread and lymph node metastasis was higher (57.6%, 15/26) than other recurrent site. The number of distant failure in the patients with postoperative adjuvant radiotherapy was more than chemotherapy in advanced staged endometrial cancer.

peritoneal dissemination and lymph node spread is an important failure pattern and should be considered a top priority in an attempt to improve survival in patients with endometrial carcinoma. We conclude that adjuvant chemoradiation therapy will be useful and effective therapeutic strategy in recurrent and advanced stage endometrial cancer although the role of chemoradiation is debatable.