Bony metastases as identified by PET/CT in early stage and advanced endometrial cancer

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Abstract

Objectives: Recurrences of endometrial cancer are typically confined to the pelvis with distant recurrences primarily seen in lymph nodes, lung, or liver. Bone metastases in endometrial cancer are thought to be rare. As such, studies of bone metastasis in endometrial cancer are few, and there is little data to guide management. In this study we aimed to quantify the rate of bony metastasis in endometrial cancer as stratified by histology. Methods: 220 charts of patients with the diagnosis of endometrial cancer presenting as new consults to a single institution gynecologic oncology academic practice between 2013-2016 were reviewed. Abstracted data included age at diagnosis, treatment received, imaging modalities used for surveillance, symptoms leading to imaging, treatment received for bony metastases, overall survival (OS), and survival from diagnosis of bony metastases. Abstracted data was analyzed with descriptive statistics. Results: 10/219 (5%) patients were found to have bony metastases. 7 patients diagnosed with bony metastases had stage IV disease, 2 patients had stage I clear cell or serous cancer, 1 patient had stage 11 grade 2 endometrioid cancer. Bone metastases were detected by PET/CT in 9/10 (90%) cases, 1 with CT scan alone. 5/10 patients were asymptomatic from bony metastases, 4 had back or hip pain, 1 had urinary retention and gait instability. Overall, 59/219 patients presented with at least stage III disease, 7/59 (12%) patients with stage III-IV disease were found to have bony metastases, with 6/7 cases detected by PET/CT. At time of follow up, 2/10 patients were dead of disease, with survival post bony metastases diagnosis ranging from 3-17 months, OS ranging from 3-68 months. Treatment modalities were multi-disciplinary including hospice/palliation (4 patients), radiation alone (1 patient), surgery alone (1 patient), radiation alone (1 patient), denosumab (1 patient), and multi-modality treatment of surgery, radiation, and denosumab (2 patients, OS 68 months and OS not reached). Conclusions: Bony metastases may be more prevalent in advanced endometrial cancer than previously believed, with higher detection rate by imaging via PET/CT scans. Treatment modalities are variable, with preferred treatment course yet to be determined. Further data on a larger scale is forthcoming regarding incidence of bony metastases in endometrial cancer, OS, and preferred treatment. Learning objective: Learners will be able to describe the suspected bony metastases rate in endometrial cancer. Learners will explore the roles of CT vs PET/CT in detection of endometrial cancer. Learners will be able to describe treatment approaches for patients with endometrial cancer and bony metastases.
Original languageAmerican English
Pages (from-to)225
JournalGynecologic Oncology
Volume147
Issue number1
DOIs
StatePublished - Oct 2017

Disciplines

  • Radiology
  • Medicine and Health Sciences
  • Surgery

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