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Beleid bij recidief/gemetastaseerd endometriumcarcinoom

Beleid bij recidief/gemetastaseerd endometriumcarcinoom. Philippe Van Trappen MD PhD Gynaecologisch/Oncologisch chirurg AZ Sint-Jan Brugge. VVOG Jaarcongres 10-11/10/2013 Genk. Beleid bij recidief/gemetastaseerd endometriumcarcinoom. Inhoud:

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Beleid bij recidief/gemetastaseerd endometriumcarcinoom

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  1. Beleid bij recidief/gemetastaseerd endometriumcarcinoom Philippe Van Trappen MD PhD Gynaecologisch/Oncologisch chirurg AZ Sint-Jan Brugge VVOG Jaarcongres 10-11/10/2013 Genk

  2. Beleid bij recidief/gemetastaseerd endometriumcarcinoom • Inhoud: • Locatie recidief/metastasen endometrium carcinoom • Beeldvorming bij diagnose van recidief/metastasen • Chirurgie bij recidief endometrium carcinoom • Chemotherapie bij recidief/gemetastaseerd endometrium carcinoom • Moleculaire target therapieën

  3. Locatie van recidief/gemetastaseerd endometriumcarcinoom . Location of Disease in Patients Who Die From Endometrial Cancer: A Study of 414 Patients From a Single Institution. Barlin, Joyce; Wysham, Weiya; Ferda, Aaron; Khoury-Collado, Fady; Cassella, Danielle; Alektiar, Kaled; Hensley, Martee; Chi, Dennis; Barakat, Richard; Abu-Rustum, Nadeem International Journal of Gynecological Cancer. 22(9):1527-1531, November 2012

  4. Location of Disease in Patients Who Die From Endometrial Cancer: A Study of 414 Patients From a Single Institution. Barlin, Joyce; Wysham, Weiya; Ferda, Aaron; Khoury-Collado, Fady; Cassella, Danielle; Alektiar, Kaled; Hensley, Martee; Chi, Dennis; Barakat, Richard; Abu-Rustum, Nadeem International Journal of Gynecological Cancer. 22(9):1527-1531, November 2012. TABLE 1 Follow-up status of patients with endometrial cancer 2

  5. Location of Disease in Patients Who Die From Endometrial Cancer: A Study of 414 Patients From a Single Institution. Barlin, Joyce; Wysham, Weiya; Ferda, Aaron; Khoury-Collado, Fady; Cassella, Danielle; Alektiar, Kaled; Hensley, Martee; Chi, Dennis; Barakat, Richard; Abu-Rustum, Nadeem International Journal of Gynecological Cancer. 22(9):1527-1531, November 2012. TABLE 2 Clinical characteristics of all patients with endometrial cancer and patients who died of the disease FIGO IB (2009) 3

  6. Location of Disease in Patients Who Die From Endometrial Cancer: A Study of 414 Patients From a Single Institution. Barlin, Joyce; Wysham, Weiya; Ferda, Aaron; Khoury-Collado, Fady; Cassella, Danielle; Alektiar, Kaled; Hensley, Martee; Chi, Dennis; Barakat, Richard; Abu-Rustum, Nadeem International Journal of Gynecological Cancer. 22(9):1527-1531, November 2012. TABLE 3 Location of disease at the time of death for patients with endometrial cancer who died of the disease 4

  7. Location of Disease in Patients Who Die From Endometrial Cancer: A Study of 414 Patients From a Single Institution. Barlin, Joyce; Wysham, Weiya; Ferda, Aaron; Khoury-Collado, Fady; Cassella, Danielle; Alektiar, Kaled; Hensley, Martee; Chi, Dennis; Barakat, Richard; Abu-Rustum, Nadeem International Journal of Gynecological Cancer. 22(9):1527-1531, November 2012. FIGURE 1 . Location of disease at time of death for patients with endometrial cancer who died of the disease. 5

  8. Location of Disease in Patients Who Die From Endometrial Cancer: A Study of 414 Patients From a Single Institution. Barlin, Joyce; Wysham, Weiya; Ferda, Aaron; Khoury-Collado, Fady; Cassella, Danielle; Alektiar, Kaled; Hensley, Martee; Chi, Dennis; Barakat, Richard; Abu-Rustum, Nadeem International Journal of Gynecological Cancer. 22(9):1527-1531, November 2012. TABLE 4 Adjuvant treatment for patients who died of disease 6

  9. Endometriumcarcinoom patienten die overlijden aan hun ziekte: overlevingsduur na primaire diagnose? • - Mediane ziekte-vrije overleving: 12.3 maanden (0.4-98.6 maanden) • Mediane overleving: 20.5 maanden (0.4-116.4 maanden) • 80% recidiveert binnen de eerste 24 maanden • Type I endometriumcarcinoom (endometrioïde type): • mediane overleving: 25.8 maanden • Type II/high risk endometriumcarcinoom (UPSC, Clear cel ca): • mediane overleving: 16.4 maanden

  10. Identificeren van recidief/gemetastaseerd endometriumcarcinoom

  11. PET-CT in identificeren locatie recidief/gemetastaseerd endometriumcarcinoom: SENSITIVITEIT

  12. PET-CT in identificeren locatie recidief/gemetastaseerd endometriumcarcinoom: SPECIFICITEIT

  13. PET-CT in follow-up bij symptomatische/asymptomatische patiënten met endometriumcarcinoom

  14. Chirurgie recidief endometriumcarcinoom: bij wie? Locoregionaal recidief/letsel in voorheen bestraalde regio (evidentie: level C). Enkel indien maximale resectie mogelijk is, cfr meta-analyse 2010 (vroeger enkel exenteratie als type chirurgie). Rekening houden met co-morbiditeiten (cave: obesitas; cardiovasculair, etc.) Is patiente fit voor debulking chirurgie/exenteratie?

  15. FIT FOR SURGERY?

  16. 14 retrospective studies (n patients: 20 to 75) • 1997-2009 • Total of 672 patients • Optimal cytoreduction: 52% to 75% • Complete surgical resection: 18% to 75%

  17. Complete chirurgische resectie bij locaal gevorderd of recidief endometriumcarcinoom (GOG 122)

  18. Beleid (palliatief) bij metastasen op afstand van een endometriumcarcinoom (Evidentie: level C) * Fiorica JV et al, Gynecol Oncol, 2004 (GOG): Response Rate 27%, Median OS 14 maanden.

  19. Chemotherapie voor recidiverend/gemetastaseerd endometrium carcinoom: mono- of combinatietherapie? Grisham RN et al, Int J Gynecol Cancer, 2012 Nomura H et al, Ann Oncol, 2011 Katsumata N et al, Br J Cancer, 2005

  20. Chemotherapie voor recidiverend/gemetastaseerd endometrium carcinoom: mono- of combinatietherapie? • Nomura H et al, Ann Oncol, 2011 • Sorbe B et al, Int J Gynecol Cancer, 2008 • Egawa-Takata T et al, Cancer Chem Pharm, 2011 • du Bois A et al, Gynecol Oncol, 2007

  21. Gemcitabine for Advanced Endometrial Cancer: A Retrospective Study of the Memorial Sloan-Kettering Cancer Center Experience. Grisham, Rachel; Adaniel, Christina; Hyman, David; Ma, Weining; Iasonos, Alexia; Aghajanian, Carol; Konner, Jason International Journal of Gynecological Cancer. 22(5):807-811, June 2012.

  22. Gemcitabine for Advanced Endometrial Cancer: A Retrospective Study of the Memorial Sloan-Kettering Cancer Center Experience. Grisham, Rachel; Adaniel, Christina; Hyman, David; Ma, Weining; Iasonos, Alexia; Aghajanian, Carol; Konner, Jason International Journal of Gynecological Cancer. 22(5):807-811, June 2012. TABLE 3 Response by histology 4

  23. 2 verschillende casussen recidief endometriumcarcinoom “almost 40% can be salvaged” (Rosenberg et al, 1993) “all patients who recurred from their UPSC died of their disease (Rosenberg et al, 1993)

  24. Toekomst: moleculaire targets in endometrium carcinoom

  25. Moleculaire target therapie in endometrium carcinoom

  26. Moleculaire target therapie in endometrium carcinoom: Phase II trials

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