Surgical management of advanced or recurrent endometrial cancer.

Most patients who have endometrial cancer are diagnosed with early stage disease and have excellent long-term survival. For patients who have evidence of metastatic disease at surgery, there is a survival benefit to be gained if all gross evidence of disease can be resected. Even in cases in which complete gross excision cannot be attained, surgical debulking to small-volume residual disease leads to an improved prognosis compared with patients left with bulky residual disease. Patients with endometrial cancer who have not previously received pelvic irradiation and develop isolated pelvic recurrences can be effectively treated with pelvic radiotherapy. The treatment options for patients who develop recurrent disease are limited. Hormonal and chemotherapeutic treatments typically do not provide durable responses. In carefully selected patients with isolated central recurrences, pelvic exenteration is the only potential option for cure. Long-term survival has been achieved although complication rates are significant. Further investigation into the techniques of IORT may increase the pool of patients for whom surgically based salvage therapy may be offered.