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« Back to Contents MISCELLANEOUS

LiFE re

Literature for ENYGO

Follow-up after gynaecological malignancies

Editor Anne van Altena

Descriptive summary Ye and colleagues asked all Canadian radiation oncologists about
their experiences with follow-up. This survey dealt not only with
General: Zola et al. analysed the follow up strategies for ovarian, oncologists treating gyneacological cancer patients but the complete
endometrial, and cervical cancer. All of the topics discussed arose field of oncology. Most would follow up gyneacological patients.
from the “ESGO State of Art Conference-Follow-up in gyneacological Lack of resources and a belief that follow-up by family physicians is
malignancies” in Turin. The main conclusion was that all surveillance equally effective were the top reasons for not following. Treatment
procedures should be evidence-based with a clearly defined purpose: toxicity and possibility of further treatment were the most common
there is a need for prospective studies to compare the effectiveness reasons for routine follow-up. Transfer of follow-up care to family
of different follow-up regimens measuring overall survival, detection practitioners turned out to be desired and feasible.
of recurrence, quality of life (QoL), and costs as outcomes. So far,
this literature is lacking. Cost effectivnes of follow-up: One study group looked at the
available literature on costs of follow-up. They evaluated 2 studies
Faubian and colleagues wrote a, what they call, narrative review on gyneacologic cancers in general, 3 specific on ovarian cancer, 7
of the data and guidelines regarding care and surveillance of the on endometrium, and 9 on cervix. The identified economic literature
gyneacologic cancer survivor based on a non-systematic literature on economic evaluation of gyneacologic cancer follow-up procedures
search. They offer clinical recommendations for the management showed to be based on weak evidence of effectiveness and that
of gyneacologic cancer survivors based on this literature and their they lack formal methodological approaches. They concluded that
collective clinical experience. They conclude that a holistic approach no properly designed randomised trials including cost-effectiveness
to care extending beyond cancer treatment alone benefits gynea- analysis are available.
cologic cancer survivors with guidance on hormonal, contraceptive,
and fertility management and promotion of cardiovascular, bone,
brain, and sexual health.

Another review, written by Elit et al provides recommendations re-
garding follow-up care for women with gyneacologic malignancies.
They too state that there is very little high-quality evidence available
to guide follow-up care.

Endometrial cancer: A report from a consensus conference on
endometrial cancer has been published. This report summarises
the recommendations of a multidisciplinary panel of 40 leading
experts in the management of endometrial cancer. Although the title
suggests follow-up will be discussed as well, the recommendations
do not apply to the follow-up of endometrial cancer patients who
underwent primary and adjuvant therapy.

Angioli et al. evaluated the role of HE4, at primary diagnosis and as
an indicator of endometrial cancer recurrence. It is a retrospective
study on 252 patients. HE4 levels at primary diagnosis correlated
with an increased risk of recurrent endometrial cancer (especially
in endometrioid histology). HE4 cut-off of 201.3 pmol/L is able to
correctly classify patients at high or low risk of EC recurrence, with
a sensitivity of 80 % and a specificity of 91 %. So the marker could
be used to identify patients who need a more intensive follow-up
regimen but it is not used to identify recurrences.

Continued on the next page 

International Journal of Gynecological Cancer, Volume 26, Supplement #1 Page 59