A 58-year-old woman develops vaginal vault recurrence of endometrioid adenocarcinoma two years after surgery and radiotherapy. The recurrent tumour is Grade 1, and immunohistochemistry shows strong oestrogen and progesterone receptor positivity. Which systemic therapy offers the best chance of disease control in this situation?

• A Whole abdominal radiation
• B Carboplatin plus paclitaxel
• C Pelvic exenteration
• D Megestrol acetate or medroxyprogesterone acetate ✓

Explanation

Well-differentiated, hormone receptor positive endometrial carcinoma recurs indolently and responds to progestational agents such as megestrol or medroxyprogesterone, with response rates highest in Grade 1 tumours expressing receptors; response correlates inversely with tumour grade. Platinum-taxane chemotherapy is generally held for hormone refractory or high-grade disease. Exenteration is a radical pelvic surgical option unsuited here, and repeat radiation to a previously irradiated field risks unacceptable morbidity and is not standard.

Reference: Berek and Novak's Gynecology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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