Laparotomy wound recurrence of endometrial carcinoma

OBJECTIVES: Most endometrial cancer relapses are either pelvic or distant metastases. Recurrences in the laparotomy scar are extremely rare, as to our knowledge this is only the sixth reported case and the first treated with brachytherapy. We also present a review of the literature with an emphasis on radiation therapy treatment. CASE: A 64-year-old woman underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy for IIIA endometrial adenocarcinoma, followed by systemic chemotherapy and pelvic external-beam radiotherapy. Three years later, a recurrence in the laparotomy scar was resected and additional chemotherapy was administered. A solitary mass in the abdominal wound was then found 4 years after that and was reirradiated by combining external-beam radiation therapy and interstitial brachytherapy after complete resection. Histology of the abdominal wall implants was very similar to that of the primary tumour. CONCLUSIONS: Laparotomy wound recurrence (LWR) for endometrial cancer usually appears as a solitary mass that grows slowly without concomitant failure sites a few years after hysterectomy. In these six patients there is no common histology pattern that could suggest predictive factors for LWR. Common postoperative irradiation does not deliver sufficient a dose to the anterior abdominal wall to prevent this kind of failure.