According to study findings presented at the virtual 2021 American Society of Clinical Oncology (ASCO) Annual Meeting, the use of frequent routine imaging and laboratory exams in patients treated for endometrial cancer should be discouraged.

For patients with cancer, intensive follow-up can be a source of increased stress, and is often proposed on the notion that early recognition of relapse can lead to better outcomes.

Among patients with endometrial cancer in particular, data are lacking on whether routine serum, cytologic, or imaging follow-up can actually improve overall survival (OS) and quality of life (QoL).

Thus, Paolo Zola, MD, PhD, Department of Surgical Sciences, University of Turin, Italy, and colleagues developed the TOTEM study to compare an intensive (INT) versus minimalist (MIN) 5-year follow-up regimen in patients with endometrial cancer with regard to OS.

A total of 1884 patients surgically treated for endometrial cancer at 42 centers between 2008 and 2018, and in complete clinical remission, were stratified based on their cancer center and their low or high risk for recurrence. These patients were then randomized to receive INT or MIN follow-up regimens.

The primary end point of the study was to demonstrate an improvement from 75% to 80% (expected hazard ratio [HR], 0.78) of the 5-year OS with the INT regimen. The secondary end points were to compare relapse-free survival, health-related QoL (HRQoL), and costs.

Ultimately, 1847 patients (60% low-risk) were available for the final analysis. There was an approximately 75% compliance rate with the follow-up visits between both INT and MIN arms, whereas the INT arm had a markedly higher mean number of recorded exams than the MIN arm (9.7 vs 2.9, respectively; P <.0001).

After a median follow-up of 66 months, the 5-year OS was 91.3% overall, and 90.6% in the INT arm versus 91.9% in the MIN arm (HR, 1.12; 95% CI, 0.85-1.48; P = .429). When comparing the INT and MIN arms, the 5-year OS rates were 94.1% and 96.8% (HR, 1.48; 95% CI, 0.92-2.37; P = .104) in the low-risk group and 85.3% and 84.7% (HR, 0.96; 95% CI, 0.68-1.36; P = .814) in the high-risk group.

Of note, there were no relevant differences in relapse-free survival between INT and MIN regimens (HR, 1.13; 95% CI, 0.87-1.48; P = .365), and most patients were asymptomatic at the time of relapse. HRQoL was only available for 1 subgroup (50% at baseline) and did not differ between arms.

“Intensive follow-up in endometrial cancer treated patients showed a weak and uncertain advantage in detecting earlier asymptomatic relapses but did not improve OS, even in high-risk patients, nor influenced HRQoL,” reported Dr Zola and colleagues, who concluded that the use of frequent routine imaging and laboratory exams among these patients should be discouraged.—Hina Porcelli

Zola P, Ciccone g, Piovano E, et al. Intensive versus minimalist follow-up in patients treated for endometrial cancer: A multicentric randomized controlled trial (The TOTEM study—NCT00916708). Presented at: the 2021 ASCO Annual Meeting; June 4-8, 2021; virtual. Abstract 5506.