Dr. Anupama R., Clinical Assistant Professor in the Department of Surgical Oncology at the Amrita School of Medicine won the second prize for her research paper presented at the Annual Conference of the Association of Gynecologic Oncologists of India recently convened in Bhubaneshwar.

The research paper titled Recurrences in Carcinoma Endometrium – Lessons Learned was a retrospective analysis of all cases of carcinoma endometrium that were treated at the Amrita Institute of Medical Sciences during January 2004 – December 2008 with a special emphasis on the recurrence pattern.

Endometrial carcinomas refers to cancer in the endometrium, or lining, of the uterus. In developed countries, endometrial carcinomas are among the most common types of cancer that occur in women after breast, colorectal and lung cancers. The incidence of endometrial cancer is rising in India due to changes in lifestyles lately.

The Amrita doctor analyzed 145 new cases of carcinoma endometrium; of which 82 patients were operated upon at Amrita and 63 were operated upon in some other hospital and referred to Amrita for adjuvant treatment.

Of the cases analyzed, 48% were of low risk, 30% were of intermediate risk and 17% belonged to the high risk category.

“The analysis of our data showed that in patients with low-risk carcinoma endometrium, the disease was effectively treated by surgical management only. Even if the carcinoma recurred, it was contained in the local area,” explained Dr. Anupama.

“But in patients with intermediate or high risk endometrial cancers, external radiation did not give a survival benefit in spite of treatment with radiation post surgery. Additionally, patients suffered from side effects of the treatment. In some cases, the carcinoma recurred at distant sites including in the lungs, liver and abdomen.”

“Based on these results, external radiation was avoided and vaginal brachytherapy alone was given to patients in the intermediate risk category and to selected patients in the high risk category. This helped reduce the side effects of external radiation therapy, and survival rates were found to be similar.”

Dr. Anupama also noted that trials conducted worldwide for treatment of patients with intermediate risk carcinoma endometrium yielded similar findings.

“The PORTEC trial published in Lancet found that there is no survival benefit with adjuvant external radiation. The ASTEC /EN5 trial which was published in Lancet 2009 recommended that external radiation therapy should not be given as a routine for intermediate and high risk endometrial cancers. The PORTEC 2 trial published in Lancet 2010 said that vaginal brachytherapy alone is an effective adjuvant treatment in the high-intermediate risk patients with carcinoma endometrium,” she explained.

Based on the doctor’s research work and the inferences obtained, the treatment policy for intermediate and selected cases of high risk carcinoma endometrium at Amrita was changed from a combination of external radiation therapy and vaginal brachytherapy to vaginal brachytherapy alone.

Dr. Anupama joined Amrita in March 2009. In 2010, she won the best paper award in oncology at the All India Conference of Obstetricians and Gynecologists. That year, she was also nominated as a member of the Royal College of Obstetricians and Gynecologists, UK.

In 2011, Dr. Anupama received the International Gynecologic Cancer Society Traveling Scholarship for learning more about Minimally Invasive and Robotic Surgery in McGill University, Montreal, Canada.

January 25, 2012
School of Medicine, Kochi