ABSTRACT
Uterine leiomyosarcomas are rare aggressive tumors, with high recurrence rates, even when confined to the uterine corpus at the time of diagnosis. It arises from smooth muscle of uterus and is a rare tumor that accounts for 2-5% of all uterine malignancies. These tumors typically spread hematogenously. Patients present with vague symptoms similar to those of patients with leiomyomas. Most patients are diagnosed with leiomyosarcoma postoperatively. Although prognosis remains dismal, various ongoing studies are investigating the role of advanced imaging, multimodality treatment, prognostic nomograms, and unique biomedical pathways to increase understanding of leiomyosarcoma and improve therapeutic options for patients. 46 years old para2 live2 postmenopausal (since 1.5 year) female presented to outpatient clinic with complaints of bleeding per vaginum, foul smelling discharge, unquantified weight loss and something coming out of vagina since 1.5 months. On abdominal examination, an irregular midline mass arising from pelvis corresponding to 20 weeks gestational size of uterus was present. On vaginal examination, 3 infected vaginal growths were present in vagina maximum 4x4cm. Intra-operatively, uterus was nearly 20 weeks size with irregular surface. A 3×3 cm subseroal fibroid with necrotic surface was present on posterior wall of uterus. Cut section of the operative specimen showed myohyperplasia which was compressing the uterine cavity, some necrotic areas were also present. Vaginal growths - 4×4 cm on left vaginal wall near introitus with necrotic surface, 3×3 cm on right vaginal wall, 1×1 cm on right upper vaginal wall present. Excision of vaginal growth was done and was sent for histopathology. Histopathologic examination of sections of uterus showed all features were suggestive of leiomyosarcoma uterus.
ABSTRACT
Objective:This study aimed to assess the efficacy of comprehensive laparoscopic surgical staging in early-stage ovari-an cancer, and provide references for clinical practice and research. Methods: Electronic databases, such as Embase, Medline, Co-chrane Library, CBM, and CNKI, were searched for studies on comprehensive laparoscopic surgical staging versus comprehensive lapa-rotomic surgical staging. Other sources, such as related references, were also retrieved. The literature was screened according to inclu-sion criteria. Data were extracted from the selected references, and the quality of the included studies was assessed. This meta-analysis was performed using RevMan 5.2 software. Results:A total of 11 studies involving 591 cases were selected, of which 235 cases be-longed to the laparoscopy group and 356 belonged to the laparotomy group. No statistically significant differences were observed be-tween groups in age, body mass index, clinical stage, histological type, and histological grade. The laparoscopy group had less intraoper-ative blood loss, earlier general diet intake, less postoperative complications, and lower postoperative recurrence rate than the laparoto-my group. No statistically significant difference was observed between groups in operation time, pelvic lymph node number (apart from pelvic and para-aortic lymph nodes), mortality. Conclusion:The results of this systematic review show that laparoscopic surgical stag-ing of early-stage ovarian cancer demonstrated staging adequacy and accuracy that were similar to those of laparotomic surgical stag-ing. Based on the principle of minimal invasion and radical treatment to tumor, laparoscopy showed more favorable operative outcomes than laparotomy.
ABSTRACT
PURPOSE: The aim of this retrospective study is to assess the necessity of staging laparotomy in the management of supradiaphragmatic CS I-II Hodgkin's disease. Prognostic factors and the usefulness of prognostic factor groups were also analyzed. MATERIALS AND METHODS: From 1985 to 1995, fifty one patients who were diagnosed as supradiaphragmatic CS I-II Hodgkin's disease at Yonsei Cancer Center in Seoul, Korea were enrolled in this study. Age range was 4 to 67 with median age of 30. The number of patients with each CS IA, IIA, and IIB were 16, 25, and 10, respectively. Radiotherapy (RT) was delivered using 4 or 6 MV photon beam to a total dose of 19.5 to 55.6Gy (median dose : 45Gy) with a 1.5 to 1.8Gy per fraction. Chemotherapy (CT) was given in 2-12 cycles (median : 6 cycles). Thirty one patients were treated with RT alone, 4 patients with CT alone and 16 patients with combined chemoradiotherapy. RT volumes varied from involved fields (3), subtotal nodal fields (18) or mantle fields (26). RESULTS: Five-year disease-free survival rate (DFS) was 78.0% and overall survival rate (OS) was 87.6%. Fifty patients achieved a complete remission after initial treatment and 8 patients were relapsed. Salvage therapy was given to 7 patients, 1 with RT alone, 4 with CT alone, 2 with RT+CT. Only two patients were successfully salvaged. Feminine gender and large mediastinal adenopathy were significant adverse prognostic factors in the univariate analysis for DFS. The significant adverse prognostic factors of OS were B symptom and clinical stage. When patients were analyzed according to European Organization for Research and Treatment of Cancer (EORTC) prog-nostic factor groups, the DFS in patients with very favorable, favorable and unfavorable group was 100, 100 and 55.8% (p<0.05), and the OS in each patients' group was 100, 100 and 75.1% (p<0.05), respectively. In very favorable and favorable groups, the DFS and OS were all 100% by RT alone, but in unfavorable group, RT with CT had a lesser relapse rate than RT alone. The subtotal nodal irradiation had better DFS than mantle RT in patients treated with RT. CONCLUSION: In present study, the DFS and OS in patients who did not undergo staging laparotomy were similar with the results in the literatures of which patients were surgically staged. Therefore, we may suggest that staging laparotomy would not influence the outcome of treatments. In univariate analysis, gender, large mediastinal adenopathy, B symptoms and clinical stage were significant prognostic factors for the survival rate. We confirm the usefulness of EORTC prognostic factor groups which may be a good indicator to select the treatment modality.
Subject(s)
Humans , Chemoradiotherapy , Disease-Free Survival , Drug Therapy , Hodgkin Disease , Korea , Laparotomy , Radiotherapy , Recurrence , Retrospective Studies , Salvage Therapy , Seoul , Survival RateABSTRACT
PURPOSE: The aim of this retrospective study is to assess the necessity of staging laparotomy in the management of supradiaphragmatic CS I-II Hodgkin's disease. Prognostic factors and the usefulness of prognostic factor groups were also analyzed. MATERIALS AND METHODS: From 1985 to 1995, fifty one patients who were diagnosed as supradiaphragmatic CS I-II Hodgkin's disease at Yonsei Cancer Center in Seoul, Korea were enrolled in this study. Age range was 4 to 67 with median age of 30. The number of patients with each CS IA, IIA, and IIB were 16, 25, and 10, respectively. Radiotherapy (RT) was delivered using 4 or 6 MV photon beam to a total dose of 19.5 to 55.6Gy (median dose : 45Gy) with a 1.5 to 1.8Gy per fraction. Chemotherapy (CT) was given in 2-12 cycles (median : 6 cycles). Thirty one patients were treated with RT alone, 4 patients with CT alone and 16 patients with combined chemoradiotherapy. RT volumes varied from involved fields (3), subtotal nodal fields (18) or mantle fields (26). RESULTS: Five-year disease-free survival rate (DFS) was 78.0% and overall survival rate (OS) was 87.6%. Fifty patients achieved a complete remission after initial treatment and 8 patients were relapsed. Salvage therapy was given to 7 patients, 1 with RT alone, 4 with CT alone, 2 with RT+CT. Only two patients were successfully salvaged. Feminine gender and large mediastinal adenopathy were significant adverse prognostic factors in the univariate analysis for DFS. The significant adverse prognostic factors of OS were B symptom and clinical stage. When patients were analyzed according to European Organization for Research and Treatment of Cancer (EORTC) prog-nostic factor groups, the DFS in patients with very favorable, favorable and unfavorable group was 100, 100 and 55.8% (p<0.05), and the OS in each patients' group was 100, 100 and 75.1% (p<0.05), respectively. In very favorable and favorable groups, the DFS and OS were all 100% by RT alone, but in unfavorable group, RT with CT had a lesser relapse rate than RT alone. The subtotal nodal irradiation had better DFS than mantle RT in patients treated with RT. CONCLUSION: In present study, the DFS and OS in patients who did not undergo staging laparotomy were similar with the results in the literatures of which patients were surgically staged. Therefore, we may suggest that staging laparotomy would not influence the outcome of treatments. In univariate analysis, gender, large mediastinal adenopathy, B symptoms and clinical stage were significant prognostic factors for the survival rate. We confirm the usefulness of EORTC prognostic factor groups which may be a good indicator to select the treatment modality.