Outcomes of intermediate-risk to high-risk stage I endometrial cancer: 10-year clinical experiences of using in-house multi-channel applicators in a single center / 中华医学杂志(英文版)

Background@#There are only very few reports on clinical outcomes using multi-channel applicators (MCA) for patients with endometrial cancer (EC) in China. We aimed to evaluate the clinical experience of treating intermediate-risk (IR) to high-risk (HR) stage I EC using in-house made multi-channel applicators (IH-MCA) in a single institution.@*Methods@#Three hundred and ninety patients with stage I IR to HR EC were treated with hysterectomy and adjuvant radiotherapy from 2003 to 2015. All patients received post-operative vaginal cuff brachytherapy (VBT) alone or as a boost after external beam radiotherapy (EBRT). The prescriptions were 500 cGy per fraction for a total of 5 to 6 fractions with brachytherapy alone or 400 to 600 cGy per fraction for 2 to 3 fractions if it was combined with EBRT. Two types of applicators including a traditional rigid IH-MCA and a recent model custom-made with 3 dimension printing technology were used for treatment. The Kaplan-Meier method was used to calculate survival rate.@*Results@#Follow-up rate was 92.8% and the median follow-up time was 48 months (range 4–172 months). The 5-year overall survival (OS), progression-free survival, local recurrence, and distant metastasis rates for all patients were 96.3%, 92.1%, 2.9%, and 4.8% respectively. Two patients had isolated relapse in vagina outside the irradiated volume. The univariate and multivariate analysis showed that age and grade were the prognostic factors correlated with OS (hazard ratio: 0.368, 95% confidence interval [CI]: 0.131–1.035, P = 0.048; hazard ratio: 0.576, 95% CI: 0.347–0.958, P = 0.026,).@*Conclusions@#For patients with IR to HR stage I EC, adjuvant VBT alone or in combination with EBRT using IH-MCA led to excellent survival and recurrence rates. Age and grade were the prognostic factors correlated with OS.

Clinical efficacy of radiotherapy in treatment of recurrent lesions at vaginal cuff after hysterectomy for cervical cancer / 中华放射肿瘤学杂志

Objective To analyze the long-term efficacy and adverse effects of radiotherapy in the treatment of recurrent lesions at the vaginal cuff after hysterectomy for cervical cancer, and to investigate prognostic factors.Methods A total of 105 patients who were admitted to our hospital due to recurrent lesions at the vaginal cuff after hysterectomy for cervical cancer from January 2005 to July 2011 were enrolled in this study and divided into group A (6-12 months), group B (12-24 months), and group C (≥24 months) according to the time to recurrence.All patients received radiotherapy and only 96 patients also received concurrent chemotherapy.The long-term outcomes and adverse events were compared between the three groups, and the prognostic factors were analyzed.Survival curves were analyzed by the Kaplan-Meier method.Results The follow-up rate was 98.1%.The response rates of group A, B, and C were 60%, 82%, and 86%, respectively.The 3-and 5-year survival rates for all patients were 58.1% and 31.4%, respectively.The median survival time for all patients was 42 months.Group C had a significantly longer median survival time than group A (P=0.010).The patients with a maximum tumor diameter of<4 cm had a significantly better treatment outcome than those with a maximum tumor diameter of ≥4 cm (P=0.000).There was a significant difference in median survival time between the patients with recurrent lesions limited to the vaginal cuff and those with recurrent lesions beyond the vaginal cuff (47 months vs.32 months, P=0.005).Conclusions For patients with recurrent lesions at the vaginal cuff after hysterectomy for cervical cancer, radiotherapy is a salvage treatment and has significant clinical efficacy.The treatment outcome and prognosis are related to time to recurrence, tumor size, and the extent of recurrent lesions.

Evisceración vaginal tras tratamiento con radioterapia e histerectomía abdominal / Vaginal evisceration after treatment with radiotherapy and abdominal hysterectomy

La evisceración vaginal es una complicación muy rara. Es más frecuente en mujeres posmenopáusicas y con antecedente de cirugía vaginal, fundamentalmente histerectomía. También puede darse en mujeres premenopáusicas, vinculándose en estos casos a traumatismos, iatrogenia o introducción de cuerpos extraños. El íleon distal es el órgano más frecuentemente eviscerado, aunque el prolapso de epiplón, trompas de Falopio y apéndice también se han descrito. Presentamos el caso de una mujer de 43 años con evisceración transvaginal de epiplón a los seis meses de realizarse una histerectomía abdominal por recidiva de un cáncer escamoso de cérvix.

Vaginal evisceration is a very rare complication. It is more often in postmenopausal women with a history of vaginal surgery, mainly hysterectomy. It can also occur in premenopausal women, linking these cases to trauma, iatrogenic or foreign bodies. The distal ileum is most often gutted organ prolapse, although omentum, fallopian tubes and appendix are also described. We report a 43-year old transvaginal omental evisceration after six months of an abdominal hysterectomy for recurrent squamous cervical cancer.

Study on Repairing Method of Vaginal Cuff in Total Laparoscopic Hysterectomy / 대한산부인과학회잡지

OBJECTIVE: Hysterectomy is one of the most common gynecological operations. The objective of this study is to compare the efficacy of suturing methods of vaginal cuff between laparoscopic and vaginal approach. METHODS: One hundred and sixty one cases of laparoscopic hysterectomy were devided into two groups. In group A(n=67), vaginal cuff was sutured by laparoscopic suture technique and in group B(n=94), vaginal cuff was repaired by vaginal approach. RESULTS: There were no significant differences in uterine weight, hospital stay, pre-and postoperative hemoglobin level and complications including febrile morbidity in two groups. Operation time was significantly shorter in group B(p=0.05). CONCLUSION: Transvaginal repair of vaginal cuff showed shorter duration of operation time than laparoscopic suture technique in total laparoscopichy sterectomy.

A comparative Study for morbidity and Compilication in Total AbdominalHysterectomy ; -Open Versus Closed Vaginal Cuff / 대한산부인과학회잡지

Post-operative morbidity and complication, focused on open versus closed vaginal cuff, were compared. The patients were divided into two groups according to the method of cuff management(open cuff : n=53, closed cuff : n=52). From Jan, 1990 to Dec. 1994 one hundred five cases of total abdominal hysterectomy on the benign uterine disease were carried out by the same operator at the Dept. of Ob/Gyn. Pusan Paik Hospital. The vaginal cuff was opened during the first half periods(1990. 1~1993.3), and it was closed during the later peroids(1993.4 ~ 1994.12). As to the postoperative morbidity and complication(closed : open), urinary tract infection(9.4% : 5.8%), vaginal cuff infection(7.5% : 3.8%), febrile morbidity(3.8% : 3.8%), wound infection(1.9% : 3.8%), pelvic hematoma(0: 1.9%) developed but there were no statistical differences between the two groups. Granulation tissue formation on the vaginal cuff was found in 26 cases(49.1%) of the open cuff and in 18 cases(34.6%) of the closed cuff(p=0.134, X(2) test ) within 6 months after operation. Post operative increased vaginal discharge developed in 7 cases(13.2%) of the open cuff and in 10 cases (19.2%) of the closed cuff group(p=0.516, Fisher's Exact test).