ABSTRACT
OBJECTIVES: To evaluate the clinico-pathological features, surgical procedures and postoperative treatment and their relation to survival in women with granulosa cell tumours. METHODS: Data of 37 women with granulosa cell tumours were collected and reviewed retrospectively. Mann-Whitney test, log rank test and Kaplan-Meier survival analysis were applied appropriately. RESULTS: Thirty-seven women of median age 48.6 years were diagnosed in stage Ia (45.9 %), stage Ic (27 %), stage III (16.2 %) and unstaged (10.8 %). The median follow up was 5 years. Overall survival was 93 % at 5 years. Disease-free survival at 5 years was 63 %. Tumour stage and residual disease were associated with poor prognosis (p < 0.001). Mitotic rate and tumour grade were not of prognostic significance. CONCLUSIONS: Stage of disease and residual disease are valuable prognostic factors. Prospective studies with large sample sizes and long-term follow up are needed to confirm our findings.
ABSTRACT
OBJECTIVES: The aim of this retrospective study was to evaluate the behavior and treatment outcomes of uterine carcinosarcomas in relation to their clinical and pathogenic features and to determine the optimal treatment strategy. Secondary objectives were to identify parameters predictive of survival. MATERIALS AND METHODS: The hospital records of all 25 patients of uterine carcinosarcoma operated between 2000 and 2008 in Gujarat cancer research institute, Ahmedabad, were reviewed. Patients who presented with clinical evidence of recurrent disease or those who had incomplete medical records were excluded from our analysis. The status of these patients was updated up to November, 2010. Patients were classified according to the new 2009 FIGO staging system for endometrial carcinoma, to see what difference the assigned stage has on survival with the old treatment strategy. Survival was calculated by Kaplan-Meier method and compared by Log-Rank test. Median survival time was derived with the Brookmeyer 95% confidence interval. For comparison of qualitative data, Chi-Square test and Fisher extract χ(2) were used. RESULTS: Median age of patients was 56 years (range, 36-77 years). Only 36% of patients had stage I at diagnosis and another 36% were stage III. Most of the tumors (56%) were with homologous sarcomatous components and 64% of tumors were high grade (grade 2/3) at diagnosis. Fifty-two percent patients received postoperative adjuvant treatment. Twelve patients had no postoperative treatment: two were lost to follow-up immediately after surgery, four could not receive adjuvant treatment on account of severe medical complications and age factor which could have increased morbidity, and six patients declined treatment. Four of these patients expired within one year of diagnosis, two other within 18 months, and rest were lost to follow-up. The difference in survival of 13 patients who had taken adjuvant treatment was significantly more than the group who had not taken adjuvant therapy (P=0.025). The overall 3-year disease-free survival of 13 patients who had taken adjuvant therapy was 40%. However, these adjuvant treatment modalities had borderline statistical significance on overall survival of patients (P=0.075). The only statistically significant predictor of survival in this study was stage of the disease (P=0.035). CONCLUSIONS: This highly aggressive uterine malignancy warrants comprehensive surgical staging to assess tumor dissemination followed by systematic adjuvant therapy in patients with both early and advanced disease. The value of pelvic Radiotherapy in addition to systemic treatment remains ill-defined. Stage is the significant predictor of survival for the disease. Our results indicate that in this highly aggressive malignancy, further exploration of potential outcome benefits of postoperative treatment, especially chemoradiation, is warranted in larger group of patients after comprehensive surgical staging.
ABSTRACT
OBJECTIVE: To evaluate and analyze the results of chemotherapy (EMA-CO [etoposide, methotrexate, actinomycin D-cyclophosphamide, vincristine]) in high-risk gestational trophoblastic neoplasia (GTN). STUDY DESIGN: A total of 97 women with high-risk GTN were evaluated for a period of 13 years (1995-2008). All women received EMA-CO as a first-line chemotherapy. EMA-EP (etoposide, methotrexate, actinomycin and cisplatinum), PVB (cisplatin, vinblastine and bleomycin), and BEP (bleomycin, etoposide and cisplatin) were the chemotherapies used as second-line therapy in women who experienced resistance to primary chemotherapy. Intrathecal methotrexate was given in women with brain metastasis and also as prophylaxis in pulmonary metastasis. Eleven women had brain metastasis and received cranial radiotherapy. The most common toxicity was hematologic. . RESULTS: Of 97 women, 78 (80.4%) were evaluable and 19 (19.6%) were lost to follow-up with incomplete treatment. Of the 78 patients, 6 women developed resistance and had progression of disease. Seven women had died (5 due to disease, 2 due to chemotherapy toxicity). Overall 65 of the 78 (83.3%) women achieved remission. Of the 78 women, 66.7% (52/78) had complete remission with first-line chemotherapy, and an additional 16.6% (13/78) achieved remission with second-line chemotherapy, resulting in a total of 83.3% (65/78) attaining remission. A total of 46% (30/ 65) had follow-up of > 3 years, and 32.4% (21/65) had follow-up of 1-3 years. Three of 9 women with brain metastasis achieved remission. Sixty percent (39/65) resumed normal menstrual function (had remission for at least 2 years). Twelve women became pregnant since the completion of the chemotherapy, with 10 live births of healthy infants without any congenital abnormalities. CONCLUSION: High-risk GTNs are highly curable if properly treated, and patients can anticipate a normal future reproductive outcome. EMA-CO remains the preferred chemotherapy for management.
