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1.
Clin. transl. oncol. (Print) ; 11(10): 677-680, oct. 2009. tab
Article in English | IBECS | ID: ibc-123694

ABSTRACT

PURPOSE: Uterine tumours with a sarcomatous component are rare neoplasms with a wide pathologic heterogeneity in which the stage is the main prognostic factor. These aspects and their aggressiveness make the analysis of prognostic factors and radiotherapy difficult. The aim of this study was to evaluate the prognostic factors by stages and to assess the impact of prognostic factors and the effect of radiotherapy on the outcome of the disease. METHODS AND MATERIALS: Eighty-one patients diagnosed and treated for uterine tumours with a sarcomatous component at the Hospital Clinic in Barcelona between 1975 and 2003 were retrospectively studied; 76/81 patients underwent surgery (total hysterectomy plus bilateral salpingo-oophorectomy, and in 13/76 of these patients an additional pelvic lymphadenectomy was performed). All 76 patients were staged after pathological evaluation of the surgical specimen by FIGO classification with 54 patients being stages I-II and 27 patients stages III-IVA. Only 5 patients were clinically staged as III-IVA. Radiotherapy was administered in 21 women with early-stage tumours and in 16 with advanced neoplasms. 5/81 patients received complementary chemotherapy to the surgery and 5 patients received chemotherapy as treatment of local and distant relapse (All the patients were treated with a different chemotherapy schedule). The impact of pathologic prognostic factors and radiotherapy on specific overall survival (OS), disease-free survival (DFS), local relapse-free survival (LRFS) and distant metastasis-free survival (DMFS) were analysed by Log Rank test and Cox proportional risk models. The effect of each risk factor was studied by the hazard ratio and 95% confidence interval. RESULTS: An increased frequency of several adverse prognostic factors was observed in tumours with advanced stages compared to early neoplasms in deep myometrial invasion (83% vs. 27%), VLSI (75% vs. 29%), tumour size >8 cm (50% vs. 30%) and multicentricity (36% vs. 10%), and similar values were found for necrosis (79% vs. 78%) and high mitotic index (78% vs. 80%). For pathological type the frequency by advanced vs. early stages was 54% vs. 52% for carcinosarcomas, 33.5% vs. 17.5% for leiomyosarcoma, and 30.5% and 12.5% for adenosarcoma and endometrial stromal sarcoma, respectively. Univariate analysis showed that the stage was the only independent prognostic factor. Stratification by early (I-II) and advanced stages (III, IV) revealed tumour size >8 cm was the only prognostic factor significantly associated with OS, DFS, LRFS and DMFS on univariate analysis for early stages (HR: OS 2.52, DFS 3.10, LRFS 3.10 and DMFS 2.63). For advanced stages, radiotherapy was the only prognostic factor associated with OS, DFS, LRFS and DMFS on multivariate analysis (HR: OS 4.26, DFS 3.14, LRFS 3.25 and DMFS 3.66). CONCLUSIONS: Uterine tumours with a sarcomatous component have a poor outcome in spite of treatment in comparison to endometrial carcinoma, probably due to the higher frequency of adverse prognostic factors. In early stages tumour size was the most determining factor for OS, DFS, LRFS and DMFS. Radiotherapy significantly improved these survivals in advanced cases (AU)


No disponible


Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Carcinosarcoma/radiotherapy , Leiomyosarcoma/radiotherapy , Uterine Neoplasms/radiotherapy , Carcinosarcoma/secondary , Leiomyosarcoma/secondary , Neoplasm Staging/methods , Neoplasm Staging/trends , Neoplasm Staging , Prognosis , Retrospective Studies , Survival Rate , Treatment Outcome , Uterine Neoplasms/pathology
2.
Clin. transl. oncol. (Print) ; 10(8): 505-511, ago. 2008. tab, ilus
Article in English | IBECS | ID: ibc-123488

ABSTRACT

INTRODUCTION: The objective of this study was to evaluate different surgical treatments and radiotherapy on patterns of recurrence and overall survival in patients with endometrioid-type endometrial cancer. MATERIALS AND METHODS: The retrospective records of 162 patients with endometrioid endometrial cancer were collected. Patients were surgically treated from 1997 to 2002. Recurrence and survival were analyzed according to patient age, surgical procedure, lymphadenectomy, externalbeam irradiation, brachytherapy, surgical stage, myometrial invasion, and tumor grade. Standard statistical calculations were used. RESULTS: Median age was 64 years. Median follow-up was 44 months. Overall, ten patients (5.6%) experienced recurrence and 14 (8.6%) died. With univariate analysis, statistical significance for survival was found for age older than 70 years, tumor grade, myometrial invasion, and stage. Multivariate analysis, however, found only age, stage, and grade to be significant. With univariate analysis, statistical significance for recurrence was found for tumor grade, stage, and external-beam radiotherapy as risk factors. Multivariate analysis found only radiotherapy and brachytherapy to be significant, but in an inverted sense, with brachytherapy having a protective effect. CONCLUSION: Our results suggest that brachytherapy protects against recurrence and that neither a surgical approach nor a lymphadenectomy appear to affect recurrence or survival in patients with surgically treated endometrioid endometrial cancer (AU)


No disponible


Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Endometrial Neoplasms/mortality , Endometrial Neoplasms/surgery , Carcinoma, Endometrioid/mortality , Carcinoma, Endometrioid/surgery , Lymph Node Excision/methods , Neoplasm Recurrence, Local/mortality , Endometrial Neoplasms/radiotherapy , Carcinoma, Endometrioid/radiotherapy , Brachytherapy/methods , Prognosis , Neoplasm Recurrence, Local/therapy , Retrospective Studies , Treatment Outcome , Survival Rate
3.
Int J Gynecol Cancer ; 18(3): 584-9, 2008.
Article in English | MEDLINE | ID: mdl-18476952

ABSTRACT

The aim of this study was to evaluate the feasibility, efficacy, and morbidity of laparoscopic ovarian transposition on the preservation of hormonal function in patients younger than 45 years operated for early cervical cancer. According to risk factors on pathologic evaluation of the specimen, some of them will receive postoperative pelvic radiotherapy. This subset of patients could benefit from taking the ovaries away from the irradiation field in an effort to preserve their functionality. This prospective study included 28 FIGO stage IB1 cervical cancer patients, 45 years old or younger, maintaining menstrual cycles, who were considered suitable for conservation of the ovaries. The ovarian transposition was performed by laparoscopy as a part of the same celio-Schauta operation. Twelve patients underwent adjuvant pelvic radiotherapy. No intraoperative or postoperative morbidity related to the ovarian transposition was observed, and the procedure only entailed a minimum delay of the operative time. There were no cases of ovarian metastasis. At a mean follow-up of 44 months, 63.6% of patients receiving radiotherapy and 93% of those who nonirradiated maintained normal ovarian function. Two patients developed benign ovarian cysts, requiring oophorectomy, but no other long-term adverse effects of the transposition were identified. To the best of our knowledge, this is the largest series of the laparoscopic procedure reported to date in this setting. According to our results, laparoscopic ovarian transposition is a safe and effective procedure for the preservation of ovarian function in young patients with early cervical cancer undergoing adjuvant radiotherapy after surgery.


Subject(s)
Infertility, Female/prevention & control , Laparoscopy/methods , Ovary/surgery , Radiation Injuries/prevention & control , Uterine Cervical Neoplasms/radiotherapy , Adult , Female , Follow-Up Studies , Humans , Hysterectomy/methods , Neoplasm Staging , Ovary/physiology , Preoperative Care/methods , Probability , Prospective Studies , Radiotherapy, Adjuvant , Risk Assessment , Time Factors , Treatment Outcome , Uterine Cervical Neoplasms/pathology , Uterine Cervical Neoplasms/surgery
4.
Arch Gynecol Obstet ; 278(6): 535-9, 2008 Dec.
Article in English | MEDLINE | ID: mdl-18368415

ABSTRACT

OBJECTIVE: To determine the diagnostic accuracy of magnetic resonance imaging (MRI) in detecting myometrial invasion and cervical involvement in endometrial cancer. STUDY DESIGN: Seventy two consecutive patients with endometrial carcinoma underwent preoperative MRI. We compared the MRI results with the final histopathological findings. We classify myometrial invasion as <50 or>or=50% and cervical involvement as positive or negative. Standard statistical calculations were used. RESULTS: The sensitivity, specificity, and accuracy of MRI for the detection of myometrial invasion>or=50% were 71, 86, and 58%, respectively. Positive and negative predictive values are 77 and 83%, respectively. The sensitivity, specificity, and accuracy of MRI for the detection of cervical invasion were 41, 97, and 46%, respectively. Positive and negative predictive values are 71 and 89%, respectively. The possible causes of misdiagnosis included a tumor isointense with the myometrium, polypoid tumor, myometrial thinning, exceedingly irregular myometrium, presence of adenomiosis, and presence of leiomyomas. CONCLUSION: MRI assists in planning the surgical treatment of endometrial cancer with an acceptable accuracy and a good specificity, although sensitivity is suboptimal.


Subject(s)
Adenocarcinoma/diagnosis , Endometrial Neoplasms/diagnosis , Magnetic Resonance Imaging/methods , Myometrium/pathology , Uterine Cervical Neoplasms/diagnosis , Adenocarcinoma/pathology , Endometrial Neoplasms/pathology , Female , Humans , Neoplasm Invasiveness , Neoplasm Staging , Predictive Value of Tests , Retrospective Studies , Sensitivity and Specificity , Uterine Cervical Neoplasms/pathology
5.
Acta Obstet Gynecol Scand ; 86(4): 491-5, 2007.
Article in English | MEDLINE | ID: mdl-17486474

ABSTRACT

OBJECTIVE: The aim of this study was to evaluate the feasibility of extraperitoneal laparoscopic para-aortic lymphadenectomy for lymph node recurrence of gynecological cancers. METHODS: Seven patients underwent extraperitoneal laparoscopic para-aortic lymphadenectomies for suspected lymph node recurrence, detected by magnetic resonance image or CT scan. The suspicious nodes were removed through an extraperitoneal laparoscopic approach. RESULTS: The median age of patients was 51 years (range: 39-67). The median operating time was 207 min (range 120-300). There were no intraoperative or postoperative complications. The median nodal yield was 7.3 (range: 1-15). The median hospital stay was 2.5 days (range: 2-3). Histological examination revealed metastasis in 6 of the 7 patients. CONCLUSION: The extraperitoneal laparoscopic para-aortic lymphadenectomy for lymph node recurrence of gynecological cancers is a safe and feasible procedure which should be considered in the case of possible recurrence.


Subject(s)
Endometrial Neoplasms/pathology , Lymph Node Excision/methods , Lymph Nodes/pathology , Neoplasm Recurrence, Local/diagnosis , Ovarian Neoplasms/pathology , Uterine Cervical Neoplasms/pathology , Adult , Aged , Endometrial Neoplasms/surgery , Fatal Outcome , Female , Follow-Up Studies , Humans , Intraoperative Complications/epidemiology , Laparoscopy/methods , Length of Stay , Lymphatic Metastasis , Magnetic Resonance Imaging , Middle Aged , Neoplasm Recurrence, Local/pathology , Neoplasm Staging , Ovarian Neoplasms/surgery , Para-Aortic Bodies/pathology , Postoperative Complications/epidemiology , Tomography, X-Ray Computed , Uterine Cervical Neoplasms/surgery
6.
Int J Gynecol Cancer ; 16(1): 385-90, 2006.
Article in English | MEDLINE | ID: mdl-16445663

ABSTRACT

The objective of this study was to determine the value of myometrial invasion by magnetic resonance imaging (MRI), histologic typing and grading by endometrial biopsy, and the intraoperative evaluation of both parameters by frozen section in the evaluation of endometrial cancer. The preoperative and intraoperative records of 180 patients with endometrial cancer were used to compare the preoperative endometrial biopsy, the myometrial invasion by MRI, and the intraoperative frozen sections, with the final histopathologic findings. The preoperative endometrial biopsy gave us the tumor histologic type and grade. MRI gave us the depth of myometrial invasion. The evaluation of intraoperative frozen sections gave us the tumor histologic type, the tumor grade, and also the myometrial invasion. Patients were classified as low risk (grade 1 and 2, and myometrial invasion <50%) and high risk (grade 3 or myometrial invasion >50%). Standard statistical calculations were used. Evaluation of the tumor grade by preoperative biopsy has a sensitivity and a specificity of 75% and 95%, respectively. Evaluation of the tumor grade by intraoperative biopsy has a sensitivity and a specificity of 40% and 98%, respectively. Evaluation of the depth of myometrial invasion with MRI has a sensitivity and a specificity of 79% and 82%, respectively. Evaluation of the depth of myometrial invasion with intraoperative frozen sections has a sensitivity and a specificity of 74% and 95%, respectively. Evaluation of all four of the parameters together has a sensitivity and a specificity of 80% and 82%, respectively with a kappa of 0.621. In our opinion, the combination of preoperative biopsy and intraoperative frozen section is the best way to decide whether a lymphadenectomy is necessary with a low rate of understaging patients. MRI would have a fringe benefit in these patients.


Subject(s)
Endometrial Neoplasms/pathology , Frozen Sections , Magnetic Resonance Imaging , Myometrium/pathology , Neoplasm Invasiveness/pathology , Adult , Aged , Confidence Intervals , Endometrial Neoplasms/surgery , Female , Humans , Intraoperative Care/methods , Middle Aged , Multivariate Analysis , Neoplasm Staging , Preoperative Care/methods , Probability , Prognosis , Retrospective Studies , Risk Assessment , Sensitivity and Specificity
7.
Gynecol Oncol ; 96(2): 539-42, 2005 Feb.
Article in English | MEDLINE | ID: mdl-15661248

ABSTRACT

BACKGROUND: Although studies have reported good results with laparoscopic-assisted vaginal hysterectomy (LAVH) to treat endometrial cancer, it has been associated with recurrent disease at trocar insertion sites. Long-term follow-up is necessary to detect possible adverse effects of this technique. CASES: We present two case reports of stage IIB endometrial cancer with port-site metastasis 39 and 48 months after initial surgery with LAVH. CONCLUSION: Although LAVH is a good technique to treat patients with endometrial cancer, port-site metastasis is a possible complication and should be taken into consideration until a randomized study shows the long-term benefits and risks of laparoscopic over standard treatment.


Subject(s)
Endometrial Neoplasms/pathology , Hysterectomy/adverse effects , Laparoscopy/adverse effects , Neoplasm Recurrence, Local/pathology , Neoplasm Seeding , Aged , Female , Humans , Middle Aged , Neoplasm Staging
8.
Acta Obstet Gynecol Scand ; 74(6): 467-71, 1995 Jul.
Article in English | MEDLINE | ID: mdl-7541596

ABSTRACT

BACKGROUND: To assess the potential role of magnetic resonance imaging (MRI) in evaluating the response of cervical tumor to neoadjuvant chemotherapy. METHODS: We studied 14 patients with locally advanced carcinoma of the cervix. MRI was performed before and after each cycle. All patients underwent laparotomy four weeks after the last cycle. MR images after chemotherapy were compared with surgical-pathologic findings. RESULTS: Related to parametrial state after chemotherapy, surgical examination correlated with MRI in nine patients (nine true negative). In three cases parametrial invasion was over-estimated (three false-positive) and in two it was underestimated, so that tumor resection was not possible once laparotomy was performed (two false-negative). MRI estimation of tumor size was confirmed at pathologic examination in only eight patients, whilst it was over-estimated in the other four ones. CONCLUSIONS: These initial results suggest that MRI could not be as precise for cervix cancer staging and evaluation of response to chemotherapy as has recently been postulated. This is especially important since a false negative result may induce the surgeon to perform laparotomy in error in cases of unresectable tumors.


Subject(s)
Carcinoma, Squamous Cell/diagnosis , Chemotherapy, Adjuvant , Magnetic Resonance Imaging , Uterine Cervical Neoplasms/diagnosis , Adult , Antineoplastic Agents/therapeutic use , Carcinoma, Squamous Cell/drug therapy , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/surgery , False Negative Reactions , Female , Humans , Hysterectomy , Neoplasm Invasiveness , Neoplasm Staging , Palliative Care , Uterine Cervical Neoplasms/drug therapy , Uterine Cervical Neoplasms/pathology , Uterine Cervical Neoplasms/surgery , World Health Organization
10.
Eur J Gynaecol Oncol ; 9(5): 403-9, 1988.
Article in English | MEDLINE | ID: mdl-2465157

ABSTRACT

Percutaneous intraarterial infusion chemotherapy via the internal iliac arteries was performed as a primary treatment in 14 patients with invasive cancer of the uterine cervix. The drugs used were Mitomycin-C, Bleomycin and Cis-Platinum in cycles of 52 hours which were repeated, in some cases, 21 days apart. Complete responses were observed in two patients. Partial responses were seen in 10 patients and no response in two patients. 5 patients were treated surgically and 8 patients received radiotherapy after the infusion. The effect of chemotherapy was more evident in exophytic tumors with less effect on the parametria. Tumor masses can be reduced and patients can then be treated by surgery or radiotherapy. 6 patients died from sepsis.


Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Uterine Cervical Neoplasms/drug therapy , Adult , Aged , Bleomycin/administration & dosage , Cisplatin/administration & dosage , Female , Humans , Iliac Artery , Infusions, Intra-Arterial , Middle Aged , Mitomycin , Mitomycins/administration & dosage , Neoplasm Staging , Uterine Cervical Neoplasms/pathology
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