ABSTRACT
OBJECTIVE: The objective was to determine if surgical approach affects time to recurrence in early-stage high-intermediate risk endometrial cancer (HIR-EC) treated with adjuvant vaginal brachytherapy (VBT). METHODS: In this retrospective cohort study, HIR-EC patients treated with VBT between 2005 and 2017 were identified and those who received open or minimally invasive hysterectomies (MIS) were included. Clinical and surgical variables were analyzed and time to recurrence was compared between surgical groups. RESULTS: We identified 494 patients, of which 363 had MIS hysterectomies, 92.5% had endometrioid histology, 45.7% were stage IA and 48.0% stage IB. Open hysterectomy patients had higher BMIs (p = 0.007), lower rates of lymph node sampling (p < 0.001) and lymphovascular space invasion (LVSI) (p = 0.036), however in patients who recurred, no differences were noted between groups. Overall, 65 patients (13.2%) recurred, 14 in the open group (10.7%) and 51 in the MIS group (14.0%) (p = 0.58), while vaginal recurrences were noted in 4.6% and 6.1% respectively. When compared to the open group, the MIS group had a significantly shorter time to any recurrence (p = 0.022), to pelvic (p = 0.05) and locoregional recurrence (p = 0.021) and to death from any cause (p = 0.039). After adjusting for age, BMI, grade, LVSI and surgery date, the MIS group had a higher risk of any recurrence (HR 2.29 (1.07-4.92), p = 0.034) and locoregional recurrence (HR 4.18 (1.44-12.1), p = 0.008). CONCLUSIONS: Patients with HIR-EC treated with VBT after MIS hysterectomy have a shorter time to recurrence and higher risk of recurrence when compared to open hysterectomy patients. Further studies into the safety of MIS in high-intermediate risk patients are required.
Subject(s)
Brachytherapy , Carcinoma, Endometrioid/therapy , Endometrial Neoplasms/therapy , Hysterectomy/statistics & numerical data , Minimally Invasive Surgical Procedures/statistics & numerical data , Neoplasm Recurrence, Local/epidemiology , Aged , Carcinoma, Endometrioid/diagnosis , Carcinoma, Endometrioid/mortality , Carcinoma, Endometrioid/pathology , Disease-Free Survival , Endometrial Neoplasms/diagnosis , Endometrial Neoplasms/mortality , Endometrial Neoplasms/pathology , Endometrium/pathology , Endometrium/radiation effects , Endometrium/surgery , Female , Humans , Hysterectomy/methods , Lymph Node Excision/statistics & numerical data , Middle Aged , Neoplasm Invasiveness/diagnosis , Neoplasm Recurrence, Local/prevention & control , Neoplasm Staging , Radiotherapy, Adjuvant/methods , Retrospective Studies , Risk Assessment/statistics & numerical data , Salpingo-oophorectomy/statistics & numerical data , Sentinel Lymph Node Biopsy/statistics & numerical dataABSTRACT
BACKGROUND: Sacral fractures with spinopelvic dissociation are rare, and hard to diagnose and treat. Fractures with a H- or U-shaped line are severely unstable, due to a dissociation of the spine and of the upper body of the sacrum from the pelvis. They are commonly due to high-energy trauma events, with severe neurological injuries in 80% of cases. CASES PRESENTATION: Five polytraumatized Caucasian patients, three women and two men (mean age: 34 years old) with spinopelvic dissociation were selected. All patients underwent level I-II examinations with radiographs and computed tomography total-body scans; all patients needed damage-control procedures. Sacral fractures were classified according to Denis and Roy-Camille classifications, and neurologic injuries of cauda equina according to Gibbons classification. Patients' outcome was analyzed with the Majeed score. Definitive surgical treatment was appropriate for two patients (lumbar-pelvic fixation or transverse bar). Clinical and radiographic outcomes were analyzed periodically. Four patients survived, all of them suffered severe neurologic deficits. One case of osteomyelitis was treated with the removal of the fixation implants 23 months after the accident. CONCLUSIONS: Diagnosis of spinopelvic dissociation is frequently overlooked due to the severe associated injuries affecting these patients. In cases of a fall from high height, this lesion should be investigated with a lateral sacral radiographic view and computed tomography scan of the pelvis. If untreated, it can lead to severe and progressive neurologic deficit with muskuloskeletal deformities and persistent pain. Early decompression treatment is controversial, but an early lumbopelvic fixation is recommended. A correct diagnosis and early treatment can reduce morbidity and strongly improve the outcome of these patients.
Subject(s)
Fractures, Bone , Spinal Fractures , Suicide, Attempted , Adult , Female , Fracture Fixation, Internal , Humans , Ilium , Male , Middle Aged , Sacrum/injuries , Spinal Fractures/etiology , Spinal Fractures/surgeryABSTRACT
A case of anaplastic carcinoma of the thyroid observed in a 72-year-old female patient, admitted with previous diagnosis of Riedel's thyroiditis, is reported. Clinicopathologic features and management of this rare neoplasm are discussed and Literature is reviewed. Anaplastic cancer is a locally and systemically aggressive histologic type, occurring more frequently in older patients and in those with a history of benign and/or malignant thyroid disease. Because long-term survival was seen most commonly in well-localized anaplastic tumors, a more aggressive approach to thyroid lesions, especially in the elderly, may be warranted to improve early diagnosis and effectiveness of therapy of this nearly always lethal neoplasm. Although patients can rarely be cured, efforts should be made to control the disease locally by combined treatment including surgery and radiochemotherapy, which is found to be, at times, a national palliative therapeutic approach despite patient's advanced age.
