The Meaning-Making intervention (MMi) appears to increase meaning in life in advanced ovarian cancer: a randomized controlled pilot study.

OBJECTIVE: This pilot study aimed to provide supportive evidence for the acceptability and usefulness of the Meaning-Making intervention (MMi) in patients newly diagnosed with Stage III or IV ovarian cancer, and to provide estimates of parameters needed to design a full-scale study. METHODS: A randomized controlled trial with 24 patients (12 experimental and 12 control) was conducted. Existential well-being (primary outcome), overall quality of life, distress, anxiety, depression and self-efficacy were measured. RESULTS: Compared to the control group, patients in the experimental group had a better sense of meaning in life at one and three months post-intervention. CONCLUSION: The MMi seems a promising intervention for advanced cancer patients, and a full randomized controlled trial is warranted to further investigate its efficacy.

Leiomyomatosis Peritonealis Disseminata with Features of Carcinomatosis on Laparoscopy: A case report.

Leiomyomatosis peritonealis disseminata (LPD), also known as diffuse peritoneal leiomyomatosis, is a rare disease characterised by subperitoneal proliferation of benign nodules mainly composed of benign smooth muscle cells, macroscopically mimicking peritoneal carcinomatosis. We report a 43 year-old woman who presented with menorrhagia, pelvic pressure and pain. Ultrasound of the pelvis showed uterine fibroids and an ovarian cyst. She was scheduled to have a laparoscopic hysterectomy and left salpingo-oophorectomy for symptomatic relief. A picture of carcinomatosis was seen on laparoscopy so multiple biopsies were taken and the patient was referred to the gynaecological oncology team. Definitive surgery was performed and final pathology was consistent with LPD with no evidence of malignancy. No hormone replacement therapy was offered after surgery. Macroscopically, LPD has features of malignancy; it usually pursues a benign course. To review current management of LPD and the risk of malignant transformation, we conducted a search in Medline, EMBASE, and the Cochrane Database of systematic reviews using the keywords: leiomyomatosis peritonealis disseminata, management and malignant transformation. LPD is a diagnostic challenge. Although rare, malignant transformation can occur since hormones play an important role in the pathogenesis of LPD, following surgery, patients should be followed carefully if they are on hormone replacement as these tumours could re-grow and cause symptoms or transform to malignancy.

Prognostic factors and treatment-related outcome in patients with uterine papillary serous carcinoma.

UNLABELLED: A retrospective analysis was performed in order to evaluate prognostic factors and treatment-related outcome in patients with uterine papillary serous carcinoma (UPSC). PATIENTS AND METHODS: Between 1989 and 2003 forty-five patients with UPSC were treated at the McGill University Health Centre (MUHC), and therefore were included in the analysis. Age, race, history, tumor stage and grade, invasion and metastasis, treatment and outcome for each patient were evaluated. RESULTS: According to FIGO classification, Stage I, II, III, and IV tumors were identified in 36%, 9%, 44%, and 11% of the patients, respectively. At the time of analysis, 37.8% of patients (17/45) were dead due to disease, with a mean survival of 22 months (SD +/- 7.5 months). Cause-specific survival for the entire group was 69%, 66%, and 58% at 2, 3, and 5 years, respectively. With respect to disease stage, 5-year cause-specific survival for stage I, II, III, and IV was 100%, 75%, 43%, and 0%, respectively. Univariate analysis comparing cause-specific survival curves demonstrated a statistically significant difference for disease stage (p < 0.0001) and depth of myometrial invasion (p = 0.008). However, in multivariate analysis, only disease stage had a significant impact on cause-specific survival (p < 0.01). CONCLUSION: Disease stage is the only independent significant prognostic factor regarding cause-specific survival in patients with UPSC.

Analysis of prognostic factors and patterns of recurrence in patients with pathologic stage III endometrial cancer.

PURPOSE: To retrospectively assess prognostic factors and patterns of recurrence in patients with pathologic Stage III endometrial cancer. METHODS AND MATERIALS: Between 1989 and 2003, 107 patients with pathologic International Federation of Gynecology and Obstetrics Stage III endometrial adenocarcinoma confined to the pelvis were treated at our institution. Adjuvant radiotherapy (RT) was delivered to 68 patients (64%). The influence of multiple patient- and treatment-related factors on pelvic and distant control and overall survival (OS) was evaluated. RESULTS: Median follow-up for patients at risk was 41 months. Five-year actuarial OS was significantly improved in patients treated with adjuvant RT (68%) compared with those with resection alone (50%; p = 0.029). Age, histology, grade, uterine serosal invasion, adnexal involvement, number of extrauterine sites, and treatment with adjuvant RT predicted for improved survival in univariate analysis. Multivariate analysis revealed that grade, uterine serosal invasion, and treatment with adjuvant RT were independent predictors of survival. Five-year actuarial pelvic control was improved significantly with the delivery of adjuvant RT (74% vs. 49%; p = 0.011). Depth of myometrial invasion and treatment with adjuvant RT were independent predictors of pelvic control in multivariate analysis. CONCLUSIONS: Multiple prognostic factors predicting for the outcome of pathologic Stage III endometrial cancer patients were identified in this analysis. In particular, delivery of adjuvant RT seems to be a significant independent predictor for improved survival and pelvic control, suggesting that pelvic RT should be routinely considered in the management of these patients.

Long-term results of high-dose-rate brachytherapy in the primary treatment of medically inoperable stage I-II endometrial carcinoma.

PURPOSE: Total-abdominal hysterectomy and bilateral salpingo-oophorectomy (TAHBSO) is the gold-standard therapy for patients with endometrial carcinoma. However, patients with high operative risks are usually treated with radiation therapy (RT) alone. The goal of this study was to update our experience of high-dose-rate brachytherapy (HDRB), with or without external-beam irradiation (EBRT), for such patients. METHODS AND MATERIALS: Between 1984 and 2003, 38 patients with Stage I and Stage II adenocarcinoma of the endometrium considered high operative risk received RT as the primary treatment. The median age was 74.1 years. Before 1996, the local extent of the disease was assessed by an examination under anesthesia (EUA) and by EUA and magnetic resonance imaging (MRI) thereafter. Eight patients (21%) were treated with combined HDRB and EBRT, and 30 patients (79%) were treated with with HDRB alone. The median HDRB dose was 23.9 Gy, typically delivered in 3 fractions in a weekly schedule. The median EBRT dose was 42 Gy. RESULTS: At a median follow-up of 57.5 months for patients at risk, 11 patients (29%) have failed: 6 patients (16%) locally, 4 patients (10.5%) distantly, and 1 patient (3%) locally and distantly. Local failure was established by biopsy, and 4 patients were salvaged by TAHBSO. Higher stage and higher grade were both associated with increased failure rate. The 15-year disease-specific survival (DSS) was 78% for all stages, 90% for Stage I, and 42% for Stage II (p < 0.0001). The 15-year DSS was 91% for Grade I and 67% for Grade II and III combined (p = 0.0254). Patients with Stage I disease established by MRI (11 patients) and who received a total HDRB dose of 30 Gy had a DSS rate of 100% at 10 years. Four patients experienced late toxicities: 1 Grade II and 3 Grade III or IV. CONCLUSION: Medically inoperable Stage I endometrial carcinoma may be safely and effectively treated with HDRB as the primary therapy. In selected Stage I patients, our results are equivalent to that of surgery. We believe that the alternative option of HDRB as the primary therapy for selected Stage I endometrial carcinoma, even in patients with low operative risks, needs further evaluation.

Long-term results of high-dose rate brachytherapy in cervix cancer using a small number of fractions.

OBJECTIVES: To evaluate the long-term treatment outcome of patients with carcinoma of the cervix treated with high dose rate brachytherapy (HDRB) using a small number of fractions. METHODS: Between 1984 and 1997, 282 patients with cervix cancer (stages IB to IVA) were treated with external beam radiotherapy to the whole pelvis (median dose of 45 Gy) and HDRB (median dose of 24 Gy at point A in 3 insertions given weekly). Endpoints assessed were survival, patterns of failure and complications. Multivariate analysis was performed to identify variables predictive for overall survival and local control. Variables investigated were stage, age, overall duration of treatment, HDRB scheduling and total dose to point A. RESULTS: At a median follow-up of 86.3 months for patients at risk, the 5-, 10- and 15-year overall survival rates are 57%, 52% and 47%, respectively. On multivariate analysis, only stage and age correlated with improved survival. Treatment duration beyond 47 days was associated with poorer overall survival, although it did not reach statistical significance (P = 0.10). Brachytherapy scheduling and BED to point A had no impact on overall survival. Stage and age significantly correlated with pelvic disease control. Duration of therapy, scheduling of the brachytherapy and BED at point A were not individual predictors for overall local control. Overall, gastrointestinal and genitourinary actuarial complication rates were 15% and 8%, respectively. CONCLUSIONS: In our experience, HDRB using 3 insertions is well tolerated and the results are comparable to HDRB using larger number of fractions and to low dose rate brachytherapy.