Improved Outcome of High-Grade, Early 1-Stage Endometrioid Endometrial Carcinoma With Adjuvant Chemotherapy and Radiotherapy: Comparison of 2 Treatment Strategies.

OBJECTIVE: Patients with high-grade endometrioid endometrial carcinoma have a high risk of recurrence, even in early stage. To determine the benefit of a more aggressive adjuvant treatment approach, different treatment strategies of 2 referral centers were compared. MATERIALS AND METHODS: Outcome of all patients with International Federation of Gynecology and Obstetrics IB and II high-grade endometrioid endometrial carcinoma treated between 2008 and 2012, at the Gynecological Oncology Center South (GOCS) were compared with patients treated at the British Columbia Cancer Agency (BCCA). All patients underwent primary surgical treatment. Adjuvant treatment consisted of radiotherapy dependent on final pathology (GOCS), or adjuvant chemotherapy and pelvic radiotherapy (BCCA). RESULTS: A total of 116 patients were treated at the GOCS (n = 61) and BCCA (n = 55). Patient cohorts were comparable for clinicopathological factors, except for age at diagnosis and lymphadenectomy. Radiotherapy was applied in 70.5% at the GOCS compared with 100% at the BCCA. All BCCA patients received chemotherapy compared with 3.3% at GOCS. The BCCA treatment strategy resulted in a significant reduced recurrence rate when compared with GOCS, 10.9% and 36.1%, respectively. There was no significant difference in the recurrence rate between patients with (n = 48) and without a lymphadenectomy (n = 68). Yet, numbers are relatively low. Because most recurrences were distant 78.6% (22/28), adjuvant chemotherapy resulted in reduced disease-related mortality. CONCLUSIONS: Adjuvant chemotherapy and radiotherapy in early-stage high-grade endometrioid endometrial carcinoma results in improved disease-specific and overall survival compared to radiotherapy alone. Yet, due to the relatively low numbers, validation of these findings is needed in large prospective trials.

The role of palliative colorectal stents in gynaecologic malignancy.

OBJECTIVE: The objectives of this study were to determine the clinical success of colorectal stenting in patients with large bowel obstruction secondary to gynaecologic malignancy and to determine whether there are any predictors of outcome. METHODS: This was a retrospective cohort study of all patients with a gynaecologic malignancy and large bowel obstruction referred for colorectal stenting at Vancouver General Hospital between January 2006 and February 2013. All stents were placed using image guidance with the exception of one placed endoscopically. Information was extracted from the medical record. Data were analysed using descriptive statistics. Chi-square and Fisher's exact tests were used to compare stent outcomes and clinical variables. RESULTS: There were 32 patients in the study. The median age was 66 (range 40-78). The median follow-up was 28.9 months (range 0.8-481). The primary tumour was ovarian in 75% and uterine in 18.8%. Seventy-five percent of patients had a technically successful stent insertion. Of these, 37.5% had a complication requiring intervention. The rate of clinical success was 47%. There were no statistically significant associations between any clinical variables and failed stent insertion or complications. CONCLUSION: Colorectal stenting in patients with a large bowel obstruction secondary to gynaecologic malignancy is associated with a high rate of technical success but a low rate of clinical success. There were no clinical predictors of outcome identified in this study. If patients are offered this procedure, they should be counselled about the anticipated benefit and associated risks.

The importance of adjuvant chemotherapy and pelvic radiotherapy in high-risk early stage endometrial carcinoma.

OBJECTIVE: To determine the impact of a policy change in which women with high-risk early stage endometrioid endometrial cancer (EEC) received adjuvant chemoradiotherapy. METHODS: This is a population-based retrospective cohort study of British Columbia Cancer Registry patients diagnosed from 2008 to 2012 with high-risk early stage EEC, who received adjuvant chemoradiotherapy after primary surgery. High-risk early stage was defined as the presence of two or more high-risk uterine factors: grade 3 tumor, more than 50% myometrial invasion, and/or cervical stromal involvement. Adjuvant therapy consisted of 3 or 4 cycles of carboplatin and paclitaxel chemotherapy, followed by pelvic radiotherapy. Sites and rate of recurrence were compared to a historical cohort diagnosed from 2005 to 2008 in which none of the patients received adjuvant chemoradiotherapy. Five-year progression-free and overall survival rates were calculated. RESULTS: The study includes 55 patients. All patients except for 2 received at least 3 cycles of chemotherapy. All patients received pelvic radiotherapy except for 2 who received brachytherapy only. Median follow-up was 27 months (7-56 months). Four patients (7.3%) recurred, including three with distant recurrence only and one with both a pelvic and paraaortic nodal recurrence. The historical cohort had a 29.4% recurrence rate, and therefore the hazard ratio for recurrence was 0.27 (95% CI 0.02-4.11). Five-year progression-free and overall survival rates were 88.6% and 97.3%, respectively. CONCLUSION: Patients with high-risk early stage endometrial carcinoma treated with adjuvant chemoradiotherapy have a low rate of recurrence compared to those not receiving such therapy.

Recruiting medical students to rural practice: perspectives of medical students and rural recruiters.

OBJECTIVE: To explore the strategies used by rural recruitment programs and their perceived influence on medical students. DESIGN: Two original questionnaires delivered electronically, one to medical students and the other to recruiters in rural Ontario communities. SETTING: Ontario, Canada. PARTICIPANTS: All 525 medical students enrolled in the Schulich School of Medicine & Dentistry at the University of Western Ontario in London and physician recruiters in 71 rural communities in Ontario were invited to participate in the study. MAIN OUTCOME MEASURES: The factors that influence medical students to consider rural practice, strategies used by recruiters, and student perceptions of the ethical appropriateness of both. RESULTS: The questionnaire was completed by 42.1% of medical students. Lifestyle considerations were an important influence for 93.1% of students. Themes from the qualitative analysis included the ethical appropriateness of financial considerations, economic forces, perceived disadvantages of rural practice, competition between communities, and lack of altruism. Responses were received from recruiters in 43.7% of communities; of those, 92.9% offered financial incentives to attract prospective physicians. CONCLUSION: Financial and lifestyle considerations are important influences on medical students' choice to practise in rural communities. Most medical students felt incentive programs offered by rural communities were ethically appropriate.