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Abu-Zaid A, Azzam AZ, AlOmar O, Salem H, Amin T, Al-Badawi IA. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for managing peritoneal carcinomatosis from endometrial carcinoma: a single-center experience of 6 cases. Ann Saudi Med 2014; 34:159-66. [PMID: 24894786 PMCID: PMC6074854 DOI: 10.5144/0256-4947.2014.159] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Endometrial carcinoma is the most common gynecologic malignancy worldwide. Prognosis of patients with peritoneal carcinomatosis (PC) from endometrial carcinoma is deadly, with an estimated median survival not exceeding 12 months. The objective of this study was to report our experience with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for managing PC from primary and recurrent endometrial carcinoma. DESIGN AND SETTINGS A retrospective analysis of 6 patients with PC arising from endometrial cancer, who were managed with CRS and HIPEC at our referral tertiary care center, from November 2010 to August 2013. MATERIALS AND METHODS Six patients underwent CRS and HIPEC. CRS was performed using standard peritonectomy procedures and visceral resections directed toward the complete elimination of tumors from ab.dominopelvic cavity. HIPEC was performed with cisplatin (50 mg/m2) and doxorubicin (15 mg/m2) and allowed to circulate in abdominopelvic cavity for 90 minutes at 41.0 to 42.2°C. RESULTS Two patients with primary endometrial carcinoma and 4 patients with recurrent endometrial carcino.ma confined to peritoneal cavity were studied. Complete cytoreduction (CC-0) was achieved in 5 patients. The International Federation of Gynecology and Obstetrics (FIGO) stages and histopathological types were as follows: IB endometrioid adenocarcinomas (n=1), IC mesonephric carcinomas (n=1), IIIA endometrioid adenocarcino.mas (n=2), IIIA papillary serous carcinomas (n=1), and IIIC clear-cell carcinomas (n=1). Anastomotic leak (grade I) was the most commonly encountered postoperative complication. Two patients developed grade IV compli.cations due to septicemia and pulmonary embolism. No intraoperative mortality occurred. Postoperatively, all patients received chemotherapy (carboplatin and paclitaxel). In 1 patient, the clear-cell carcinoma histologic lesion relapsed within 6 months; the metastases spread to hepatic, pelvic, and mesenteric lymph nodes, and the patient died 5 months later. One patient with cytoreduction completeness of CC-2 developed hepatic metastases within 3 months and is still alive at a follow-up up 6 months. Remaining patients (n=4) are alive and disease free without evidence of recurrence of follow-ups at 35, 34, 19, and 7 months. CONCLUSION CRS and HIPEC are well-tolerated and feasibly promising management modalities in PC from primary and recurrent endometrial carcinoma. Further research is needed for in-depth analysis.
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Affiliation(s)
| | | | | | | | | | - Ismail A Al-Badawi
- Dr. Ismail A. Al-Badawi, MBC 52 Department of Obstetrics and Gynecology,, PO Box 3354, King Faisal Specialist Hospital and Research Centre,, Riyadh 11211, Saudi Arabia, T: +966-11- 442-7392, F: +966-11-442-7393,
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102
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Ren Y, Shan B, Shi D, Wang H. Salvage cytoreductive surgery for patients with recurrent endometrial cancer: a retrospective study. BMC Cancer 2014; 14:135. [PMID: 24571733 PMCID: PMC3941750 DOI: 10.1186/1471-2407-14-135] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 02/19/2014] [Indexed: 11/29/2022] Open
Abstract
Background Salvage cytoreductive surgery (SCR) has been shown to improve the survival of cancer patients. This study aimed to determine the survival benefits of SCR for recurrent endometrial cancer in Chinese population. Methods Between January 1995 and May 2012, 75 Chinese patients with recurrent endometrial cancer undergoing SCR were retrospectively analyzed. Results 43 patients (57.3%) had R0 (no visible disease), 15 patients (20.0%) had R1 (residual disease ≤1 cm), and 17 (22.7%) had R2 (residual disease >1 cm) Resection. 35 patients (46.7%) had single, and 40 (53.3%) had multiple sites of recurrence. The median survival time was 18 months, and 5-year overall survival (OS) rate were 42.0%. Multivariate analysis showed that residual disease ≤1 cm and high histology grade were significantly associated with a better OS. The size of the largest recurrent tumors (≤6 cm), solitary recurrent tumor, and age at recurrence (≤56 years old) were associated with optimal SCR. Conclusion Optimal SCR and high histology grade are associated with prolonged overall survival for patients with recurrent endometrial cancer. Patients with young age, tumor size < 6 cm, and solitary recurrent tumor are more likely to benefit from optimal cytoreductive surgery.
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Affiliation(s)
| | | | | | - Huaying Wang
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
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103
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Holland C. Unresolved issues in the management of endometrial cancer. Expert Rev Anticancer Ther 2014; 11:57-69. [DOI: 10.1586/era.10.207] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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104
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Eto T, Saito T, Shimokawa M, Hatae M, Takeshima N, Kobayashi H, Kasamatsu T, Yoshikawa H, Kamura T, Konishi I. Status of treatment for the overall population of patients with stage IVb endometrial cancer, and evaluation of the role of preoperative chemotherapy: A retrospective multi-institutional study of 426 patients in Japan. Gynecol Oncol 2013; 131:574-80. [DOI: 10.1016/j.ygyno.2013.08.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 08/26/2013] [Accepted: 08/30/2013] [Indexed: 11/27/2022]
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105
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Hickey R, Vouche M, Sze D, Hohlastos E, Collins J, Schirmang T, Memon K, Ryu RK, Sato K, Chen R, Gupta R, Resnick S, Carr J, Chrisman H, Nemcek A, Vogelzang R, Lewandowski RJ, Salem R. Cancer concepts and principles: primer for the interventional oncologist-part II. J Vasc Interv Radiol 2013; 24:1167-88. [PMID: 23810312 PMCID: PMC3800031 DOI: 10.1016/j.jvir.2013.04.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 04/20/2013] [Accepted: 04/20/2013] [Indexed: 02/07/2023] Open
Abstract
This is the second of a two-part overview of the fundamentals of oncology for interventional radiologists. The first part focused on clinical trials, basic statistics, assessment of response, and overall concepts in oncology. This second part aims to review the methods of tumor characterization; principles of the oncology specialties, including medical, surgical, radiation, and interventional oncology; and current treatment paradigms for the most common cancers encountered in interventional oncology, along with the levels of evidence that guide these treatments.
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Affiliation(s)
- Ryan Hickey
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Michael Vouche
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Daniel Sze
- Department of Radiology, Stanford University, Palo Alto, CA
| | - Elias Hohlastos
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Jeremy Collins
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Todd Schirmang
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Khairuddin Memon
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Robert K Ryu
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Kent Sato
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Richard Chen
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Ramona Gupta
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Scott Resnick
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - James Carr
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Howard Chrisman
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Al Nemcek
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Robert Vogelzang
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Robert J Lewandowski
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
| | - Riad Salem
- Department of Radiology, Division of Interventional Oncology, Northwestern University, Chicago IL
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107
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Is selective lymphadenectomy more cost-effective than routine lymphadenectomy in patients with endometrial cancer? Gynecol Oncol 2013; 128:166-70. [DOI: 10.1016/j.ygyno.2012.10.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 10/02/2012] [Accepted: 10/08/2012] [Indexed: 12/16/2022]
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108
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Eto T, Saito T, Kasamatsu T, Nakanishi T, Yokota H, Satoh T, Nogawa T, Yoshikawa H, Kamura T, Konishi I. Clinicopathological prognostic factors and the role of cytoreduction in surgical stage IVb endometrial cancer: A retrospective multi-institutional analysis of 248 patients in Japan. Gynecol Oncol 2012; 127:338-44. [DOI: 10.1016/j.ygyno.2012.08.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Revised: 08/07/2012] [Accepted: 08/12/2012] [Indexed: 12/22/2022]
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Liu FY, Chao A, Lai CH, Chou HH, Yen TC. Metabolic tumor volume by 18F-FDG PET/CT is prognostic for stage IVB endometrial carcinoma. Gynecol Oncol 2012; 125:566-71. [DOI: 10.1016/j.ygyno.2012.03.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 03/08/2012] [Accepted: 03/10/2012] [Indexed: 12/22/2022]
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111
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Einstein MH, Rice LW. Current Surgical Management of Endometrial Cancer. Hematol Oncol Clin North Am 2012; 26:79-91. [DOI: 10.1016/j.hoc.2011.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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112
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[Advanced endometrial carcinoma: primary debulking surgery or neoadjuvant chemotherapy?]. Bull Cancer 2011; 99:43-9. [PMID: 22198346 DOI: 10.1684/bdc.2011.1515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Endometrial cancers with peritoneal spread are stage IVB of FIGO classification. Their pattern is similar to that of ovarian cancer. Optimal debulking surgery and chemotherapy are predictor of better overall and disease free survival. Despite the poor outcome, there is a need for new treatment options. Recommended management for this group of patients should consist of surgical cytoreduction followed by chemotherapy. There may be a role for neoadjuvant chemotherapy followed by interval surgery in selected subgroups of patients.
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113
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Marnitz S, Köhler C. Current therapy of patients with endometrial carcinoma. A critical review. Strahlenther Onkol 2011; 188:12-20. [PMID: 22189438 DOI: 10.1007/s00066-011-0004-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 09/28/2011] [Indexed: 10/14/2022]
Abstract
Magnetic resonance imaging (MRI), 18-FDG positron emission tomography ((18)FDG PET-CT), and computed tomography (CT) have demonstrated disappointing detectability of lymph node metastases in endometrial cancer. The treatment of choice in patients with endometrial cancer is hysterectomy and bilateral salpingoophorectomy. Above all, obese patients with comorbidity have benefited the most from laparoscopically assisted approaches. For inoperable patients in FIGO stage I/II, radiation remains an alternative to hysterectomy. The role of pelvic and paraaortic lymphadenectomy is the most controversial issue in endometrial carcinoma treatment. The current spectrum of treatment ranges from no lymphadenectomy, exclusive pelvic or additional inframesentric paraaortic sampling, or complete pelvic to infrarenal paraaortic lymphadenectomy. The sentinel concept in patients with endometrial carcinoma is far from being introduced into routine clinical practice. Without a lymphadenectomy, decision making for adjuvant therapy remains a challenge, because no information is available from lymph node status and the reliability of pathologic grading is poor. For patients after hysterectomy with a low risk of local relapse (stage I/II without additional risk factors), vaginal brachytherapy is sufficient to prevent vaginal relapses. Adjuvant external beam irradiation (EBRT) in stage I/II demonstrated improved local control which impacted overall survival only in patients with high-risk features (higher age, grading myometrial infiltration). Stage IIIC patients seem to benefit from EBRT with regard to overall survival. In patients at high risk of progression (grade 3, MI > 50%, FIGO IIIC, unfavorable histology), multimodal treatment should be considered. The optimal substances and sequences are under investigation.
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Affiliation(s)
- S Marnitz
- Department of Radiooncology, Charité University Medicine, Charité - Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
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Tanner EJ, Leitao MM, Garg K, Chi DS, Sonoda Y, Gardner GJ, Barakat RR, Jewell EL. The role of cytoreductive surgery for newly diagnosed advanced-stage uterine carcinosarcoma. Gynecol Oncol 2011; 123:548-52. [DOI: 10.1016/j.ygyno.2011.08.020] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 08/19/2011] [Accepted: 08/20/2011] [Indexed: 11/16/2022]
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Shih K, Yun E, Gardner G, Barakat R, Chi D, Leitao M. Surgical cytoreduction in stage IV endometrioid endometrial carcinoma. Gynecol Oncol 2011; 122:608-11. [DOI: 10.1016/j.ygyno.2011.05.020] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 05/13/2011] [Accepted: 05/18/2011] [Indexed: 11/28/2022]
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Barlin JN, Bristow RE. Response to: “What is the role of neoadjuvant chemotherapy in advanced endometrial cancer?”. Gynecol Oncol 2010. [DOI: 10.1016/j.ygyno.2010.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Amant F, Vergote I. What is the role of neoadjuvant chemotherapy in advanced endometrial cancer? Gynecol Oncol 2010; 119:601; author reply 601-2. [DOI: 10.1016/j.ygyno.2010.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 08/10/2010] [Indexed: 11/26/2022]
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