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Hu Z, Li J, Du J. New online dynamic nomograms to predict recurrence-free and overall survival after resection of endometrial cancer: a single-institution retrospective cohort study. Arch Gynecol Obstet 2024:10.1007/s00404-024-07596-x. [PMID: 38886217 DOI: 10.1007/s00404-024-07596-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 06/09/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE The significant global burden of endometrial cancer (EC) and the challenges associated with predicting EC recurrence indicate the need for a dynamic prediction model. This study aimed to propose nomograms based on clinicopathological variables to predict recurrence-free survival (RFS) and overall survival (OS) after surgical resection for EC. METHODS This single-institution retrospective cohort study included patients who underwent surgical resection for EC. Web-based nomograms were developed to predict RFS and OS following resection for EC, and their discriminative and calibration abilities were assessed. RESULTS This study included 289 patients (median age, 56 years). At a median follow-up of 51.1 (range, 4.1-128.3) months, 13.5% (39/289) of patients showed relapse or died, and 10.7% (31/289) had non-endometrioid tumors (median size: 2.8 cm). Positive peritoneal cytology result (hazard ratio [HR], 35.06; 95% confidence interval [CI], 1.12-1095.64; P = 0.0428), age-adjusted Charlson comorbidity index (AACCI) (HR, 52.08; 95% CI, 12.35-219.61; P < 0.001), and FIGO (Federation of Gynecology and Obstetrics) stage IV (HR, 138.33; 95% CI, 17.38-1101.05; P < 0.001) were predictors of RFS. Similarly, depth of myometrial invasion ≥ 1/2 (HR, 1; 95% CI, 0.46-2.19; P = 0.995), AACCI (HR, 93.63; 95% CI, 14.87-589.44; P < 0.001), and FIGO stage IV (HR, 608.26; 95% CI, 73.41-5039.66; P < 0.001) were predictors of OS. The nomograms showed good predictive capability, positive discriminative ability, and calibration (RFS: 0.895 and OS: 0.891). CONCLUSION The nomograms performed well in internal validation when patients were stratified into prognostic groups, offering a personalized approach for risk stratification and treatment decision-making.
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Affiliation(s)
- Zhen Hu
- Gynecology and Obstetrics Unit, Dongyang Hospital of Wenzhou Medical University, 60 Wuning West RoadDongyang City, Jinhua City, Zhejiang Province, China
| | - Junying Li
- Gynecology and Obstetrics Unit, Dongyang Hospital of Wenzhou Medical University, 60 Wuning West RoadDongyang City, Jinhua City, Zhejiang Province, China
| | - Junqiang Du
- Gynecology and Obstetrics Unit, Dongyang Hospital of Wenzhou Medical University, 60 Wuning West RoadDongyang City, Jinhua City, Zhejiang Province, China.
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Vargiu V, Rosati A, Capozzi VA, Gioè A, Restaino S, Berretta R, Cosentino F, Scambia G, Fanfani F. Major determinants of survival in recurrent endometrial cancer-the role of secondary cytoreductive surgery: a multicenter study. Int J Gynecol Cancer 2023; 33:1572-1579. [PMID: 37648408 DOI: 10.1136/ijgc-2023-004533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVE The main objective of the study was to assess the influence of different clinical and therapeutic variables on the oncological outcomes of patients with endometrial cancer relapse. In particular, we evaluated the impact of cytoreductive surgery with the achievement of complete gross resection. METHODS This is a multicenter retrospective cohort study conducted in three centers in Italy and including all patients with first relapse of endometrial cancer from January 2010 to December 2021. RESULTS Data from 331 women with recurrent endometrial cancer were analyzed. Secondary cytoreductive surgery was performed in 56.2% of cases (186 patients). Complete gross resection was achieved in 178 patients (95.7%). Complete gross resection conferred a statistically significant survival benefit both for post-relapse survival and post-relapse free survival (3 years post-relapse survival: 75.4% vs 56.4%, p<0.001; 3 years post-relapse free survival: 32.6% vs 26.5%, p=0.027). At multivariate Cox regression analysis, age ≥75 years, Eastern Cooperative Oncology Group Performance Status ≥2, the advanced-metastatic risk group, complete gross resection, and multiple site relapses were identified as independent significant predictors for post-relapse survival; regarding post-relapse free survival, only age ≥75, the high and advanced-metastatic risk groups, and complete gross resection confirmed their statistical significance. CONCLUSIONS Secondary cytoreductive surgery with achievement of complete gross resection was confirmed to be an independent positive predictor for survival in patients with recurrent endometrial cancer and should be considered a valid primary treatment in the therapeutic decision-making process.
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Affiliation(s)
- Virginia Vargiu
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Andrea Rosati
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Roma, Lazio, Italy
| | | | - Alessandro Gioè
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Stefano Restaino
- Obstetrics, Gynecology and Pediatrics Department, Udine University Hospital, DAME, Udine, Italy
| | - Roberto Berretta
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Giovanni Scambia
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Roma, Lazio, Italy
| | - Francesco Fanfani
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Roma, Lazio, Italy
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Li N, Jiang P, Huang Y, Tu Y, Kong W, Jiang S, Zhang J, Wu Y, Zhang X, Xie Q, Yuan R. Estrogen Receptor- And Progesterone Receptor-Positive Thresholds in Predicting the Recurrence of Early Low-Risk Endometrial Cancer. Clin Med Insights Oncol 2022; 16:11795549221103200. [PMID: 35721388 PMCID: PMC9203725 DOI: 10.1177/11795549221103200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background Estrogen receptors (ER) and progesterone receptors (PR) have important prognostic value in endometrial cancer, but there is no recognized positive immunohistochemical threshold for predicting the recurrence of early low-risk endometrial cancer. The purpose of this study was to clarify the optimal positive thresholds of the immunohistochemical parameters the ER and PR in early low-risk endometrial cancer. Methods A total of 332 patients with stage IA endometrial cancer were enrolled from the First Affiliated Hospital of Chongqing Medical University and People's Hospital of Sha ping ba District in Chongqing between January 2013 and December 2018. First, univariate and multivariate Cox regression analyses were used to analyze the correlation between various clinical factors and the prognosis of early low-risk endometrial cancer. Then, the receiver operating characteristic curve (ROC curve) and Youden index were used to determine the positive thresholds of ER and PR. Results The positive thresholds of ER and PR for predicting the recurrence of early low-risk endometrial cancer were 12% and 8%, respectively. Multivariate analysis showed that ER (P = 0.004), PR (P = 0.026), and p53 (P = 0.021) were risk factors for the prognosis of patients with early low-risk endometrial cancer. The recurrence-free survival and the overall survival in the low ER group and PR group were much lower than those in the high ER group and PR group (P < 0.001 of all). Conclusions ER and PR positive thresholds of 12% and 8%, respectively, are the most suitable for predicting the recurrence of early low-risk endometrial cancer.
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Affiliation(s)
- Ning Li
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Department of Gynecology, People's Hospital of Shapingba District, Chongqing, China
| | - Peng Jiang
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuzhen Huang
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuan Tu
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Kong
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shan Jiang
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jingni Zhang
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yijun Wu
- Department of Gynecology, People's Hospital of Shapingba District, Chongqing, China
| | - Xiaorong Zhang
- Department of Gynecology, People's Hospital of Shapingba District, Chongqing, China
| | - Qingning Xie
- Department of Gynecology, People's Hospital of Shapingba District, Chongqing, China
| | - Rui Yuan
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Shin DW, Jung KW, Ha J, Bae J. Conditional relative survival of patients with endometrial cancer: a Korean National Cancer Registry study. J Gynecol Oncol 2022; 33:e23. [PMID: 35245001 PMCID: PMC8899867 DOI: 10.3802/jgo.2022.33.e23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 12/05/2021] [Accepted: 12/10/2021] [Indexed: 12/24/2022] Open
Abstract
Objective The purpose of this study was to estimate 5-year conditional relative survival (5Y CRS) rates of endometrial cancer (EC) in Korea accounting for time already survived. Subgroup-specific estimates stratified by various patient characteristics were also presented. Methods Using the data from the Korean Central Cancer Registry, 5Y CRS rates were calculated in patients who were diagnosed with EC between 1998 and 2017. The CRS rates were presented by year of diagnosis, age at diagnosis, histology, cancer stage, and treatment received. Results The 5-year relative survival rate at the time of diagnosis was 89.0% for all cases. The probability of surviving an additional 5 years (i.e., 5Y CRS), if the patient survived 1, 2, 3, 4, and 5 years after diagnosis was 91.8%, 94.1%, 95.6%, 96.5%, and 97.3%, respectively. Patients with poor initial prognoses, i.e., those who were older, had non-endometrioid histology, and high stage, showed the largest improvements in 5Y CRS, reaching >90% for most subgroups, except those with serous histology (88.4%) and distant stage (77.7%). Patients aged ≥70 years had the highest probability of death in the 1st and 2nd years after diagnosis (13.8 and 11.0%), but the conditional probability of death in the 3rd, 4th, and 5th years declined rapidly to 7.3%, 4.5%, and 3.7%, respectively. Conclusion The CRS rates for patients with EC improved with increased time elapsed from diagnosis. The greatest improvements in 5Y CRS were observed among patients who were older, those with non-endometrioid histology, and those with more advanced disease. There is paucity of research which estimated the conditional relative survival (CRS) rates for patients with endometrial cancer, and the Asian population is underrepresented in these studies, despite that Asian patients have different age and histologic distribution. CRS rates were presented by year of diagnosis, age at diagnosis, histology, cancer stage, and treatment received. Such estimates based on patient's evolving risk profile will provide updated prognostic information useful for both patients and healthcare providers.
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Affiliation(s)
- Dong Wook Shin
- Supportive Care Center, Samsung Comprehensive Cancer Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
| | - Kyu-Won Jung
- Division of Cancer Registration and Surveillance, National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Korea Central Cancer Registry, National Cancer Center, Goyang, Korea
| | - Johyun Ha
- Division of Cancer Registration and Surveillance, National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Korea Central Cancer Registry, National Cancer Center, Goyang, Korea
| | - Jaeman Bae
- Department of Obstetrics and Gynecology, Hanyang University, Seoul, Korea
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Nwachukwu C, Baskovic M, Von Eyben R, Fujimoto D, Giaretta S, English D, Kidd E. Recurrence risk factors in stage IA grade 1 endometrial cancer. J Gynecol Oncol 2021; 32:e22. [PMID: 33470064 PMCID: PMC7930446 DOI: 10.3802/jgo.2021.32.e22] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/03/2020] [Accepted: 11/29/2020] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES Patients with early-stage endometrial cancers (EC) with disease recurrences have worse survival outcomes. The purpose of this study was to identify clinical and pathologic factors that predict for all recurrences in stage IA grade 1 (IAG1) EC. METHODS Records from patients diagnosed with EC were retrospectively reviewed. Baseline characteristics of 222 patients with IAG1 EC who underwent surgical resection were analyzed. Cox proportional hazard analysis was used to identify univariate and multivariate risk factors that predict for recurrence. RESULTS Seventeen (7.65%) patients had recurrences. The 3-year cumulative incidence of recurrence were significantly higher for patients with time from biopsy to surgery ≥6 months (54% vs. 8%, p=0.003), simple hysterectomy with ovarian preservation vs. total hysterectomy and bilateral salpingo-oophorectomy (31% vs. 9%, p=0.032), any myometrial invasion vs. no invasion (18% vs. 2%, p=0.004), and tumor size ≥2 cm (15% vs. 2%, p=0.021). On, multivariate analysis, any myometrial invasion, increasing time from biopsy to surgery, and larger tumor size were independent predictors of any recurrence. Patients with recurrences had worse outcomes than those without (5-year overall survival [OS]=60%; 95% confidence interval [CI]=16%-86% vs. 5-year OS=95%; 95% CI=87%-99%, respectively, p=0.003). CONCLUSION Time from biopsy to surgery, larger tumors, and myometrial invasion are the most important predictors of recurrence. Though the recurrence rates are generally low in IAG1 EC, the survival rate for the patients with recurrences was worse than those without. Identification of additional recurrence risk factors can help select patients who may benefit from adjuvant treatment.
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Affiliation(s)
- Chika Nwachukwu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA, USA
| | - Mana Baskovic
- Division of Gynecologic Oncology, Department of Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Rie Von Eyben
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA, USA
| | - Dylann Fujimoto
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA, USA
| | - Stephanie Giaretta
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA, USA
| | - Diana English
- Division of Gynecologic Oncology, Department of Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Elizabeth Kidd
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford Cancer Institute, Stanford, CA, USA.
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Bendifallah S, Ilenko A, Daraï E. High risk endometrial cancer: Clues towards a revision of the therapeutic paradigm. J Gynecol Obstet Hum Reprod 2019; 48:863-871. [PMID: 31176047 DOI: 10.1016/j.jogoh.2019.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 05/16/2019] [Accepted: 06/04/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Endometrial cancer (EC) is a major cause of mortality worldwide with nearly 200 000 cases diagnosed annually. The recent ESMO-ESGO-ESTRO guidelines include a new classification defining a heterogeneous high-risk group of recurrence (HR) comprising: (i) endometrioid (type 1) FIGO stage IB grade 3 tumors (type 1/G3ECs), (ii) non-endometrioid tumors (type 2) and (iii) advanced stages whatever the histological type (Colombo et al., 2016). AREAS COVERED The aim of this review is to summarize current evidence for therapeutic approaches in HR-EC according to the updated ESMO-ESGO-ESTRO classification by discussing the following issues: i) HR-EC heterogeneity, (ii) prognostic factors and current classification, and (iii) optimal staging strategies (site and extent) and the role of adjuvant treatment. EXPERT COMMENTARY HR-EC treatment is based on surgery, radiation therapy, brachytherapy, and chemotherapy, either alone or sequentially, in combination with other treatments depending on disease stage, histological grade and risk group. Specific trials are needed to establish the role of systematic pelvic and paraaortic lymphadenectomy, adjuvant therapies and targeted drugs. Although molecular characterization has been reported to customize therapeutic strategies and thereby improve therapeutic outcomes in EC, none of the targeted agents investigated (antiangiogenic and mTOR/PI3K pathway inhibitor agents) have resulted in a change in clinical practice in HR-EC.
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Affiliation(s)
- S Bendifallah
- Department of Obstetrics and Gynaecology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; INSERM UMR S 938, Sorbonne université, Paris 6, France
| | - A Ilenko
- Department of Obstetrics and Gynaecology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France.
| | - E Daraï
- Department of Obstetrics and Gynaecology, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France; INSERM UMR S 938, Sorbonne université, Paris 6, France
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A Proposal for a Classification for Recurrent Endometrial Cancer: Analysis of a French Multicenter Database From the FRANCOGYN Study Group. Int J Gynecol Cancer 2018; 28:1278-1284. [PMID: 29994907 DOI: 10.1097/igc.0000000000001296] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Endometrial cancer (EC) recurrences are relatively common with no standardized way of describing them. We propose a new classification for them called locoregional, nodal, metastasis, carcinomatosis recurrences (rLMNC). PATIENTS AND METHODS The data of 1230 women with EC who were initially treated by primary surgery were included in this French multicenter retrospective study. Recurrences were classified based on dissemination pathways: (1) locoregional recurrence (rL); (2) nodal recurrence (rN) for lymphatic pathway; (3) distant organ recurrence (rM) for hematogenous pathway; and (4) carcinomatosis recurrence (rC) for peritoneal pathway. These pathways were further divided into subgroups. We compared recurrence free survival and overall survival (OS) between the 4 groups (rL/rN/rM/rC). RESULTS The median follow-up was 35.6 months (range, 1.70-167.60). One hundred ninety-eight women (18.2%) experienced a recurrence: 150 (75.8%) experienced a single-pathway recurrence and 48 (24.2%) a multiple-pathway recurrence. The 5-year OS was 34.1% (95% confidence interval [CI], 27.02%-43.1%), and the median time to first recurrence was 18.9 months (range, 0-152 months). The median survival after recurrence was 14.8 months (95% CI, 11.7-18.8). Among women with single pathway of recurrence, a difference in 5-year OS (P < 0.001) and survival after recurrence (P < 0.01) was found between the 4 rLNMC groups. The carcinomatosis group had the worst prognosis compared with other single recurrence pathways. Women with multiple recurrences had poorer 5-year OS (P < 0.001) and survival after recurrence (P < 0.01) than those with single metastasis recurrence, other than women with peritoneal carcinomatosis. CONCLUSIONS This easy-to-use and intuitive classification may be helpful to define EC recurrence risk groups and develop guidelines for the management of recurrence. Its prognosis value could also be a tool to select homogenous populations for further trials.
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Ouldamer L, Bendifallah S, Body G, Touboul C, Graesslin O, Raimond E, Collinet P, Coutant C, Lavoué V, Lévêque J, Daraï E, Ballester M. Predicting poor prognosis recurrence in women with endometrial cancer: a nomogram developed by the FRANCOGYN study group. Br J Cancer 2016; 115:1296-1303. [PMID: 27824810 PMCID: PMC5129824 DOI: 10.1038/bjc.2016.337] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 09/14/2016] [Accepted: 09/23/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The purpose of this study was to develop a nomogram to predict 'poor prognosis recurrence' (PPR) in women treated for endometrial cancer (EC). METHODS The data of 861 women who received primary surgical treatment between January 2001 and December 2013 were abstracted from a prospective multicenter database. Data were randomly split into two sets: training and validation with a predefined 2/3 ratio. A Cox proportional hazards multivariate model of selected prognostic features was performed in the training cohort (n=574) to develop a nomogram predicting PPRs. The nomogram was validated in the validation cohort of 287 patients. RESULTS In the training cohort, 82 (14.3%) developed subsequent PPR. Age, histologic type and grade, lymphovascular space invasion status, FIGO stage, and nodal staging (SLN±pelvic and/or para-aortic lymphadenectomy) were independently associated with subsequent PPR. The nomogram showed an area under the receiver operating characteristic curve (AUC) of 0.82 (95% confidence interval (CI), 0.73-0.89) in the training set. The validation set showed a good discrimination with an AUC of 0.75 (95% CI, 0.65-0.83). CONCLUSIONS We have developed a robust tool that is able to predict subsequent PPRs in women with FIGO I-III EC.
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Affiliation(s)
- Lobna Ouldamer
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, Tours, France
- INSERM U1069; Université François-Rabelais, 10 Boulevard Tonnellé, 3704 Tours, France
| | - Sofiane Bendifallah
- Department of Obstetrics and Gynaecology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, GRC-6 UPMC, Université Pierre et Marie Curie, Paris, France
- UMR S 707, Epidemiology, Information Systems, Modeling, Université Pierre et Marie Curie, Paris, France
| | - Gilles Body
- Department of Gynecology, Centre Hospitalier Universitaire de Tours, Tours, France
- INSERM U1069; Université François-Rabelais, 10 Boulevard Tonnellé, 3704 Tours, France
| | - Cyril Touboul
- Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal, Créteil, France
| | - Olivier Graesslin
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - Emilie Raimond
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - Pierre Collinet
- Department of Gynecological surgery, Jeanne de Flandre University Hospital, Lille, France
| | - Charles Coutant
- Centre de lutte Contre le Cancer Georges François Leclerc, Dijon, France
| | - Vincent Lavoué
- Departement of Gynecological Surgery, Rennes University Hospital, Rennes, France
| | - Jean Lévêque
- Departement of Gynecological Surgery, Rennes University Hospital, Rennes, France
| | - Emile Daraï
- Department of Obstetrics and Gynaecology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, GRC-6 UPMC, Université Pierre et Marie Curie, Paris, France
- INSERM UMR S 938, Université Pierre et Marie Curie, Paris, France
| | - Marcos Ballester
- Department of Obstetrics and Gynaecology, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, GRC-6 UPMC, Université Pierre et Marie Curie, Paris, France
- INSERM UMR S 938, Université Pierre et Marie Curie, Paris, France
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Vulvar Metastasis of an Early-Stage Well-Differentiated Endometrial Cancer After Minimally Invasive Surgery. J Minim Invasive Gynecol 2014; 21:708-11. [DOI: 10.1016/j.jmig.2014.01.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 01/31/2014] [Accepted: 01/31/2014] [Indexed: 11/20/2022]
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10
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Rech AB, Barbi GL, Ventura LHA, Guimarães FS, Oliveira HF, Baffa O. In vivo dose evaluation during gynaecological radiotherapy using L-alanine/ESR dosimetry. RADIATION PROTECTION DOSIMETRY 2014; 159:194-198. [PMID: 24751984 DOI: 10.1093/rpd/ncu128] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The dose delivered by in vivo 3-D external beam radiation therapy (EBRT) was verified with L-alanine/electron spin resonance (ESR) dosimetry for patients diagnosed with gynaecological cancer. Measurements were performed with an X-band ESR spectrometer. Dosemeters were positioned inside the vaginal cavity with the assistance of an apparatus specially designed for this study. Previous phantom studies were performed using the same conditions as in the in vivo treatment. Four patients participated in this study during 20-irradiation sessions, giving 220 dosemeters to be analysed. The doses were determined with the treatment planning system, providing dose confirmation. The phantom study resulted in a deviation between -2.5 and 2.1 %, and for the in vivo study a deviation between -9.2 and 14.2 % was observed. In all cases, the use of alanine with ESR was effective for dose assessment, yielding results consistent with the values set forth in the International Commission on Radiation Units and Measurements (ICRU) reports.
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Affiliation(s)
- Amanda Burg Rech
- Departamento de Física, FFCLRP, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
| | - Gustavo Lazzaro Barbi
- Serviço de Radioterapia, HCFMRP, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
| | | | - Flavio Silva Guimarães
- Serviço de Radioterapia, HCFMRP, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
| | - Harley Francisco Oliveira
- Serviço de Radioterapia, HCFMRP, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil Departamento de Clínica Médica, FMRP, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
| | - Oswaldo Baffa
- Departamento de Física, FFCLRP, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
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11
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Sala E, Rockall AG, Freeman SJ, Mitchell DG, Reinhold C. The added role of MR imaging in treatment stratification of patients with gynecologic malignancies: what the radiologist needs to know. Radiology 2013; 266:717-40. [PMID: 23431227 DOI: 10.1148/radiol.12120315] [Citation(s) in RCA: 232] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Many treatment options are available to patients with endometrial, cervical, or ovarian cancer. Magnetic resonance (MR) imaging plays an important role in the patient journey from the initial evaluation of the extent of the disease to appropriate treatment selection and follow-up. The purpose of this review is to highlight the added role of MR imaging in the treatment stratification and overall care of patients with endometrial, cervical, or ovarian cancer. Several MR imaging techniques used in evaluation of patients with gynecologic malignancies are described, including both anatomic MR imaging sequences (T1- and T2-weighted sequences) and pulse sequences that characterize tissue on the basis of physiologic features (diffusion-weighted MR imaging), dynamic contrast agent-enhanced MR imaging, and MR spectroscopy. MR imaging findings corresponding to the 2009 revised International Federation of Gynecology and Obstetrics staging of gynecologic malignancies are also described in detail, highlighting possible pearls and pitfalls of staging. With the growing role of the radiologist as a core member of the multidisciplinary treatment planning team, it is crucial for imagers to recognize that MR imaging has become central in tailoring treatment options and therapy in patients with gynecologic malignancies.
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Affiliation(s)
- Evis Sala
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, England, UK.
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Recurrence-free and 5-year survival following robotic-assisted surgical staging for endometrial carcinoma. Gynecol Oncol 2013; 129:49-53. [DOI: 10.1016/j.ygyno.2012.12.020] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 12/11/2012] [Accepted: 12/12/2012] [Indexed: 11/20/2022]
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Current World Literature. Curr Opin Obstet Gynecol 2013; 25:81-9. [DOI: 10.1097/gco.0b013e32835cc6b6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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