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Escande A, Leblanc J, Hannoun-Levi JM, Renard S, Ducassou A, Hennequin C, Chargari C. Place of radiotherapy for treatment of metastatic cervical, vaginal and endometrial uterine cancer. Cancer Radiother 2024; 28:15-21. [PMID: 37507287 DOI: 10.1016/j.canrad.2023.06.012] [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] [Received: 01/24/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 07/30/2023]
Abstract
Beyond classical palliative-intent irradiation schemes, there are increasing data suggesting a benefit for intensive locoregional treatments in metastatic gynecological cancers. Such approach aims at avoiding local symptoms related to tumor progression, but may also improve survival outcome by shrinking tumor burden to a microscopic state. This strategy is rarely considered upfront (in highly selected patients with very limited oligometastatic disease), but rather after systemic treatment. In case of tumor response (especially if complete response) of the metastatic sites, pelvic±para-aortic radiotherapy can be considered in combination with a brachytherapy boost to obtain long-term local control, in particular in cervical or vaginal cancer patients. Such approach seems particularly relevant when there is isolated persistence or progression of macroscopic disease within the pelvis. In parallel, there is also an increasing place for radiotherapy of oligo-metastatic sites. We review the literature on the place of radiotherapy in the management of cancers of the cervix and metastatic endometrial cancer.
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Affiliation(s)
- A Escande
- Radiotherapy department, Centre Léonard de Vinci, Dechy, France, CRIStAL lab, UMR9189, University of Lille, Villeneuve d'Ascq, France, H.Warembourg, School of medicine, University of Lille, Lille, France
| | - J Leblanc
- Service d'Oncologie Radiothérapie-Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - J-M Hannoun-Levi
- Département de radiothérapie, centre Antoine-Lacassagne, université de Nice-Sophia, Nice, France
| | - S Renard
- Département de radiothérapie, centre Alexis Vautrin, Vandœuvre-lès-Nancy, France
| | - A Ducassou
- Radiotherapy Department, Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - C Hennequin
- Service de cancérologie-radiothérapie, Hôpital Saint-Louis, 75475 Paris, France
| | - C Chargari
- Service d'oncologie radiothérapie-centre hospitalier universitaire Pitié Salpêtrière-Assistance publique des Hôpitaux de Paris, Paris 75013, France.
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Can B, Karataşli V, Çakir İ, Sayhan S, Hansu K, Kuru O. The prognostic significance of the heterologous component in uterine carcinosarcomas. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230517. [PMID: 37729375 PMCID: PMC10508891 DOI: 10.1590/1806-9282.20230517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 06/25/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE Uterine carcinosarcomas are aggressive, rare biphasic tumors with malignant epithelial and malignant sarcomatous components. The prognostic significance of the presence of extrauterine sarcoma (heterologous component) is controversial. Therefore, the aim of this study was to investigate the effect of heterologous components in uterine carcinosarcomas on disease-free survival, overall survival, and other prognostic factors. METHODS Clinical and histopathological data from patients treated for uterine carcinosarcoma in a tertiary cancer center in Turkey between July 2000 and January 2020 were collected. Independent risk factors affecting overall survival and disease-free survival were analyzed by univariate and multivariate Cox regression analyses. RESULTS A total of 98 patients were identified. The median follow-up was 21.8 (1.2-233.1) months. In the multivariate analysis, the median overall survival and disease-free survival were 23.8 and 20.7 months in those with homologous mesenchymal components and 17.6 and 9.7 months in those with heterologous mesenchymal components, respectively. It was found that the presence of heterologous mesenchymal components significantly reduced both overall survival and disease-free survival (odds ratio [OR], 2.861; 95% confidence interval [CI] 1.196-6.841; p=0.018 and OR, 3.697; 95%CI 1.572-8.695; p=0.003, respectively). In addition, both lymphadenectomy and adjuvant radiotherapy were found to significantly increase overall survival and disease-free survival. Age was found to increase only disease-free survival. CONCLUSION The results obtained in this study showed that the presence of heterologous components in uterine carcinosarcoma is a prognostic factor that adversely affects both overall survival and disease-free survival. Lymphadenectomy and adjuvant radiotherapy have beneficial effects on both overall survival and disease-free survival.
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Affiliation(s)
- Behzat Can
- Necip Fazil City Hospital, Department of Gynecological Oncology – Kahramanmaraş, Turkey
| | - Volkan Karataşli
- Şanlıurfa State Hospital, Department of Gynecological Oncology – Sanlıurfa, Turkey
| | - İlker Çakir
- Buca Seyfi Demirsoy Training and Research Hospital, Department of Gynecological Oncology – İzmir, Turkey
| | - Sevil Sayhan
- İzmir Tepecik Training and Research Hospital, Department of Pathology – İzmir, Turkey
| | - Kemal Hansu
- Necip Fazil City Hospital, Department of Obstetrics and Gynecology – Kahramanmaraş, Turkey
| | - Oğuzhan Kuru
- Istanbul University, Cerrahpasa Faculty of Medicine, Department of Gynecological Oncology – Istanbul, Turkey
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Influence of Clinical and Surgical Factors on Uterine Carcinosarcoma Survival. Cancers (Basel) 2023; 15:cancers15051463. [PMID: 36900255 PMCID: PMC10001122 DOI: 10.3390/cancers15051463] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/16/2023] [Accepted: 02/23/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND The aim of this study was to assess the impact of prognostic factors on the survival of patients diagnosed with uterine carcinosarcoma. METHODS A sub-analysis of the SARCUT study, a multicentric retrospective European study, was carried out. We selected 283 cases of diagnosed uterine carcinosarcoma for the present study. Prognosis factors influencing survival were analyzed. RESULTS Significant prognostic factors for overall survival were: incomplete cytoreduction (HR = 4.02; 95%CI = 2.68-6.18), FIGO stages III and IV (HR = 3.21; 95%CI = 1.83-5.61), tumor persistence after any treatment (HR = 2.90; 95%CI = 1.97-4.27), presence of extrauterine disease (HR = 2.62; 95%CI = 1.75-3.92), a positive resection margin (HR = 1.56; 95%CI = 1.05-2.34), age (HR = 1.02; 95%CI = 1.00-1.05), and tumor size (HR = 1.01; 95%CI = 1.00-1.01). Significant prognostic factors for disease-free survival were: incomplete cytoreduction (HR = 3.00; 95%CI = 1.67-5.37), tumor persistence after any treatment (HR = 2.64; 95%CI = 1.81-3.86), FIGO stages III and IV (HR = 2.33; 95%CI = 1.59-3.41), presence of extrauterine disease (HR = 2.13; 95%CI = 1.44-3.17), administration of adjuvant chemotherapy (HR = 1.84; 95%CI = 1.27-2.67), a positive resection margin (HR = 1.65; 95%CI = 1.11-2.44), presence of LVSI (HR = 1.61; 95%CI = 1.02-2.55), and tumor size (HR = 1.00; 95%CI = 1.00-1.01). CONCLUSIONS Incomplete cytoreduction, presence of tumor residual after treatment, advanced FIGO stage, extrauterine disease, and tumor size are significant prognostic factors decreasing disease-free survival and overall survival of patients with uterine carcinosarcoma.
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Su MH, Wu HH, Huang HY, Lee NR, Chang WH, Lin SC, Chen YJ, Wang PH. Comparing paclitaxel-platinum with ifosfamide-platinum as the front-line chemotherapy for patients with advanced-stage uterine carcinosarcoma. J Chin Med Assoc 2022; 85:204-211. [PMID: 34698689 DOI: 10.1097/jcma.0000000000000643] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Uterine carcinosarcoma (UCS) is a rare but highly lethal disease. Adjuvant chemotherapy is highly recommended for advanced UCS. To date, the standard chemotherapy regimen is still uncertain, although two regimens as paclitaxel-platinum (PP) and ifosfamide-platinum (IP) regimens are most commonly used. The aims of the current study attempt to compare both regimens in the management of advanced UCS patients. METHODS We evaluated advanced UCS patients who were treated either with PP or with IP after primary cytoreductive surgery in single institute retrospectively. The clinical-pathological parameters, recurrence, and survival were recorded. RESULTS A total of 16 patients were analyzed. Twelve patients received adjuvant PP therapy, and the remaining four patients received IP therapy. The median follow-up time was 28 months, ranging from 3.8 months to 121 months. Disease-related death occurred in 10 patients (62.5%). The median progression-free survival was 4.9 months, ranging from 3.8 months to 36.5 months in IP, and 23.1 months, ranging from 9.3 months to 121 months in PP, with statistically significant difference (p = 0.04). The median overall survival was 9.5 months (ranging from 3.8 months to 36.5 months) and 28.7 months (ranging from 10.3 months to 121 months) in IP and PP, respectively, without statistically significant difference (p = 0.06). Presence of pelvic and para-aortic lymphadenopathy and deep myometrial invasion (>1/2) were associated with worse prognosis by univariate analysis. No prognostic factor could be identified using multivariate analysis model. CONCLUSION In the current study, due to extremely little number of subjects enrolled, the advantage of using paclitaxel-platinum regimen in the management of advanced UCS was still unclear, although a certain trend of favoring was supposed. We are looking forward to seeing more studies to identify the approximate regimen in the management of this highly lethal disease.
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Affiliation(s)
- Ming-Hsuan Su
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hua-Hsi Wu
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hsin-Yi Huang
- Biostatics Task Force, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Na-Rong Lee
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Nursing, Taipei Veterans General Hospital, Taiwan, ROC
| | - Wen-Hsun Chang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Nursing, Taipei Veterans General Hospital, Taiwan, ROC
| | - Shih-Chieh Lin
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Nursing, Taipei Veterans General Hospital, Taiwan, ROC
| | - Yi-Jen Chen
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Pathology and Laboratory Medicine, Taipei, Taiwan, ROC
- Female Cancer Foundation, Taipei, Taiwan, ROC
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Albright BB, Monuszko KA, Kaplan SJ, Davidson BA, Moss HA, Huang AB, Melamed A, Wright JD, Havrilesky LJ, Previs RA. Primary cytoreductive surgery for advanced stage endometrial cancer: a systematic review and meta-analysis. Am J Obstet Gynecol 2021; 225:237.e1-237.e24. [PMID: 33957111 DOI: 10.1016/j.ajog.2021.04.254] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 04/12/2021] [Accepted: 04/20/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Endometrial cancer uncommonly presents at an advanced stage and little prospective evidence exists to guide the management thereof. We aimed to summarize the evidence about primary cytoreductive surgery in the treatment of advanced stage endometrial cancer. DATA SOURCES MEDLINE, Embase, and Scopus databases were searched from inception to September 11, 2020, using search terms representing the themes "endometrial cancer," "advanced stage," and "primary cytoreductive surgery." STUDY ELIGIBILITY CRITERIA We included full-text, English reports that included ≥10 patients undergoing primary cytoreductive surgery for advanced stage endometrial cancer and that reported on the outcomes of primary cytoreductive surgery and survival rates based on the residual disease burden. METHODS Two reviewers independently screened the studies and with disagreements between the reviewers resolved by a third reviewer. Data were extracted using a standardized form. The percentage of cases reaching maximal (no gross residual disease) and optimal (<1 cm or <2 cm residual disease) cytoreduction were assessed by summing binomials proportions, and the association with survival was assessed using an inverse variance-weighted meta-analysis of logarithmic hazard ratios. RESULTS From 1219 unique records identified, 34 studies were selected for inclusion. Studies consisted of single or multi-institutional cohorts of patients collected over a period of 6 to 24 years and included various mixes of histologies (endometrioid, serous, clear cell, and carcinosarcoma) and disease stages (III or IV). In a meta-analysis of the extent of residual disease after primary cytoreductive surgery, we found that 52.1% of cases reached no gross residual disease status (n=18 studies; 1329 patients) and 75% reached <1 cm residual disease status (n=27 studies; 2343 patients). The proportion of cytoreduction for both thresholds was lower for studies of stage IV vs stage III to IV disease (41.4% vs 69.8% for no gross residual disease; 63.2% vs 82.2% for <1 cm residual disease) but did not vary notably by histology. In a meta-analysis of the reported hazard ratios, submaximal (any gross residual disease vs no gross residual disease) and suboptimal (≥1 cm vs <1 cm) cytoreduction thresholds were associated with worse progression-free survival (submaximal hazard ratio, 2.16; 95% confidence interval, 1.45-3.21; I2=68%; suboptimal hazard ratio, 2.55; 95% confidence interval, 1.93-3.37; I2=63%) and overall survival rates (submaximal hazard ratio, 2.57; 95% confidence interval, 2.13-3.10; I2=1%; suboptimal hazard ratio, 2.62; 95% confidence interval, 2.20-3.11; I2=15%). Sensitivity analyses limited to high-quality studies demonstrated consistent results. CONCLUSION Among cases of advanced stage endometrial cancer undergoing primary cytoreductive surgery, a significant proportion of patients are left with residual disease, which is associated with worse survival outcomes. Further investigations about the roles of neoadjuvant chemotherapy and primary cytoreductive surgery in prospective trials is warranted in this population.
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Uterine carcinosarcoma: An overview. Crit Rev Oncol Hematol 2021; 163:103369. [PMID: 34051304 DOI: 10.1016/j.critrevonc.2021.103369] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 12/28/2022] Open
Abstract
Uterine carcinosarcoma (UCS), also known as malignant mixed Müllerian tumor, is a rare gynecological malignancy characterized by poor prognosis. This "biphasic" neoplasm presents an admixture of epithelial and mesenchymal/sarcomatoid tumor cells which partially share their molecular signature and exhibit a typical epithelial-to-mesenchymal transition gene expression profile. Due to the rarity of this cancer, at present there is a scarcity of specific treatment guidelines. Surgical resection remains the best curative option for localized disease, whereas the addition of peri-operative radiotherapy, chemotherapy and chemoradiation has been shown to further improve disease outcomes. In the metastatic setting, palliative chemotherapy is currently the treatment of choice, although no consensus exists about the best regimen to be delivered. Besides standard treatment options for the advanced disease, mechanistic insights into UCS pathogenesis and identification of its histopathological and molecular features boosted the development of novel, and potentially more effective, therapeutic agents, that will be here discussed.
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7
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Durmuş Y, Karalok A, Duru Çöteli SA, Boran N, Ünsal M, Boyraz G, Turan T. Pulmonary morbidity related to diaphragm surgery performed for gynecological cancers. Turk J Obstet Gynecol 2020; 17:292-299. [PMID: 33343976 PMCID: PMC7731606 DOI: 10.4274/tjod.galenos.2020.54781] [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: 05/05/2020] [Accepted: 07/18/2020] [Indexed: 12/01/2022] Open
Abstract
Objective: To evaluate pulmonary morbidity related to diaphragm surgery performed for gynecological cancers and to identify the impact of transdiaphragmatic thoracotomy. Materials and Methods: We reviewed clinical and pathologic data of 232 women who had undergone diaphragm surgery as a part of cytoreductive surgery procedures performed for gynecological cancers. Results: Transdiaphragmatic thoracotomy occurred in 52 patients (22.4%). Rate of pulmonary complications among patients who had a transdiaphragmatic thoracotomy was higher compared with patients who did not have a transdiaphragmatic thoracotomy (40.4% vs 20.6%, p=0.004). Transdiaphragmatic thoracotomy [odds ratio (OR), 2.66; 95% confidence interval (CI), 1.20-5.92; p=0.016], colon resection (OR, 5.21; 95% CI, 2.34-11.63; p<0.001), ileostomy (OR, 19.61; 95% CI, 1.64-250.0; p=0.019), and any extra-pulmonary complication occurrence (OR, 2.35; 95% CI, 1.13-4.88; p=0.023) were identified as independent predictors of pulmonary morbidity. Patients with transdiaphragmatic thoracotomy developed pleural effusion, pleural effusion necessitating drainage, pneumothorax, pneumonitis, and atelectasis more frequently compared with patients who did not have transdiaphragmatic thoracotomy. Rate of admission to postoperative intensive care of patients with transdiaphragmatic thoracotomy (30.8%) was significantly higher than that of patients without transdiaphragmatic thoracotomy (12.2%) (p=0.001). Conclusion: Transdiaphragmatic thoracotomy is an independent predictor of pulmonary morbidity among patients who underwent diaphragm surgery. Avoiding accidental transdiaphragmatic thoracotomies with maximal attention and performing full-thickness resection procedures with alternative surgical techniques preventing a thoracotomy may help decrease pulmonary morbidity rates and postoperative care costs.
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Affiliation(s)
- Yasin Durmuş
- University of Health Sciences Turkey, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Alper Karalok
- University of Health Sciences Turkey, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Sinem Ayşe Duru Çöteli
- University of Health Sciences Turkey, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Nurettin Boran
- University of Health Sciences Turkey, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Mehmet Ünsal
- University of Health Sciences Turkey, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Gökhan Boyraz
- University of Health Sciences Turkey, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Taner Turan
- University of Health Sciences Turkey, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
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Najjar O, Erickson BK, Nickles-Fader AN. Diagnosis and management of uterine serous carcinoma: current strategies and clinical challenges. Expert Opin Orphan Drugs 2020. [DOI: 10.1080/21678707.2020.1784723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Omar Najjar
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Britt K. Erickson
- Division of Gynecologic Oncology, Department of Obstetrics Gynecology and Women’s Health, University of Minnesota, Minneapolis, MN, USA
| | - Amanda N. Nickles-Fader
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Tai YJ, Hsu HC, Chiang YC, Chen YL, Chen CA, Cheng WF. Impact of Adjuvant Modalities on Survival in Patients with Advanced Stage Endometrial Carcinoma: A Retrospective Analysis from a Tertiary Medical Center. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16142561. [PMID: 31323767 PMCID: PMC6678420 DOI: 10.3390/ijerph16142561] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/14/2019] [Accepted: 07/15/2019] [Indexed: 12/20/2022]
Abstract
Adjuvant treatment in advanced-stage (stages III /IV) endometrial carcinomas in terms of tumor grades has not yet been explored. We retrospectively analyzed 194 patients with advanced-stage endometrioid endometrial carcinoma who received surgery, followed by adjuvant therapy, at National Taiwan University Hospital between January 1, 2000 and August 31, 2017. Adjuvant therapies included radiation (RT), chemotherapy alone (CT), and combined modality treatment (CMT: radiation and chemotherapy). The prognostic factors were determined from multivariate survival analyses using Cox regression models. Progression-free survival (PFS) and overall survival (OS) times were estimated with the Kaplan–Meier method. The median follow-up was 45.5 months (range: 6.2–207.9). In grade 1/2 endometrioid carcinoma, neither adjuvant CT nor CMT could prolong PFS significantly compared to RT (CT: HR 1.59, 95% CI 0.64–3.97; CMT: HR 2.03, 95% CI 0.72–5.74). Notably, maximal cytoreduction independently improved PFS (HR 0.31, 95% CI 0.10–0.90). No particular adjuvant treatment provided an OS advantage over the others for grade 1/2 endometrioid carcinomas. However, for grade 3 endometrioid carcinoma, CMT showed OS benefits (HR 0.15, 95% CI 0.03–0.89) compared to RT and CT. In conclusion, maximal cytoreduction should be the goal in patients with grade 1/2 advanced-stage endometrioid carcinomas. Based on our results, patients with grade 3 endometrioid carcinomas might benefit from adjuvant CMT.
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Affiliation(s)
- Yi-Jou Tai
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei 100, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Heng-Cheng Hsu
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei 100, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan
- Department of Obstetrics and Gynecology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu City 300, Taiwan
| | - Ying-Cheng Chiang
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei 100, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Yu-Li Chen
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei 100, Taiwan
- Graduate Institute of Anatomy and Cell Biology, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Chi-An Chen
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Wen-Fang Cheng
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei 100, Taiwan.
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan.
- Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei 100, Taiwan.
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10
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Iheagwara UK, Vargo JA, Chen KS, Burton DR, Taylor SE, Berger JL, Boisen MM, Comerci JT, Orr BC, Sukumvanich P, Olawaiye AB, Kelley JL, Edwards RP, Courtney-Brooks MB, Beriwal S. Neoadjuvant Chemoradiation Therapy Followed by Extrafascial Hysterectomy in Locally Advanced Type II Endometrial Cancer Clinically Extending to Cervix. Pract Radiat Oncol 2019; 9:248-256. [DOI: 10.1016/j.prro.2019.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/30/2019] [Accepted: 02/14/2019] [Indexed: 11/27/2022]
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11
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Sagebiel TL, Bhosale PR, Patnana M, Faria SC, Devine CE. Uterine Carcinosarcomas. Semin Ultrasound CT MR 2019; 40:295-301. [PMID: 31375170 DOI: 10.1053/j.sult.2019.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Uterine carcinosarcoma (UCS) is a rare and aggressive variant of endometrial cancer, distinguished by its containment of both epithelial and sarcomatous elements. This article reviews the epidemiology, pathologic classification and staging of UCS, along with the typical findings seen on different imaging modalities. Prognosis and therapies will also be discussed.
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Affiliation(s)
- T L Sagebiel
- The University of Texas MD Anderson Cancer Center, Diagnostic Radiology, T. Boone Pickens Academic Tower (FCT15.5023), Houston, TX.
| | - P R Bhosale
- The University of Texas MD Anderson Cancer Center, Diagnostic Radiology, T. Boone Pickens Academic Tower (FCT15.5023), Houston, TX
| | - M Patnana
- The University of Texas MD Anderson Cancer Center, Diagnostic Radiology, T. Boone Pickens Academic Tower (FCT15.5023), Houston, TX
| | - S C Faria
- The University of Texas MD Anderson Cancer Center, Diagnostic Radiology, T. Boone Pickens Academic Tower (FCT15.5023), Houston, TX
| | - C E Devine
- The University of Texas MD Anderson Cancer Center, Diagnostic Radiology, T. Boone Pickens Academic Tower (FCT15.5023), Houston, TX
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Bacalbasa N, Balescu I, Filipescu A. Debulking Surgery for High-grade Serous Endometrial Cancer with Disseminated Peritoneal Lesions. ACTA ACUST UNITED AC 2018; 31:719-722. [PMID: 28652446 DOI: 10.21873/invivo.11120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 04/30/2017] [Accepted: 05/02/2017] [Indexed: 11/10/2022]
Abstract
Endometrial cancer is one of the most common malignancies in postmenopausal women with good results in terms of survival, especially when diagnosed in early stages. However, prognosis significantly worseness when disseminated lesions are found. We present the case of a 60-year-old patient who presented with diffuse abdominal pain and weight loss. The patient was diagnosed with endometrial cancer with disseminated lesions and successfully submitted to debulking surgery. At two-year follow-up, the patient presents no recurrent disease.
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Affiliation(s)
- Nicolae Bacalbasa
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Irina Balescu
- Department of General Surgery, Ponderas Academic Hospital, Bucharest, Romania
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Cornali T, Sammartino P, Kopanakis N, Christopoulou A, Framarino Dei Malatesta M, Efstathiou E, Spagnoli A, Ciardi A, Biacchi D, Spiliotis J. Cytoreductive Surgery Plus Hyperthermic Intraperitoneal Chemotherapy for Patients with Peritoneal Metastases from Endometrial Cancer. Ann Surg Oncol 2017; 25:679-687. [PMID: 29282600 PMCID: PMC5814516 DOI: 10.1245/s10434-017-6307-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Indexed: 01/26/2023]
Abstract
Background More information is needed for selection of patients with peritoneal metastases from endometrial cancer (EC) to undergo cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC). Methods This study analyzed clinical, pathologic, and treatment data for patients with peritoneal metastases from EC who underwent CRS plus HIPEC at two tertiary centers. The outcome measures were morbidity, overall survival (OS), and progression-free survival (PFS) during a median 5 year follow-up period. Uni- and multivariate analyses were performed to identify significant factors related to outcome. Results A total of 33 patients met the inclusion criteria and completed the follow-up period. At laparotomy, the median peritoneal cancer index (PCI) was 15 (range 3–35). The CRS procedure required a mean 8.3 surgical procedures per patient, and for 22 patients (66.6%), a complete cytoreduction was achieved. The mean hospital stay was 18 days, and major morbidity developed in 21% of the patients. The operative mortality was 3%. When surgery ended, HIPEC was administered with cisplatin 75 mg/m2 for 60 min at 43 °C. During a median follow-up period of 73 months, Kaplan–Meier analysis indicated a 5 year OS of 30% (median 33.1 months) and a PFS of 15.5% (median 18 months). Multivariate analysis identified the completeness of cytoreduction (CC) score as the only significant factor independently influencing OS. Logistic regression for the clinicopathologic variables associated with complete cytoreduction (CC0) for patients with metachronous peritoneal spread from EC who underwent secondary CRS plus HIPEC identified the PCI as the only outcome predictor. Conclusions For selected patients with peritoneal metastases from EC, when CRS leaves no residual disease, CRS plus HIPEC achieves outcomes approaching those for other indications such as colon and ovarian carcinoma.
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Affiliation(s)
- Tommaso Cornali
- Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - Paolo Sammartino
- Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy. .,Department of Surgery "Pietro Valdoni", Azienda Policlinico Umberto, Rome, Italy.
| | - Nikolaos Kopanakis
- First Department of Surgical Oncology, Metaxa Cancer Hospital, Pireaus, Greece
| | | | | | - Elias Efstathiou
- First Department of Surgical Oncology, Metaxa Cancer Hospital, Pireaus, Greece
| | - Alessandra Spagnoli
- Department of Public Health and Infection Disease, Statistics Section, Sapienza University of Rome, Rome, Italy
| | - Antonio Ciardi
- Department of Radiological Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Daniele Biacchi
- Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - John Spiliotis
- First Department of Surgical Oncology, Metaxa Cancer Hospital, Pireaus, Greece
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14
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Şükür YE, Taşkın S, Varlı B, Ateş C, Güngör M, Ortaç F. Prognostic factors for disease-free and overall survival of patients with uterine carcinosarcoma. Int J Clin Oncol 2017; 23:114-120. [DOI: 10.1007/s10147-017-1181-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 08/12/2017] [Indexed: 11/24/2022]
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15
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Abstract
Surgery is the primary treatment for uterine carcinosarcoma (UCS). Lymphadenectomy should be performed for staging purposes in tumors apparently confined to the uterus. Most studies found that lymphadenectomy is of therapeutic value. The therapeutic value of cytoreduction to no residual macroscopic disease in advanced UCS is based mostly on small retrospective uncontrolled studies. Postoperative adjuvant therapy should be considered for all stages of UCS. Adjuvant pelvic radiotherapy may reduce locoregional recurrences. However, this does not translate into improved overall survival since most recurrences are distant outside the irradiated field, and the survival rates remain poor, the 5-year overall survival being about 50%. Several adjuvant platin-based combination chemotherapy schedules such as cisplatin/ifosfamide, ifosfamide/paclitaxel, and paclitaxel/carboplatin have been found to be an effective mode of adjuvant treatment. Multimodal therapy (i.e., adjuvant chemotherapy plus radiotherapy) has also been shown to be effective. Most studies dealing with adjuvant treatment are retrospective and prospective randomized controlled trials (i.e., phase III studies) comparing that between the various adjuvant chemotherapy schedules and between them and multimodal treatment are lacking. Quality of life with the various treatment modalities needs also to be assessed. An effective targeted therapy has so far not been found. In spite of the multiple studies with regard to the treatment of UCS published during the last 15 years, the optimal management of UCS is still not established.
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Affiliation(s)
- Joseph Menczer
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, E. Wolfson Medical Center, Holon, Israel.
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16
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Rauh-Hain JA, Diver E, Meyer LA, Clemmer J, Lu KH, Del Carmen MG, Schorge JO. Patterns of care, associations and outcomes of chemotherapy for uterine serous carcinoma: analysis of the National Cancer Database. Gynecol Oncol 2015; 139:77-83. [PMID: 26325526 DOI: 10.1016/j.ygyno.2015.08.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 08/21/2015] [Accepted: 08/23/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Evaluate rates of chemotherapy and radiotherapy delivery in the treatment of uterine serous carcinoma, and compare clinical outcomes of treated and untreated patients. METHODS The National Cancer Database was queried to identify patients diagnosed with uterine serous carcinoma between 2003 and 2011. The impact of chemotherapy on survival was analyzed using the Kaplan-Meier method. Factors predictive of outcome were compared using the Cox proportional hazards model. RESULTS A total of 13,752 patients met the study eligibility criteria. Stage I, II, III, and IV disease accounted for 4355 (31.7%), 1023 (7.4%), 3484 (25.3%), and 2451 (17.8%) of the study population, respectively. 2439 (17.7%) women had unknown stage. Chemotherapy was administered in 4290 (35.4%) patients, radiotherapy to 1673 (12.2%), adjuvant chemo-radiation to 2915 (21.2%), and 4874 (35.4%) of women did not receive adjuvant therapy during the study period. Utilization of chemotherapy became more frequent over time. Over the entire study period, after adjusting for age, period of diagnosis, race, facility location, facility type, insurance provider, socioeconomic status, comorbidity index, lymph node dissection, treatment modality, and stage, there was an association between treatment modality and survival, with the lowest hazard ratio in patients that received chemo-radiation. After adjusting for the same factors in women with stages I and II, chemo-radiation was associated with improved survival compared to patients that received no treatment. Radiotherapy or chemotherapy alone was not associated with improved survival. CONCLUSION Utilization of chemotherapy is increased in this population over the study period from 2003-2012 and more importantly that survival, particularly in advanced stage patients, is improving.
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Affiliation(s)
- J Alejandro Rauh-Hain
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Elisabeth Diver
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Larissa A Meyer
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX, United States
| | - Joel Clemmer
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Karen H Lu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX, United States
| | - Marcela G Del Carmen
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - John O Schorge
- Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
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