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Barlin JN, Mahar B, Ata A, Cormier B, Michelin D, Salani R, Backes F, Levinson K, Cantrell LA, Weinberg L, Wagreich A, Savage D, Gasson C, Denniston K, Martin J, McElrath T, Timmins PF. Lunchbox trial: A randomized phase III trial of cisplatin and irradiation followed by carboplatin and paclitaxel versus sandwich therapy of carboplatin and paclitaxel followed by irradiation then carboplatin and paclitaxel for advanced endometrial carcinoma. Gynecol Oncol 2024; 180:63-69. [PMID: 38052110 DOI: 10.1016/j.ygyno.2023.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 11/01/2023] [Accepted: 11/12/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND The objective was to compare sequencing strategies for treatment of advanced endometrial carcinoma. METHODS Patients were eligible if they had FIGO 2009 Stage III or IVA endometrial carcinoma or Stage I or II serous or clear cell endometrial carcinoma and positive cytology. Patients were randomized to: Cisplatin 50 mg/m2 IV Days 1 and 29 plus radiation followed by Carboplatin AUC 5 or 6 plus Paclitaxel 175 mg/m2 q 21 days for 4 cycles (chemoRT then chemo) vs. Carboplatin AUC 6 plus Paclitaxel 175 mg/m2 q 21 days for 3 cycles followed by radiation followed by Carboplatin AUC 5 or 6 plus Paclitaxel 175 mg/m2 q 21 days for 3 cycles (sandwich therapy). Futility analysis was planned. The primary objective was to determine if chemoRT then chemo improves recurrence-free survival (RFS) compared to sandwich therapy. RESULTS Of the 48 patients enrolled at 8 sites, 42 patients were eligible for futility analysis, and the trial was closed early. The median follow-up was 30.9 months. The 3-year RFS was 85.7% (95% confidence interval [CI], 62 to 95) in the chemoRT then chemo arm and 73.4% (95% CI, 43 to 89) in the sandwich therapy group (p = 0.58). The 3-year overall survival (OS) was 88.4% (95% CI, 61 to 97) in the chemoRT then chemo arm and 80.9% (95% CI, 51 to 93) in the sandwich therapy group (p = 0.55). CONCLUSION There was no observed significant difference between chemoRT then chemo compared to sandwich therapy in terms of RFS, OS, or adverse events, although the trial was underpowered and closed early due to low accrual.
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Affiliation(s)
| | - Barb Mahar
- Women's Cancer Care Associates, Albany, NY, USA
| | - Ashar Ata
- Albany Medical Center, Albany, NY, USA
| | - Beatrice Cormier
- Centre Hospitalier de l'Université de Montréal, Montreal, Canada
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Zola P, Jacomuzzi ME, Mazzola S, Fuso L, Ferrero A, Landoni F, Gadducci A, Sartori E, Maggino T. Analysis of the Evolution in the Management of Endometrial Cancer in Italy: A CTF Study. TUMORI JOURNAL 2018; 88:481-8. [PMID: 12597143 DOI: 10.1177/030089160208800610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective In 1994 we mailed questionnaires to referral centers in Italy in order to evaluate the different opinions concerning aspects of endometrial cancer treatment, which is still controversial. The data processing showed a significant nonhomogeneity in disease management and prompted the Italian Society of Gynecologic Oncology to define guidelines for endometrial cancer adjuvant treatment. In 2001, we mailed again the same questionnaire to the same referral Centers in Italy. The aim of the second enquiry was the evaluation of changes in endometrial cancer management and the effective impact of the guidelines published. Methods The enquiry used the same questionnaires mailed in 1994; actually, we mailed those questionnaires to the same referral centers in Italy twice: in December 2000 and March 2001. The results of both the enquiries were collected in a relational data base, and the statistical evaluations were calculated using SPSS-statistics (Window ver. 8). Results Endometrial cancer treatment consists in abdominal hysterectomy and bilateral salpingo-oophorectomy. The unique relevant difference as to 1994 consists in the systemic performing of peritoneal cytology in endometrial cancer staging. Unlike the previous enquiry, adjuvant radiotherapy is not systematically performed in disease at stage Ic because of the substantial absence of confirmed data demonstrating a real benefit in terms of survival rate. The comparison between the two enquiries shows a significant change in medical planning and diversification attitude according to patient age and menopausal state. The disease management changes in patients over 75 years old, mainly with respect to surgery and primary therapy. Conclusions We noted a resistance of many centers to accept some trends actually widespread in the literature but not yet performed in practical clinical.
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Affiliation(s)
- Paolo Zola
- Cattedra di Ginecologia Oncologica, Ospedale Mauriziano Umberto 1, Torino, Italy.
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Wong AT, Rineer J, Lee YC, Schwartz D, Safdieh J, Weiner J, Choi K, Schreiber D. Utilization of adjuvant therapies and their impact on survival for women with stage IIIC endometrial adenocarcinoma. Gynecol Oncol 2016; 142:514-9. [DOI: 10.1016/j.ygyno.2016.07.091] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 06/27/2016] [Accepted: 07/06/2016] [Indexed: 10/21/2022]
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Should the Optimal Adjuvant Treatment for Patients With Early-Stage Endometrial Cancer With High-Intermediate Risk Factors Depend on Tumor Grade? Int J Gynecol Cancer 2016; 25:1445-52. [PMID: 26397067 PMCID: PMC5106082 DOI: 10.1097/igc.0000000000000572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objectives To explore whether the optimal adjuvant treatments for patients with early-stage endometrial cancer with high-intermediate risk (HIR) factors should depend on tumor grade. Methods A retrospective analysis of patients with HIR endometrial cancer from 1999 to 2012 was conducted. The adjuvant treatments and survival were evaluated. Results A total of 129 patients with HIR were identified, of which 71 had grade 1–2 tumor and 58 had grade 3 tumor. The adjuvant treatment chosen differed significantly between patients with grade 1–2 and grade 3 tumors (P < 0.001). Most of the patients (76.1%) with grade 1–2 tumors received no adjuvant treatment; however, chemotherapy alone was the most frequent (75.9%) adjuvant treatment for patients with grade 3 tumors. In the grade 1–2 group, no significant differences in the 5-year progression-free survival (94.1% vs 96.3%; P = 0.857) and overall survival (OS) rates (94.1% vs 98.1%; P = 0.401), respectively, were observed between patients who received adjuvant treatment (radiation and chemotherapy with or without radiation) and those who did not. For grade 3 disease, patients undergoing adjuvant chemotherapy alone had a favorable outcome with the 5-year progression-free survival rate of 84.4% and the OS rate of 95.5%. Conclusion It is logical to speculate that surgery followed by observation might be sufficient for patients with HIR with grade 1–2 tumor. Further prospective trials are required to confirm the issue owing to the limited number of this population. More studies are warranted to clarify the feasibility and efficacy of adjuvant chemotherapy alone in patients with HIR with grade 3 tumor.
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Solmaz U, Mat E, Dereli ML, Turan V, Ekin A, Tosun G, Dogan A, Ozdemir IA, Oztekin O, Sanci M. Stage-III and -IV endometrial cancer: A single oncology centre review of 104 cases. J OBSTET GYNAECOL 2015; 36:81-6. [PMID: 26467294 DOI: 10.3109/01443615.2015.1041890] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The objective of this study was to evaluate the clinicopathological characteristics, treatment and prognosis of advanced endometrial cancer (EC). Patients who underwent surgery for advanced EC between January 1995 and December 2012 were retrospectively reviewed. Patients with missing data, concurrent cancers or uterine sarcomas and those who did not undergo surgery were excluded. The effects of clinicopathological factors on progression-free survival (PFS) and overall survival (OS) were analyzed. A total of 104 patients were included. Most presented with endometrioid histology (74%) and stage-III disease (87.5%), and 76.9% underwent optimal cytoreduction. A multivariate analysis confirmed that lymphovascular space invasion (LVSI) is an independent poor prognostic factor for PFS [odds ratio (OR): 21.37, p = 0.005] and OS [OR: 8.09, p = 0.044]. Suboptimal cytoreduction is another independent poor prognostic factor for PFS [OR: 5.68, p < 0.001]. Our study demonstrated that LVSI and optimal cytoreduction are the most significant factors affecting the survival of advanced EC patients.
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Affiliation(s)
- U Solmaz
- a Department of Gynecologic Oncology , Tepecik Training and Research Hospital , Izmir , Turkey
| | - E Mat
- a Department of Gynecologic Oncology , Tepecik Training and Research Hospital , Izmir , Turkey
| | - M L Dereli
- b Department of Obstetrics and Gynecology , Tavas State Hospital , Denizli , Turkey
| | - V Turan
- a Department of Gynecologic Oncology , Tepecik Training and Research Hospital , Izmir , Turkey
| | - A Ekin
- a Department of Gynecologic Oncology , Tepecik Training and Research Hospital , Izmir , Turkey
| | - G Tosun
- a Department of Gynecologic Oncology , Tepecik Training and Research Hospital , Izmir , Turkey
| | - A Dogan
- a Department of Gynecologic Oncology , Tepecik Training and Research Hospital , Izmir , Turkey
| | - I A Ozdemir
- a Department of Gynecologic Oncology , Tepecik Training and Research Hospital , Izmir , Turkey
| | - O Oztekin
- c Department of Obstetrics and Gynecology , Medical School of Pamukkale University , Denizli , Turkey
| | - M Sanci
- a Department of Gynecologic Oncology , Tepecik Training and Research Hospital , Izmir , Turkey
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Binesh F, Akhavan A, Behniafard N, Zabihi S, Hosseinizadeh E. Prognostic value of peritoneal washing cytology in gynecologic malignancies: a controversial issue. Asian Pac J Cancer Prev 2015; 15:9405-10. [PMID: 25422232 DOI: 10.7314/apjcp.2014.15.21.9405] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To evaluate the prognostic impact of peritoneal washing cytology in patients with endometrial and ovarian cancers. MATERIALS AND METHODS We retrospectively identified 86 individuals with ovarian carcinomas, ovarian borderline tumors and endometrial adenocarcinomas. The patients had been treated at Shahid Sadoughi Hospital and Ramazanzadeh Radiotherapy Center, Yazd, Iran between 2004 and 2012. Survival differences were determined by Kaplan-Meier analysis. Multivariate analysis was performed using the Cox regression method. A p<0.05 value was considered statistically significant. RESULTS There were 36 patients with ovarian carcinomas, 4 with borderline ovarian tumors and 46 with endometrial carcinomas. The mean age of the patients was 53.8±15.2 years. In patients with ovarian carcinoma the overall survival in the negative cytology group was better than the patients with positive cytology although this difference failed to reach statistical significance (p=0.30). At 0 to 50 months the overall survival was better in patients with endometrial adenocarcinoma and negative cytology than the patients with positive cytology but then it decreased (p=0.85). At 15 to 60 months patients with FIGO 2009 stage IA-II endometrial andocarcinoma and negative peritoneal cytology had a superior survival rate compared to 1988 IIIA and positive cytology only, although this difference failed to reach statistical significance(p=0.94). Multivariate analysis using Cox proportional hazards model showed that stage and peritoneal cytology were predictors of death. CONCLUSIONS Our results show good correlation of peritoneal cytology with prognosis in patients with ovarian carcinoma. In endometrial carcinoma it had prognostic importance. Additional research is warranted.
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Affiliation(s)
- Fariba Binesh
- Department Of Pathology, Shahid Sadoughi University of Medical Sciences, Iran E-mail :
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Cho H, Nam BH, Kim SM, Cho CH, Kim BG, Ryu HS, Kang SB, Kim JH. A phase 2 trial of radiation therapy with concurrent paclitaxel chemotherapy after surgery in patients with high-risk endometrial cancer: a Korean Gynecologic Oncologic Group study. Int J Radiat Oncol Biol Phys 2014; 90:140-6. [PMID: 25015202 DOI: 10.1016/j.ijrobp.2014.05.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 05/12/2014] [Accepted: 05/16/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE A phase 2 study was completed by the Korean Gynecologic Oncologic Group to evaluate the efficacy and toxicity of concurrent chemoradiation with weekly paclitaxel in patients with high-risk endometrial cancer. METHODS AND MATERIALS Pathologic requirements included endometrial endometrioid adenocarcinoma stages III and IV. Radiation therapy consisted of a total dose of 4500 to 5040 cGy in 5 fractions per week for 6 weeks. Paclitaxel 60 mg/m(2) was administered once weekly for 5 weeks during radiation therapy. RESULTS Fifty-seven patients were enrolled between January 2006 and March 2008. The median follow-up time was 60.0 months (95% confidence interval [CI], 51.0-58.2). All grade 3/4 toxicities were hematologic and usually self-limited. There was no life-threatening toxicity. The cumulative incidence of intrapelvic recurrence sites was 1.9% (1/52), and the cumulative incidence of extrapelvic recurrence sites was 34.6% (18/52). The estimated 5-year disease-free and overall survival rates were 63.5% (95% CI, 50.4-76.5) and 82.7% (95% CI, 72.4-92.9), respectively. CONCLUSIONS Concurrent chemoradiation with weekly paclitaxel is well tolerated and seems to be effective for high-risk endometrioid endometrial cancers. This approach appears reasonable to be tested for efficacy in a prospective, randomized controlled study.
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Affiliation(s)
- Hanbyoul Cho
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung-Ho Nam
- Cancer Biostatistics Branch, Research Institute for National Cancer Control and Evaluation, National Cancer Center, Goyang, Republic of Korea
| | - Seok Mo Kim
- Department of Obstetrics and Gynecology, Chonnam National University School of Medicine, Gwangju, Republic of Korea
| | - Chi-Heum Cho
- Department of Obstetrics and Gynecology, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Byoung Gie Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee-Sug Ryu
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Soon Beom Kang
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jae-Hoon Kim
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea.
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microRNA 31 functions as an endometrial cancer oncogene by suppressing Hippo tumor suppressor pathway. Mol Cancer 2014; 13:97. [PMID: 24779718 PMCID: PMC4067122 DOI: 10.1186/1476-4598-13-97] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 04/21/2014] [Indexed: 01/29/2023] Open
Abstract
Background We aimed to investigate whether MIR31 is an oncogene in human endometrial cancer and identify the target molecules associated with the malignant phenotype. Methods We investigated the growth potentials of MIR31-overexpressing HEC-50B cells in vitro and in vivo. In order to identify the target molecule of MIR31, a luciferase reporter assay was performed, and the corresponding downstream signaling pathway was examined using immunohistochemistry of human endometrial cancer tissues. We also investigated the MIR31 expression in 34 patients according to the postoperative risk of recurrence. Results The overexpression of MIR31 significantly promoted anchorage-independent growth in vitro and significantly increased the tumor forming potential in vivo. MIR31 significantly suppressed the luciferase activity of mRNA combined with the LATS2 3’-UTR and consequently promoted the translocation of YAP1, a key molecule in the Hippo pathway, into the nucleus. Meanwhile, the nuclear localization of YAP1 increased the transcription of CCND1. Furthermore, the expression levels of MIR31 were significantly increased (10.7-fold) in the patients (n = 27) with a high risk of recurrence compared to that observed in the low-risk patients (n = 7), and this higher expression correlated with a poor survival. Conclusions MIR31 functions as an oncogene in endometrial cancer by repressing the Hippo pathway. MIR31 is a potential new molecular marker for predicting the risk of recurrence and prognosis of endometrial cancer.
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Nagar H, Boothe D, Parikh A, Yondorf M, Parashar B, Gupta D, Holcomb K, Caputo T, Chao KSC, Nori D, Wernicke AG. Administration of concurrent vaginal brachytherapy during chemotherapy for treatment of endometrial cancer. Int J Radiat Oncol Biol Phys 2013; 87:665-9. [PMID: 24138915 DOI: 10.1016/j.ijrobp.2013.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 07/24/2013] [Accepted: 08/13/2013] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the tolerability and toxicity of administering vaginal brachytherapy (VB) concurrently during chemotherapy compared with the sequential approach for patients with endometrial cancer. METHODS AND MATERIALS A retrospective analysis of 372 surgically staged patients with endometrial cancer American Joint Committee on Cancer 2009 stages I to IV treated with adjuvant postoperative radiation therapy (RT) at our institution from 2001 to 2012 was conducted. All patients received VB+external beam RT (EBRT)+6 cycles of adjuvant carboplatin- and paclitaxel-based chemotherapy. The VB mean dose was 15.08 Gy (range, 15-20 Gy), with 3 to 4 weekly applications, and the EBRT mean dose was 45 Gy delivered with 3-dimensional or intensity modulated RT techniques. Hematologic, gastrointestinal (GI), and genitourinary (GU) toxicities were assessed by Common Toxicity Criteria (CTC) and compared between sequential and concurrent chemotherapy and VB schedules. RESULTS Among patients who received RT and adjuvant chemotherapy, 180 of 372 patients (48%) received RT sandwiched between cycles 3 and 4 of chemotherapy. A separate group of 192 patients (52%) were treated with VB during the first 3 cycles of chemotherapy, with a weekly application on nonchemotherapy days, and received the EBRT portion in a sandwiched fashion. Patients treated with VB during chemotherapy had a decreased overall treatment time by 4 weeks (P<.001; 95% confidence interval: 3.99-4.02) and sustained no difference in CTC-graded acute hematologic, GI, or GU toxicities in comparison with the patients treated with VB and chemotherapy in a sequential manner (P>.05). CTC grade 3 or 4 hematologic, GI, and GU toxicities were zero. CONCLUSIONS VB during chemotherapy is well tolerated, decreases overall treatment time, and does not render more toxicity than the sequential regimen.
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Affiliation(s)
- Himanshu Nagar
- Department of Radiation Oncology, Weill Cornell Medical College of Cornell University, New York, New York
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The benefit of adjuvant chemotherapy combined with postoperative radiotherapy for endometrial cancer: a meta-analysis. Eur J Obstet Gynecol Reprod Biol 2013; 170:39-44. [PMID: 23810000 DOI: 10.1016/j.ejogrb.2013.06.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 03/31/2013] [Accepted: 06/05/2013] [Indexed: 11/20/2022]
Abstract
The objective of our study was to determine whether adjuvant chemotherapy combined with postoperative radiotherapy would have benefits for the disease-free survival and overall survival in patients with high-risk endometrial cancer. Electronic searches for studies of adjuvant chemotherapy combined with postoperative radiotherapy in endometrial cancer patients between March 1971 and March 2012 were made on MEDLINE, SCOPUS, and the Cochrane library. Articles with more than 4 stars on the Newcastle-Ottawa scale or a score of more than 4 on the modified Jadad scale were included. A meta-analysis was performed, and pooled hazard ratios (HR) of progression-free survival (PFS) and overall survival (OS) between patients whose adjuvant chemotherapy was combined with radiotherapy (the CTx+RTx group) and patients with adjuvant radiotherapy only (the RTx group) were derived from the fixed effect model or random effect model. Three observational studies and 3 randomized clinical trials (RCTs) were included in the final analysis. Subgroup analysis for FIGO stage showed that the CTx+RTx group had a more significant survival benefit compared to that of the RTx group in advanced stage endometrial cancer (OS HR 0.53, 95% CI 0.36-0.80; PFS HR 0.54, 95% CI 0.37-0.77), but no significant benefit in early stage endometrial cancer (OS HR 0.96, 95% CI 0.70-1.32; PFS HR 1.00, 95% CI 0.39-2.58). This meta-analysis suggests that adjuvant chemotherapy combined with postoperative radiotherapy could probably reduce disease progression and overall death in patients with advanced-stage disease. In order to examine whether the multimodal treatment has benefit in high-risk endometrial cancer, we need further large-scale RCTs.
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Abaid LN, Rettenmaier MA, Brown JV, Micha JP, Mendivil AA, Wabe MA, Goldstein BH. Sequential chemotherapy and radiotherapy as sandwich therapy for the treatment of high risk endometrial cancer. J Gynecol Oncol 2012; 23:22-7. [PMID: 22355463 PMCID: PMC3280062 DOI: 10.3802/jgo.2012.23.1.22] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 09/23/2011] [Accepted: 10/04/2011] [Indexed: 11/30/2022] Open
Abstract
Objective The purpose of this retrospective study was to assess the tolerability and efficacy of sequential chemotherapy and radiotherapy for the treatment of high risk endometrial cancer. Methods We conducted a retrospective study of previously untreated high risk endometrial cancer patients who received sequential chemotherapy and radiotherapy in accordance with the sandwich approach from June 2008 until June 2011. High risk endometrial cancer patients underwent complete surgical staging followed by adjuvant therapy encompassing sequential chemotherapy, radiation therapy and consolidation chemotherapy. Results The study analysis comprised 32 endometrial cancer patients. All subjects were treated with carboplatin and paclitaxel chemotherapy; currently, 186 cycles have been administered and 94% of patients have completed the planned number of cycles. Grade 3 neutropenia developed in 1 (3.1%) patient; there was no incidence of grade 4 neutropenia. Moreover, we observed grade 3 anemia in four (12.5%) patients and grade 4 anemia in one (3.1%) patient. One (3.1%) patient developed grade 3 thrombocytopenia; grade 4 thrombocytopenia was not observed. Five patients exhibited progressive disease, three of whom have since expired; mean progression free survival and follow-up were 17.4 months and 18.9 months, respectively. Conclusion The preliminary results from our study suggest that the sandwich approach to treating high risk endometrial cancer patients is feasible. Hematologic toxicity was well tolerated and non-hematologic toxicity was mild and easily managed. Further study of this novel regimen in a larger patient population with extended follow-up is necessary.
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Affiliation(s)
- Lisa N Abaid
- Gynecologic Oncology Associates, Newport Beach, CA, USA
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Feddock J, Kudrimoti M, Randall M. No cookie-cutter oncology: individualized treatment approaches for women with corpus endometrial cancer. Expert Rev Anticancer Ther 2010; 10:1087-100. [PMID: 20645698 DOI: 10.1586/era.10.85] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Endometrial adenocarcinoma is the most common gynecologic malignancy and, for the majority of patients who present with stage I (approximately 70%) or stage II ( approximately 10%) disease, 5-year overall survival rates approach 85%. However, the complicated mix of medical comorbidities, the broad spectrum of techniques and treatment modalities and controversial clinical trial outcomes makes treating this heterogeneous group of patients unique and challenging. Similar management controversies exist and, when one factors in histologic variability, no flow-chart treatment algorithm can be easily constructed. This article will discuss data from key clinical trials, consider the role of routine lymphadenectomy as a component of surgical staging, discuss the heterogeneity of stage III patients in both presentation and response to treatment, review options for medically inoperable patients and reflect on current and upcoming protocols.
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Affiliation(s)
- Jonathan Feddock
- Department of Radiation Medicine, University of Kentucky Chandler Medical Center and Markey Cancer Center, Lexington, KY, USA.
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Nakayama K, Nagai Y, Ishikawa M, Aoki Y, Miyazaki K. Concomitant postoperative radiation and chemotherapy following surgery was associated with improved overall survival in patients with FIGO stages III and IV endometrial cancer. Int J Clin Oncol 2010; 15:440-6. [PMID: 20419386 DOI: 10.1007/s10147-010-0081-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2009] [Accepted: 03/31/2010] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the usefulness of concomitant postoperative radiation and chemotherapy in patients with the International Federation of Gynecology and Obstetrics (FIGO) stages III and IV endometrial cancer. METHODS A retrospective review at Shimane University and Ryukyu University, Japan, was performed of 76 patients with FIGO stages III and IV endometrial cancer. All patients had received a comprehensive staging procedure including hysterectomy, bilateral salpingo-oophorectomy, ± selective pelvic/aortic lymphadenectomy, surgical debulking, and treatment with adjuvant chemotherapy and/or radiotherapy. RESULTS Seventy-six patients with FIGO stages III and IV endometrial cancer were identified who received postoperative adjuvant therapies; 26% (N = 20) received radiotherapy alone, 40% (N = 30) chemotherapy alone, and 34% (N = 26) chemotherapy and radiotherapy. The median age was 55 years; 92% had the endometrioid type and 97% were optimally debulked. The median follow-up period was 54 (range 6-188) months. Combination therapy with chemotherapy and radiation correlated with longer overall survival compared with either chemotherapy alone (P = 0.0298) or chemotherapy alone + radiation alone (P = 0.0345). Combination therapy correlated with longer overall survival compared with radiation alone with marginal significance (P = 0.0521). No significant differences in the disease-free interval were seen among the combination therapy and chemotherapy alone or radiation alone groups. CONCLUSION Combined treatment with radiation and chemotherapy may improve overall survival in patients with FIGO stages III and IV endometrial cancer.
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Affiliation(s)
- Kentaro Nakayama
- Department of Obstetrics and Gynecology, Shimane University School of Medicine, 89-1 Enyacho, Izumo, 693-8501, Japan.
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Secord AA, Havrilesky LJ, O'Malley DM, Bae-Jump V, Fleming ND, Broadwater G, Cohn DE, Gehrig PA. A multicenter evaluation of sequential multimodality therapy and clinical outcome for the treatment of advanced endometrial cancer. Gynecol Oncol 2009; 114:442-7. [DOI: 10.1016/j.ygyno.2009.06.005] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Revised: 05/28/2009] [Accepted: 06/01/2009] [Indexed: 11/16/2022]
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Hoekstra AV, Kim RJ, Small W, Rademaker AW, Helenowski IB, Singh DK, Schink JC, Lurain JR. FIGO stage IIIC endometrial carcinoma: Prognostic factors and outcomes. Gynecol Oncol 2009; 114:273-8. [DOI: 10.1016/j.ygyno.2009.04.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2008] [Revised: 03/24/2009] [Accepted: 04/14/2009] [Indexed: 11/29/2022]
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Inamine M, Nagai Y, Hirakawa M, Mekaru K, Yagi C, Masamoto H, Aoki Y. Heparanase expression in endometrial cancer: analysis of immunohistochemistry. J OBSTET GYNAECOL 2009; 28:634-7. [PMID: 19003663 DOI: 10.1080/01443610802323542] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The human enzyme heparanase has been shown to function in tumour progression, metastatic spread and tumour angiogenesis. The aim of the present study was to assess heparanase expression assessed by immunohistochemical staining (IHC) in endometrial cancer in correlation with clinicopathological factors. A total of 52 endometrial cancers were obtained from previously untreated patients (median age, 56 years, range, 35-80 years). The expression of heparanase was evaluated by using IHC with anti-heparanase polyclonal antibody. This antibody was raised by immunising a rabbit with a peptide containing the amino acid residues from 238 to 250 of the heparanase. The IHC data were used to determine the relationship between heparanase expression, and clinicopathological parameters. IHC showed that the heparanase was expressed in 23 of 52 (44.2%) endometrial cancers. Heparanase was abundantly and equally expressed in both the cytoplasm and the cell membrane of the cells in endometrial cancer. Strong heparanase-positive staining was also seen at the invasive front of the tumour into myometrium. The expression was significantly related to lymph-vascular space involvement (p = 0.0028), depth of myometrial invasion (p = 0.0026), and histological tumour grade (p = 0.0135). In six tumours with positive lymph nodes, the heparanase expression was observed as being higher compared with tumours with negative lymph nodes, which was not significant (p = 0.2349). In terms of peritoneal cytology, ovarian metastasis, and cervical invasion, we observed no significant difference in the heparanase expression assessed by IHC. These results suggest that the expression of heparanase may promote tumour invasion into myometrium and lymph vascular space in endometrial cancer.
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Affiliation(s)
- M Inamine
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
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van Wijk F, van der Burg M, Burger CW, Vergote I, van Doorn H. Management of Surgical Stage III and IV Endometrioid Endometrial Carcinoma: An Overview. Int J Gynecol Cancer 2009; 19:431-46. [DOI: 10.1111/igc.0b013e3181a1a04f] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
This paper covers an overview of the literature on the management of advanced endometrial cancer, concentrating on patients with histopathologic endometrioid type of tumors. The different treatment modalities are described and management recommendations are proposed.The standard surgical procedure includes an extrafacial total hysterectomy with bilateral salpingo-oophorectomy, collection of peritoneal washings for cytology, and exploration of the intraabdominal contents. In cases of extensive disease in the abdomen, an optimal surgical cytoreduction is associated with improved survival. Further treatment with radiotherapy may be indicated based on the pathological staging information to improve loco-regional control. Primary radiotherapy is indicated in cases where surgery is contraindicated. Systemic treatment can either be hormone therapy or chemotherapy. Progesterons are the cornerstone of hormone therapy. Prognostic factors for response are the presence of high levels of progesterone and estrogen receptors and low grade histology. Paclitaxel is the most active single agent drug. The combination therapy with paclitaxel and carboplatin is adopted as first choice in patients with endometrial cancer because of the efficacy and low toxicity, although not proven in a randomized trial.The literature on the management of patients with advanced endometrial cancer is discussed in detail. Each stage of advanced disease is presented separately, and management recommendations are proposed, and alternative approaches are given.Ongoing clinical trials are described, and the focuses of ongoing research are mentioned.
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Fowler JM, Brady WE, Grigsby PW, Cohn DE, Mannel RS, Rader JS. Sequential chemotherapy and irradiation in advanced stage endometrial cancer: A Gynecologic Oncology Group phase I trial of doxorubicin–cisplatin followed by whole abdomen irradiation. Gynecol Oncol 2009; 112:553-7. [DOI: 10.1016/j.ygyno.2008.11.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2008] [Revised: 11/17/2008] [Accepted: 11/20/2008] [Indexed: 11/28/2022]
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Abstract
Endometrial carcinoma is the most common malignancy of the female genital tract in industrialized countries, and occurs predominantly after the menopause. Although most endometrial carcinomas are detected at low stage, there is still a significant mortality from the disease. In postmenopausal women, prolonged life expectancy, changes in reproductive behavior and prevalence of overweight and obesity, as well as hormone replacement therapy use, may partially account for the observed increases of incidence rates in some countries. In order to improve treatment and follow-up of endometrial carcinoma patients, the importance of various prognostic factors has been extensively studied. The identification of high-risk groups would make it possible to avoid unnecessary adjuvant treatment among patients with a good prognosis. Over the past few decades, several studies have demonstrated the prognostic importance of different parameters including lymph node status, histological type of carcinoma (serous carcinoma and clear cell carcinomas are poor prognostic types), histological grade, stage of disease, depth of myometrial invasion, lymphovascular space involvement and cervical involvement. Other factors currently being investigated are estrogen and progesterone receptor status, p53 status, flow cytometric analysis for ploidy and S-phase fraction, and oncogenes such as HER-2/neu (c-erbB-2).
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Affiliation(s)
- Peter Uharcek
- Department of Obstetrics and Gynecology, Faculty Hospital Nitra, Slovakia.
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Estimation of Optimal Brachytherapy Utilization Rate in the Treatment of Malignancies of the Uterine Corpus by a Review of Clinical Practice Guidelines and the Primary Evidence. Int J Radiat Oncol Biol Phys 2008; 72:849-58. [DOI: 10.1016/j.ijrobp.2008.01.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Revised: 01/09/2008] [Accepted: 01/09/2008] [Indexed: 11/23/2022]
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Denschlag D, Tan L, Patel S, Kerim-Dikeni A, Souhami L, Gilbert L. Stage III endometrial cancer: preoperative predictability, prognostic factors, and treatment outcome. Am J Obstet Gynecol 2007; 196:546.e1-7. [PMID: 17547889 DOI: 10.1016/j.ajog.2007.01.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2006] [Revised: 11/13/2006] [Accepted: 01/16/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The survival rate for the most common gynecologic cancer, endometrial cancer, has fallen significantly in the last 25 years. Stage III (International Federation of Gynecology and Obstetrics) disease accounts for most of the deaths. We evaluated prognostic factors, treatment-related survival, and routinely used assessments for identifying stage III disease before the operation. STUDY DESIGN The data for patients with endometrial cancer stage III (n = 101) who had been treated at the McGill University Health Center between 1989 and 2003 were analyzed. RESULTS Stage IIIA, IIIB, and IIIC tumors accounted for 63%, 4%, and 33% of the data, respectively. The cause-specific survival at 2, 3, and 5 years was 82%, 77%, and 67%, respectively. In multivariate analysis with an adjustment for the standard prognostic variables, the final tumor grade, adnexal involvement, and lymph node dissection were significant predictors of cause-specific survival (P = .001, .028, and .017, respectively). Of the preoperative investigations, an elevated CA-125 level was a significant predictor of cause-specific survival in multivariate analysis (P = .029). CONCLUSION An elevated CA-125 level, adnexal involvement, the final tumor grade, and lymph node dissection were independent predictors for cause-specific survival.
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Affiliation(s)
- Dominik Denschlag
- Division of Gynecological Oncology, Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada
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Patel S, Portelance L, Gilbert L, Tan L, Stanimir G, Duclos M, Souhami L. Analysis of prognostic factors and patterns of recurrence in patients with pathologic stage III endometrial cancer. Int J Radiat Oncol Biol Phys 2007; 68:1438-45. [PMID: 17418961 DOI: 10.1016/j.ijrobp.2007.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2006] [Revised: 01/30/2007] [Accepted: 02/01/2007] [Indexed: 11/23/2022]
Abstract
PURPOSE To retrospectively assess prognostic factors and patterns of recurrence in patients with pathologic Stage III endometrial cancer. METHODS AND MATERIALS Between 1989 and 2003, 107 patients with pathologic International Federation of Gynecology and Obstetrics Stage III endometrial adenocarcinoma confined to the pelvis were treated at our institution. Adjuvant radiotherapy (RT) was delivered to 68 patients (64%). The influence of multiple patient- and treatment-related factors on pelvic and distant control and overall survival (OS) was evaluated. RESULTS Median follow-up for patients at risk was 41 months. Five-year actuarial OS was significantly improved in patients treated with adjuvant RT (68%) compared with those with resection alone (50%; p = 0.029). Age, histology, grade, uterine serosal invasion, adnexal involvement, number of extrauterine sites, and treatment with adjuvant RT predicted for improved survival in univariate analysis. Multivariate analysis revealed that grade, uterine serosal invasion, and treatment with adjuvant RT were independent predictors of survival. Five-year actuarial pelvic control was improved significantly with the delivery of adjuvant RT (74% vs. 49%; p = 0.011). Depth of myometrial invasion and treatment with adjuvant RT were independent predictors of pelvic control in multivariate analysis. CONCLUSIONS Multiple prognostic factors predicting for the outcome of pathologic Stage III endometrial cancer patients were identified in this analysis. In particular, delivery of adjuvant RT seems to be a significant independent predictor for improved survival and pelvic control, suggesting that pelvic RT should be routinely considered in the management of these patients.
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Affiliation(s)
- Samir Patel
- Division of Radiation Oncology, Department of Oncology, McGill University, Montreal, Quebec, Canada
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Lupe K, Kwon J, D'Souza D, Gawlik C, Stitt L, Whiston F, Nascu P, Wong E, Carey MS. Adjuvant paclitaxel and carboplatin chemotherapy with involved field radiation in advanced endometrial cancer: A sequential approach. Int J Radiat Oncol Biol Phys 2007; 67:110-6. [PMID: 17084542 DOI: 10.1016/j.ijrobp.2006.08.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2006] [Revised: 08/10/2006] [Accepted: 08/13/2006] [Indexed: 11/21/2022]
Abstract
PURPOSE To determine the feasibility of adjuvant paclitaxel and carboplatin chemotherapy interposed with involved field radiotherapy for women with advanced endometrial cancer. METHODS AND MATERIALS This was a prospective cohort study of women with Stage III and IV endometrial cancer. Adjuvant therapy consisted of 4 cycles of paclitaxel (175 mg/m(2)) and carboplatin (350 mg/m(2)) every 3 weeks, followed sequentially by external beam radiotherapy (RT) to the pelvis (45 Gy), followed by an additional two cycles of chemotherapy. Para-aortic RT and/or HDR vault brachytherapy (BT) were added at the discretion of the treating physician. RESULTS Thirty-three patients (median age, 63 years) received treatment between April 2002 and June 2005. Median follow-up was 21 months. Stage distribution was as follows: IIIA (21%), IIIC (70%), IVB (9%). Combination chemotherapy was successfully administered to 30 patients (91%) and 25 patients (76%), before and after RT respectively. Nine patients (27%) experienced acute Grade 3 or 4 chemotherapy toxicities. All patients completed pelvic RT; 19 (58%) received standard 4-field RT and 14 (42%) received intensity-modulated radiotherapy. Ten (30%) received extended field radiation. Four patients (12%) experienced acute Grade 3 or 4 RT toxicities. Six (18%) patients developed chronic RT toxicity. There were no treatment-related deaths. Two-year disease-free and overall survival rates were both 55%. There was only one pelvic relapse (3%). CONCLUSIONS Adjuvant treatment with combination chemotherapy interposed with involved field radiation in advanced endometrial cancer was well tolerated. This protocol may be suitable for further evaluation in a clinical trial.
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Affiliation(s)
- Krystine Lupe
- Department of Radiation Oncology, University of Western Ontario and London Health Sciences Centre, London, Ontario, Canada
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Maggi R, Lissoni A, Spina F, Melpignano M, Zola P, Favalli G, Colombo A, Fossati R. Adjuvant chemotherapy vs radiotherapy in high-risk endometrial carcinoma: results of a randomised trial. Br J Cancer 2006; 95:266-71. [PMID: 16868539 PMCID: PMC2360651 DOI: 10.1038/sj.bjc.6603279] [Citation(s) in RCA: 302] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2006] [Revised: 06/19/2006] [Accepted: 06/19/2006] [Indexed: 11/16/2022] Open
Abstract
Patients with high-risk endometrial carcinoma (stage IcG3, IIG3 with myometrial invasion >50%, and III) receive adjuvant therapy after surgery but it is not clear whether radiotherapy (RT) or chemotherapy (CT) is better. We randomly assigned 345 patients with high-risk endometrial carcinoma to adjuvant CT (cisplatin (50 mg m(-2)), doxorubicin (45 mg m(-2)), cyclophosphamide (600 mg m(-2)) every 28 days for five cycles, or external RT (45-50 Gy on a 5 days week(-1) schedule). The primary end points were overall and progression-free survival. After a median follow-up of 95.5 months women in the CT group as compared with the RT group, had a no significant hazard ratio (HR) for death of 0.95 (95% confidence interval (CI), 0.66-1.36; P = 0.77) and a nonsignificant HR for event of 0.88 (95% CI, 0.63-1.23; P = 0.45). The 3, 5 and 7-year overall survivals were 78, 69 and 62% in the RT group and 76, 66 and 62% in the CT group. The 3, 5 and 7-year progression-free survivals were, respectively, 69, 63 and 56 and 68, 63 and 60%. Radiotherapy delayed local relapses and CT delayed metastases but these trends did not achieve statistical significance. Overall, both treatments were well tolerated. This trial failed to show any improvement in survival of patients treated with CT or the standard adjuvant radiation therapy. Randomised trials of pelvic RT combined with adjuvant cytotoxic therapy compared with RT alone are eagerly awaited.
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Affiliation(s)
- R Maggi
- Clinica ‘L. Mangiagalli’, Università degli Studi di Milano, Milano, Italy
| | - A Lissoni
- Ospedale ‘San Gerardo’, Università degli Studi Milano ‘Bicocca’, Monza, Italy
| | - F Spina
- Clinica ‘L. Mangiagalli’, Università degli Studi di Milano, Milano, Italy
| | - M Melpignano
- Azienda Ospedaliero-Universitaria di Parma, Università degli Studi di Parma, Italy
| | - P Zola
- Ospedale Mauriziano ‘Umberto I’, Università degli Studi di Torino, Italy
| | - G Favalli
- Ospedali Civili di Brescia, Università degli Studi di Brescia, Italy
| | | | - R Fossati
- Department of Oncology, Istituto ‘Mario Negri’, Via Eritrea 62, 20157 Milano, Italy
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van Wijk FH, Huikeshoven FJ, Abdulkadir L, Ewing PC, Burger CW. Stage III and IV endometrial cancer: a 20-year review of patients. Int J Gynecol Cancer 2006; 16:1648-55. [PMID: 16884379 DOI: 10.1111/j.1525-1438.2006.00639.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
In advanced endometrial cancer, the importance of peritoneal cytology and optimal surgical cytoreduction remain subjects of discussion. We evaluated our clinical experience of 67 patients with FIGO stage III and IV endometrial cancer treated in the Erasmus Medical Centre in Rotterdam over a 20-year period with an emphasis on stage IIIA disease based on positive cytology only and optimal cytoreduction. Lymphadenectomy was not routinely performed and peritoneal cytology was examined in 74% of the patients. Stage IIIA disease was found in 33 patients, 10 of whom had positive cytology only. Analysis showed that incidence of recurrence and survival rates of patients with stage IIIA disease based on positive cytology only were comparable with stage IIIA disease based on other factors. In 50 patients, it was possible to remove all macroscopic tumor, whereas in 17 patients, an optimal cytoreduction was not achievable. The 2- and 5-year survival rates after optimal cytoreduction were 82.2% and 65.6%; where this could not be achieved, these figures were 50.8% and 40.6%. In advanced endometrial cancer patients, positive peritoneal cytology seems an important prognostic factor in stage IIIA disease if lymph node status is unknown. Survival is improved if optimal surgical cytoreduction is achievable.
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Affiliation(s)
- F H van Wijk
- Department of Obstetrics and Gynecological Diseases, subdivision Gynecology and Gynecologic Oncology, Erasmus Medical Centre, Rotterdam, The Netherlands
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Honoré LH, Hanson J. Statistical analysis of pathologic risk factors for intramyometrial lymphvascular space involvement in myoinvasive endometrial carcinoma. Int J Gynecol Cancer 2006; 16:1330-5. [PMID: 16803525 DOI: 10.1111/j.1525-1438.2006.00538.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
In a retrospective study using univariate analysis, we identified tumor type (nonendometrioid vs endometrioid), depth of myoinvasion (MI), mode of MI (infiltrative vs cohesive), and direct anatomic invasion of the cervical wall from the isthmus as significant positive risk factors for intramyometrial lymphvascular space involvement (LVSI). On multivariate analysis, tumor grade, depth of MI, and mode of MI retained their significance. We created a grid for the relative risks of LVSI with respect to these variables individually or in combination. We suggest that our indirect estimate of the risk of LVSI can help in assessing prognosis and determining the need for adjuvant therapy whenever LVSI is important in clinical decision making, but its pathologic diagnosis is uncertain.
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Affiliation(s)
- L H Honoré
- Departments of Laboratory Medicine and Epidermiology, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta, Canada.
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Mariani A, Dowdy SC, Cliby WA, Haddock MG, Keeney GL, Lesnick TG, Podratz KC. Efficacy of systematic lymphadenectomy and adjuvant radiotherapy in node-positive endometrial cancer patients. Gynecol Oncol 2006; 101:200-8. [PMID: 16510174 DOI: 10.1016/j.ygyno.2006.01.032] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2005] [Revised: 01/05/2006] [Accepted: 01/16/2006] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess the efficacy of systematic lymphadenectomy and adjuvant radiotherapy in minimizing pelvic sidewall and para-aortic failures. METHODS Between January 1984 and December 2001, a total of 146 patients with stage III and IV endometrial cancer and lymph node metastases were treated at our institution. Adequate pelvic lymphadenectomy was defined as the removal of more than 10 pelvic lymph nodes, and adequate para-aortic lymphadenectomy was defined as removal of 5 or more para-aortic lymph nodes. The 24 patients who received adjuvant chemotherapy were excluded. We assessed the ability of adequate pelvic and para-aortic lymphadenectomy, together with radiotherapy, to prevent pelvic and para-aortic recurrences. RESULTS Of the 122 patients studied, 94 (77%) had adequate pelvic lymphadenectomy and 47 (39%) had adequate para-aortic lymphadenectomy. Pelvic radiotherapy was administered to 78% and para-aortic radiotherapy to 29% of patients. Median follow-up of censored patients was 56 months. Twenty-five percent of patients had pelvic sidewall failure at 5 years. Pelvic sidewall failures at 5 years occurred in 57% of patients who had inadequate node dissection and/or no radiotherapy, compared with 10% for those having both adequate lymphadenectomy and radiotherapy (P < 0.001). After risk factor assessment in a regression model, only treatment with adequate lymphadenectomy and radiotherapy was a significant independent predictor of pelvic control (P = 0.03). The performance of definitive pelvic lymphadenectomy may have increased treatment-related morbidity in the subgroup of patients who had postoperative radiotherapy. For the 41 patients with positive para-aortic lymph nodes, the 5-year para-aortic failure rate was 34% after adequate lymphadenectomy but without adjuvant para-aortic radiotherapy. Likewise, 69% failed in the para-aortic area when adjuvant para-aortic radiotherapy was administered to patients not having adequate para-aortic lymphadenectomy; however, none of the 11 patients failed in the para-aortic area after adequate lymphadenectomy and para-aortic radiotherapy (P = 0.08). CONCLUSIONS Adequate (pelvic and para-aortic) lymphadenectomy and adjuvant radiotherapy appear complementary in reducing failures in both the pelvis and para-aortic areas in patients with node-positive endometrial cancer.
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Affiliation(s)
- Andrea Mariani
- Division of Gynecologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Takeshima N, Umayahara K, Fujiwara K, Hirai Y, Takizawa K, Hasumi K. Effectiveness of postoperative chemotherapy for para-aortic lymph node metastasis of endometrial cancer. Gynecol Oncol 2006; 102:214-7. [PMID: 16457876 DOI: 10.1016/j.ygyno.2005.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2005] [Revised: 11/15/2005] [Accepted: 12/01/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine the effectiveness of postoperative chemotherapy for para-aortic lymph node (PAN) metastasis in patients with endometrial cancer. METHODS Among 350 clinical stage I-II endometrial cancer patients who underwent systemic pelvic and para-aortic lymphadenectomy during the period 1995 through 2002, 26 patients were identified with PAN metastasis. Of these patients, nine had only one positive PAN and 17 had two or more positive PANs (mean 4.9, range 1-22). All patients were treated postoperatively with a single chemotherapy regimen consisting of ifosfamide, epiadriamycin, and cisplatin scheduled for 5 cycles. Median (range) follow-up for surviving patients was 85 (38-119) months. Treatment outcome, including disease-free survival relative to the number of positive PANs, was investigated. RESULTS Among the 26 patients with PAN involvement, four developed recurrence. Three of the four patients had 10 or more positive PANs. Estimated 5-year disease-free survival rates were 89% for patients with one positive PAN, 82% for those with two or more positive PANs, and 85% for all patients. No significant difference was identified between the first two groups (P = 0.6543). CONCLUSIONS Postoperative chemotherapy can yield a favorable outcome in endometrial cancer patients with PAN metastasis, even those with multiple positive nodes.
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Affiliation(s)
- Nobuhiro Takeshima
- Department of Gynecology, Cancer Institute Hospital, 3-10-6 Ariake, Koto-ku, Tokyo 135-8550, Japan.
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Kodama J, Seki N, Ojima Y, Nakamura K, Hongo A, Hiramatsu Y. Correlation of presenting symptoms and patient characteristics with endometrial cancer prognosis in Japanese women. Int J Gynaecol Obstet 2005; 91:151-6. [PMID: 16162346 DOI: 10.1016/j.ijgo.2005.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2005] [Revised: 08/03/2005] [Accepted: 08/04/2005] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine whether patient characteristics and presenting symptoms could be prognostic indicators for endometrial cancer in Japanese women. METHODS Review of the medical charts, which included presenting symptoms and other patient characteristics, of 242 women who underwent surgical treatment for FIGO stage I-IV endometrial cancer. RESULTS FIGO stage, histologic grade, and lower abdominal pain were found to be significant independent factors for progression-free and overall survival. In contrast, abnormal uterine bleeding, comorbidities, and prior malignancy were not found to be prognostic factors. CONCLUSION Lower abdominal pain was found to be an independent prognostic factor in endometrial cancer among Japanese women.
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Affiliation(s)
- J Kodama
- Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama 700-8558, Japan.
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Shibata K, Kikkawa F, Kondo C, Mizokami Y, Kajiyama H, Ino K, Nomura S, Mizutani S. Placental leucine aminopeptidase (P-LAP) expression is associated with chemosensitivity in human endometrial carcinoma. Gynecol Oncol 2004; 95:307-13. [DOI: 10.1016/j.ygyno.2004.07.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2004] [Indexed: 11/26/2022]
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Aoki Y, Watanabe M, Amikura T, Obata H, Sekine M, Yahata T, Fujita K, Tanaka K. Adjuvant chemotherapy as treatment of high-risk stage I and II endometrial cancer. Gynecol Oncol 2004; 94:333-9. [PMID: 15297170 DOI: 10.1016/j.ygyno.2004.05.040] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2003] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study was performed to define the subgroups of patients who benefit from postoperative adjuvant chemotherapy in stage I and II endometrial carcinoma. METHODS A retrospective review of 170 International Federation of Gynecology and Obstetrics (FIGO) stage I and II endometrial carcinoma patients treated between 1988 and 2000 at Niigata University Hospital was performed. All patients underwent surgery, of which 41 patients underwent adjuvant chemotherapy, consisting of intravenous cisplatin, doxorubicin, and cyclophosphamide. Multivariate analysis was performed for the prognostic factors and actuarial techniques were used for the survival and recurrence rates. RESULTS The patients were divided into low-risk and high-risk groups based on the number of prognostic factors (tumor grade G3, outer half myometrial invasion, lymph-vascular space involvement (LVSI), and cervical invasion). The 5-year disease-free survival and the 5-year overall survival for the low-risk group were 97.4%, and 100%, respectively, which were significantly better than 77.4% and 88.1% for the high-risk group (P < 0.0001, P < 0.0001), respectively. Among high-risk group patients, the 5-year disease-free survival and the 5-year overall survival were 88.5% and 95.2% in 26 patients treated with adjuvant chemotherapy, and 50.0% and 62.5% in eight cases who underwent only surgery (P = 0.0150, P = 0.0226). Disease recurrence occurred in 7 (20.6%) of 34 high-risk group patients. Four of seven recurrences occurred in patients who did not receive postoperative chemotherapy, in which all four were distant failure. In the remaining three patients who were in the CAP group, two had vaginal wall recurrence and only one had pulmonary recurrence. Three recurrences were also observed in the 133 low-risk group patients. Only isolated vaginal wall recurrence occurred in three patients without adjuvant chemotherapy after the initial surgery. CONCLUSIONS There is possibility that postoperative adjuvant CAP may be omitted in surgical stage I or II endometrial cancer patients with 0 or 1 prognostic factor. The high-risk group of patients should be treated with postoperative adjuvant CAP to decrease distant failure and improve prognosis.
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Affiliation(s)
- Yoichi Aoki
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata 951-8510, Japan.
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Mell LK, Meyer JJ, Tretiakova M, Khramtsov A, Gong C, Yamada SD, Montag AG, Mundt AJ. Prognostic significance of E-cadherin protein expression in pathological stage I-III endometrial cancer. Clin Cancer Res 2004; 10:5546-53. [PMID: 15328195 DOI: 10.1158/1078-0432.ccr-0943-03] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Decreased expression of E-cadherin in endometrial cancer cells is associated with adverse prognostic features. This study aimed to evaluate the prognostic significance of decreased E-cadherin expression in patients with endometrial cancer. EXPERIMENTAL DESIGN Between 1992 and 1999, 102 endometrial cancer patients with stage I-III disease underwent primary surgery at the University of Chicago. Representative tissue specimens were immunostained with a monoclonal antibody to E-cadherin. A semiquantitative evaluation scale was developed based on the percentage of endometrial cancer cells with membranous E-cadherin staining. Tissue sections were scored as "3" if >75%, "2" if 25-75%, "1" if 5-25%, and "0" if <5% of cells stained. E-Cadherin staining was correlated with overall survival (OS), cause-specific survival (CSS), progression-free survival (PFS), and extrapelvic progression. Multivariate Cox proportional hazards modeling was used to estimate hazard ratios, controlling for clinicopathological characteristics and adjuvant treatment. Median follow-up for the study group was 58.5 months. RESULTS E-Cadherin staining was scored as 0, 1, 2, and 3 in 29.4%, 18.6%, 26.5%, 25.5% of cases, respectively. E-Cadherin expression was positively correlated with myometrial invasion (Kendall tau: 0.30, P < 0.01), and negatively correlated with grade (Kendall tau: -0.13, P = 0.15) and papillary serous or clear cell histology (Kendall tau: -0.14, P = 0.12). Five-year actuarial OS, CSS, PFS, and extrapelvic recurrence rates for negative (score = 0), heterogeneous (score = 1-2), and positive (score = 3) staining were as follows: OS, 69.2 versus 75.7 versus 81.0% (P = 0.64); CSS, 78.8 versus 91.2 versus 95.5% (P = 0.19); PFS, 69.1 versus 88.6 versus 92.2% (P = 0.079), and extrapelvic progression, 20.8 versus 7.3 versus 4.0% (P = 0.17). On multivariate Cox regression, a higher E-cadherin expression score was associated with decreased overall mortality [hazard ratio (HR), 0.59; 95% confidence interval (CI), 0.34-1.03; P = 0.066), and statistically significant decreases in endometrial cancer mortality (HR, 0.23; 95% CI, 0.055-0.94; P = 0.040), disease progression (HR, 0.28; 95% CI, 0.10-0.77; P = 0.014), and extrapelvic recurrence (HR, 0.24; 95% CI, 0.062-0.97; P = 0.045). CONCLUSIONS Decreased E-cadherin expression is an independent prognostic factor for disease progression and mortality in pathological stage I-III endometrial cancer. Evaluation of E-cadherin expression may aid in the selection of patients for more aggressive adjuvant therapy.
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Affiliation(s)
- Loren K Mell
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois, USA
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Münstedt K, Grant P, Woenckhaus J, Roth G, Tinneberg HR. Cancer of the endometrium: current aspects of diagnostics and treatment. World J Surg Oncol 2004; 2:24. [PMID: 15268760 PMCID: PMC506786 DOI: 10.1186/1477-7819-2-24] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2004] [Accepted: 07/21/2004] [Indexed: 12/24/2022] Open
Abstract
Background Endometrial cancer represents a tumor entity with a great variation in its incidence throughout the world (range 1 to 25). This suggests enormous possibilities of cancer prevention due to the fact that the incidence is very much endocrine-related, chiefly with obesity, and thus most frequent in the developed world. As far as treatment is concerned, it is generally accepted that surgery represents the first choice of treatment. However, several recommendations seem reasonable especially with lymphadenectomy, even though they are not based on evidence. All high-risk cases are generally recommended for radiotherapy. Methods A literature search of the Medline was carried out for all articles on endometrial carcinoma related to diagnosis and treatment. The articles were systematically reviewed and were categorized into incidence, etiology, precancerosis, early diagnosis, classification, staging, prevention, and treatment. The article is organized into several similar subheadings. Conclusions In spite of the overall good prognosis during the early stages of the disease, the survival is poor in advanced stages or recurrences. Diagnostic measures are very well able to detect asymptomatic recurrences. These only seem justified if patients' chances are likely to improve, otherwise such measures increases costs as well as decrease the patients' quality of life. To date neither current nor improved concepts of endocrine treatment or chemotherapy have been able to substantially increase patients' chances of survival. Therefore, newer concepts into the use of antibodies e.g. trastuzumab in HER2-overexpressing tumors and the newer endocrine compounds will need to be investigated. Furthermore, it would seem highly desirable if future studies were to identify valid criteria for an individualized management, thereby maximizing the benefits and minimizing the risks.
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Affiliation(s)
- Karsten Münstedt
- Department of Obstetrics and Gynecology, Justus-Liebig-University Giessen, Klinikstrasse 32, D 35385 Giessen, Germany
| | - Phillip Grant
- Department of Psychology, Justus-Liebig-University Giessen, Otto-Behagel-Str. 10F, D 35394 Giessen, Germany
| | - Joachim Woenckhaus
- Institute of Pathology, Justus-Liebig-University Giessen, Langhansstrasse 10, D 35385 Giessen, Germany
| | - Gabriele Roth
- Department of Obstetrics and Gynecology, Justus-Liebig-University Giessen, Klinikstrasse 32, D 35385 Giessen, Germany
| | - Hans-Rudolf Tinneberg
- Department of Obstetrics and Gynecology, Justus-Liebig-University Giessen, Klinikstrasse 32, D 35385 Giessen, Germany
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Bristow RE, Zahurak ML, Alexander CJ, Zellars RC, Montz FJ. FIGO stage IIIC endometrial carcinoma: resection of macroscopic nodal disease and other determinants of survival. Int J Gynecol Cancer 2004; 13:664-72. [PMID: 14675352 DOI: 10.1046/j.1525-1438.2003.13385.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The objective of this study was to evaluate the potential survival benefit of debulking macroscopic adenopathy and other clinical prognostic factors among patients with node-positive endometrial carcinoma. Demographic, operative, pathologic, and follow-up data were abstracted retrospectively for 41 eligible patients with FIGO stage IIIC endometrial cancer. Survival curves were generated using the Kaplan-Meier method and statistical comparisons were performed using the log rank test, logistic regression analysis, and the Cox proportional hazards regression model. All patients had positive pelvic lymph nodes and 20 patients (48.8%) had positive para-aortic lymph nodes. Postoperatively, all patients received whole pelvic radiation therapy, 17 received extended-field radiation therapy, and 15 patients received chemotherapy. The median disease-specific survival (DSS) time for all patients was 30.6 months (median follow-up 34. 0 months). Patients with completely resected macroscopic lymphadenopathy had a significantly longer median DSS time (37.5 months), compared to patients left with gross residual nodal disease (8.8 months, P = 0.006). On multivariate analysis, independent predictors of DSS were gross residual nodal disease (HR 7.96, 95% CI 2.54-24.97, P < 0. 001), age > or = 65 years (HR 6.22, 95% CI 2.05-18.87, P = 0.001), and the administration of adjuvant chemotherapy (HR 0.22, 95% CI 0.07-0.76, P = 0.016). We conclude that in patients with stage IIIC endometrial carcinoma, complete resection of macroscopic nodal disease and the administration of adjuvant chemotherapy, in addition to directed radiation therapy, are associated with improved survival.
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MESH Headings
- Adenocarcinoma, Clear Cell/mortality
- Adenocarcinoma, Clear Cell/pathology
- Adenocarcinoma, Clear Cell/surgery
- Adult
- Aged
- Aorta, Thoracic
- Carcinoma, Endometrioid/mortality
- Carcinoma, Endometrioid/pathology
- Carcinoma, Endometrioid/surgery
- Combined Modality Therapy
- Cystadenocarcinoma, Serous/mortality
- Cystadenocarcinoma, Serous/pathology
- Cystadenocarcinoma, Serous/surgery
- Disease-Free Survival
- Endometrial Neoplasms/mortality
- Endometrial Neoplasms/pathology
- Endometrial Neoplasms/surgery
- Female
- Humans
- Lymph Node Excision
- Lymph Nodes/pathology
- Lymph Nodes/surgery
- Lymphatic Metastasis
- Maryland/epidemiology
- Middle Aged
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/surgery
- Neoplasm Staging
- Pelvis
- Proportional Hazards Models
- Survival Analysis
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Affiliation(s)
- R E Bristow
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, The Johns Hopkins Medical Institutions, Baltimore, Maryland.
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Watanabe M, Aoki Y, Kase H, Tanaka K. Heparanase expression and angiogenesis in endometrial cancer. Gynecol Obstet Invest 2004; 56:77-82. [PMID: 12904690 DOI: 10.1159/000072821] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2003] [Accepted: 01/23/2003] [Indexed: 11/19/2022]
Abstract
Human heparanase has been shown to function in tumor progression, metastatic spread, and tumor angiogenesis. The aim of the present study was to assess heparanase expression in endometrial cancer in correlation with neovascularization and clinicopathological factors. Forty endometrial cancers were obtained from previously untreated patients (median age 55.5, range 33-78 years). The expression of heparanase mRNA was evaluated using a semiquantitative reverse transcriptase-polymerase chain reaction. Tumor angiogenesis was assessed using microvessel counting. The Mann-Whitney U test, one-factor ANOVA test, and Spearman's test were used to determine the relationship between heparanase expression, microvessel density, and clinicopathological parameters. The expression of heparanase mRNA was detected in 20 of 40 (50%) endometrial cancers, and was significantly correlated with FIGO stage IIIc (p=0.0075), the presence of lymph-vascular space involvement (p=0.0041), lymph node metastasis (p=0.0049), and histological tumor grade (p=0.0030). Microvessel density was also associated with FIGO stage IIIc (p=0.027), the presence of lymph-vascular space involvement (p=0.001), lymph node metastasis (p=0.038), ovarian metastasis (p=0.030) and histological tumor grade (p=0.0030). Moreover, we found a strong positive correlation between heparanase expression and microvessel density (r2=0.475, p=0.0001). These results suggest that the expression of heparanase may influence different malignant behaviors in endometrial cancer.
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Affiliation(s)
- Minoru Watanabe
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
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Yasunaga M, Yamasaki F, Tokunaga O, Iwasaka T. Endometrial Carcinomas With Lymph Node Involvement: Novel Histopathologic Factors for Predicting Prognosis. Int J Gynecol Pathol 2003; 22:341-6. [PMID: 14501813 DOI: 10.1097/01.pgp.0000092136.88121.c4] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to evaluate the clinicopathologic prognostic factors of endometrial carcinoma with lymph node metastasis (stage IIIc) in 24 patients with endometrial carcinoma. Differences in survival rates were analyzed for each clinicopathologic factor. The ratio of lymph nodes containing metastatic tumor to dissected lymph nodes (metastatic ratio), invasion of tumor cells into perinodal fat, and the presence of desmoplasia were examined. No statistically significant differences in survival rates were observed between any of the histologic parameters of the primary tumors. Cases with a high metastatic ratio exhibited significantly lower survival rates. Cases without tumor invasion into perinodal fat had significantly longer survival compared with cases with invasion. Cases without desmoplasia in the positive lymph nodes had significantly longer survival than cases with desmoplasia. The number of positive lymph nodes, desmoplasia in the lymph nodes, and invasion into perinodal fat are the most important prognostic factors in stage IIIc endometrial carcinoma.
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Affiliation(s)
- Makio Yasunaga
- Department of Pathology, Saga Medical School, Saga, Japan.
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Abstract
Surgical staging has changed the method by which patients with endometrial cancer are managed. Before the routine use of lymph node dissection, patients were presumed to have nodal disease based on imaging studies, palpation, and biopsy. The move to a surgically based staging system in 1988 created a new subgroup of patients who had documented nodal disease. The risk of nodal involvement is related primarily to tumor grade and depth of myometrial invasion. Although patients with nodal disease are uncommon, treatment of these patients poses multiple challenges. It is our belief that unless nodes are surgically assessed, the clinician will not know whether the nodes are involved. A thorough lymphadenectomy with removal of nodal tissue from multiple pelvic sites and from bilateral para-aortic regions is recommended for most patients with endometrial cancer. Identification of positive nodes allows appropriate postoperative therapies to be used, and data support that nodal dissection may be therapeutic and prognostic. Patients with positive nodes should receive radiation therapy directed to the nodal distribution, with patients having involved para-aortic nodes receiving an extended field. Whole abdominal radiation has been used, especially in patients with adnexal disease or positive cytology. The role of whole abdominal radiation remains in question. The most promising treatment option is combination therapy with sequential radiation and chemotherapy. Active chemotherapy agents in endometrial cancer are doxorubicin, cisplatin, and paclitaxel.
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Affiliation(s)
- D Scott McMeekin
- University of Oklahoma, Health Science Center, PO Box 26901, Oklahoma City, OK 73190, USA.
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Watanabe M, Aoki Y, Kase H, Fujita K, Tanaka K. Low risk endometrial cancer: a study of pelvic lymph node metastasis. Int J Gynecol Cancer 2003; 13:38-41. [PMID: 12631218 DOI: 10.1046/j.1525-1438.2003.13037.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aim of our study was to find preoperative or intraoperative pathologic indicators that would discriminate a subgroup of early corpus cancers that would not require lymphadenectomy. A retrospective review of the medical records of 107 patients with endometrioid adenocarcinoma, FIGO grade 1 or 2 tumor, myometrial invasion <or=50%, and no intraoperative evidence of macroscopic extrauterine spread was performed. Clinicopathologic risk factors were analyzed with Fisher 's exact test with regards to pelvic lymph node metastasis. The median age of the patients was 54 years. Pelvic lymph node metastasis was observed in five of 107 patients (4.7%), where two patients with small tumors of 2 cm or less had positive pelvic lymph nodes. The presence of positive pelvic lymph nodes did not correlate with depth of invasion, histologic grade, cervical invasion, peritoneal cytology, menopausal status, preoperative serum CA125 level, or primary tumor diameter. Only lymphvascular space involvement (P < 0.0001) was significantly correlated to pelvic lymph node metastasis. We suggest that all patients with endometrial cancer who are taken to the operating room for primary therapy should be prepared to undergo extended surgical staging, except when clinical or operative factors increase patients' morbidity.
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Affiliation(s)
- M Watanabe
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Asahimachi dori Niigata, Japan
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Zhu XQ, Yue TF, Zhang Y, Hui J, Wang DH. Influence of neoadjuvant intraarterial infusion chemotherapy on apoptosis and multidrug resistance associated genes of endometrial cancer. Chin J Cancer Res 2002. [DOI: 10.1007/s11670-002-0049-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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