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Amouzegar Hashemi F, Vesgari Kiasari Z, Kalaghchi B, Aghili M, Gholami S, Mansouri S, Moalej S, Maddah Safaei A. Evaluating the Incidence Rate of an Accelerated Short Course High Dose Rate Intravaginal Brachytherapy Complications in Patients with Endometrial Cancer. Asian Pac J Cancer Prev 2019; 20:2039-2043. [PMID: 31350963 PMCID: PMC6745200 DOI: 10.31557/apjcp.2019.20.7.2039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Indexed: 11/25/2022] Open
Abstract
Background: Brachytherapy in treatment of endometrial cancer patients is growing and therefore, evaluation of more feasible schedule has become of great importance. The purpose of current study was to evaluate the complications of accelerated short course high dose rate intravaginal brachytherapy (HDR IVB), a new brachytherapy approach which is a more feasible treatment option in developing countries. Method: From 2017 to 2018, 54 patients diagnosed with endometrial cancer and FIGO stages IA to IIB who underwent total abdominal hysterectomy with a bilateral salpingo-oophorectomy were enrolled in present study. They were treated with a total dose of 25 Gy in 5 fractions which was prescribed daily. A dose of 5 Gy was prescribed at a depth of 0.5 cm in the upper third and middle third of vagina. Adverse effects related to organs at risk consist of bladder, vagina and rectum were documented based on the Common Terminology Criteria for Adverse Events v3.0 (CTCAE v3.0). Results: The accelerated short course HDR IVB was well tolerated and no grade 3 or higher toxicities was reported for patients during the follow up period. There were no chronic rectal toxicities and only one patient showed chronic urinary toxicities. However, the incidence rate of vaginal toxicities at the end of 4-month and 8-month follow up periods was higher than acute toxicities and significantly lower in elderly group compared to younger group. Conclusion: Overall, the accelerated HDR IVB was safe and was well tolerated in endometrial cancer patients and the incidence rate of undue complications were equal, if not less, in elderly patients compared to the younger ones.
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Affiliation(s)
- Farnaz Amouzegar Hashemi
- Radiation Oncology Research Center (RORC), Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Zakieh Vesgari Kiasari
- Radiation Oncology Research Center (RORC), Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Bita Kalaghchi
- Radiation Oncology Research Center (RORC), Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mahdi Aghili
- Radiation Oncology Research Center (RORC), Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Soraya Gholami
- Physics Department of Radiation Oncology, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepideh Mansouri
- Radiation Oncology Research Center (RORC), Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran. ,Recombinant Proteins Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran
| | | | - Afsaneh Maddah Safaei
- Radiation Oncology Research Center (RORC), Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Barhum M, Stein M, Ronsenblatt E, Dale J, Kuten A. Pathological Stage I Endometrial Carcinoma: The Role for Adjuvant Radiotherapy. TUMORI JOURNAL 2018; 79:405-9. [PMID: 8171740 DOI: 10.1177/030089169307900607] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background In order to assess the efficacy of adjuvant radiotherapy in the treatment of pathological stage I endometrial carcinoma, we performed a retrospective analysis of 158 patients with this diagnosis who after surgery were either treated with radiation therapy or only followed from January 1980 through December 1987. Methods Patients were divided into two prognostic categories, high and low risk, on the basis of three known predictors of survival: histology, differentiation, and depth of myometrial invasion. All patients underwent total abdominal hysterectomy and bilateral salpingooophorectomy but only the high risk group received radiotherapy as well. Results After a median follow up time of 59 months the survival rates of the two groups were similar. The 5-year disease-free survival of the surgery alone group was 92 % compared to 89 % for the postoperative radiotherapy group. Side effects of treatment were minimal. Conclusions Postoperative radiation therapy for high risk pathological stage I endometrial carcinoma is an effective adjuvant therapy and confers an excellent prognosis.
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Affiliation(s)
- M Barhum
- Northern Israel Oncology Center, Rambam Medical Center, Haifa
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De Palo G, Kenda R, Andreola S, Bandieramonte G, Luciani L, Stefanon B. A Retrospective Analysis of 53 Patients with Pathologic Stage II and III Endometrial Carcinoma. TUMORI JOURNAL 2018; 68:341-7. [PMID: 7147361 DOI: 10.1177/030089168206800413] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
From 1969 to 1977, 53 patients with surgical-pathologic stages II and III endometrial carcinoma were seen at the Istituto Nazionale Tumori of Milan. The treatment was individualized. The 5-year survival was 68.8% in stage II and 75.3% in stage III. The relapse-free survival was 68.9% and 69.4%, respectively. Adjuvant type of radiotherapy, degree of differentiation, depth of myometrial invasion, and especially sites of disease were the factors influencing survival.
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The role of radiotherapy in the management of resected uterine papillary serous and clear cell carcinoma. Eur J Obstet Gynecol Reprod Biol 2008; 141:163-8. [DOI: 10.1016/j.ejogrb.2008.07.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Revised: 06/19/2008] [Accepted: 07/07/2008] [Indexed: 11/18/2022]
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Abstract
A rapidly and constantly increasing aged population in the western countries poses a wide range of specific problems to oncologists. A different way to face medical issues should be sought for older patients with cancer, looking at the characteristics that are peculiar to the elderly from different points of view. Brachytherapy is an effective form of radiotherapy which, for its specific characteristics, may be a valid alternative to more complex modalities of treatment, thus allowing a better sparing of normal tissues and structures yet achieving a similar tumor control rate. This paper reviews the literature on the subject of cancer treatment in the elderly, focusing on radiotherapy and brachytherapy, to evaluate the current attitude toward this problem in the medical community and to see if it is possible to identify a patient population that will benefit from this technique.
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Affiliation(s)
- P Montemaggi
- U.O. of Radiotherapy, Regional Cancer Center, Ospedale Mariano Santo, 87100 Cosenza, Italy.
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6
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Cirisano FD, Robboy SJ, Dodge RK, Bentley RC, Krigman HR, Synan IS, Soper JT, Clarke-Pearson DL. The outcome of stage I-II clinically and surgically staged papillary serous and clear cell endometrial cancers when compared with endometrioid carcinoma. Gynecol Oncol 2000; 77:55-65. [PMID: 10739691 DOI: 10.1006/gyno.2000.5737] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE The aim of this study was to compare survival and recurrence in clinical and surgical stage I-II papillary serous (PS), clear cell (CC), and endometrioid (EM) cancers of the endometrium and examine the prognostic utility of myometrial invasion. METHODS Clinical, surgicopathologic, and survival data were retrospectively collected on 574 clinical stage I-II endometrial cancer patients, including 53 PS and 18 CC (based on postoperative histology), undergoing hysterectomy at Duke University Medical Center between 1967 and 1990. All staging material was available and reexamined prior to this analysis, and FIGO surgical staging was retrospectively assigned. Prognostic variables examined included age, stage, grade, myometrial invasion, lymph-vascular space invasion (LVSI), and histology. PS and CC histologic subtypes were compared as both common category and discrete categories versus EM, EM grade 1 (EM1), EM grade 2 (EM2), and EM grade 3 (EM3). Statistical analyses were performed using chi(2), Fisher's exact, and Wilcoxon rank sum tests, Cox regression analysis, and Kaplan-Meier survival analysis. RESULTS PS tumors accounted for 9%, CC for 3%, and EM for 88% of cases. Recurrences were more frequent among PS (38%) and CC (22%) compared with EM (9%) (P < 0.001 and 0.08, respectively), and PS recurred more frequently than EM3 alone (20%) (P = 0.06). Among PS, CC, and EM3 patients with recurrences there were no statistical differences in the proportion that received preoperative or postoperative radiotherapy or chemotherapy. Prognostic factors for shorter survival included age >=60, surgical stage III+IV, presence of LVSI, histology (PS, CC, or EM3), and >=50% myometrial invasion. The estimated 5-year survival of PS+CC patients with <2 mm myometrial invasion is 0.56 compared to 0.93 for EM patients (P < 0. 001). PS + CC tumors confined to the endometrium had a 5-year survival of 0.60 compared to 0.98 and 1.00 for EM and EM3, respectively. The 5-year survival for surgically staged IA patients (0.57) was not different from stages IB and IC combined (0.53) (P = 0.72). The 5-year survival for surgical stage I + II PS + CC patients (0.56) was comparable to that for clinical stage I + II PS + CC patients (0.46) and remained significantly smaller than that for EM patients (0.86) (P < 0.001). CONCLUSION Recurrences are more frequent among PS and CC tumors compared with EM and among PS compared with EM3. When controlled for surgical stage I-II tumors, 5-year survival for PS + CC patients remains comparable to that of clinical stage I-II patients and below that of EM. Prognostic factors for survival in PS and CC patients include age, stage, and LVSI. PS, CC, and EM3 subtypes together are predictors of poor survival. Thorough extended surgical staging is indicated in PS and CC tumors, and prospective trials of aggressive adjuvant therapies for surgical stage I-II tumors are needed to improve outcome in PS and CC patients.
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MESH Headings
- Adenocarcinoma, Clear Cell/mortality
- Adenocarcinoma, Clear Cell/pathology
- Adenocarcinoma, Clear Cell/surgery
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Endometrioid/mortality
- Carcinoma, Endometrioid/pathology
- Carcinoma, Endometrioid/surgery
- Cystadenocarcinoma, Papillary/mortality
- Cystadenocarcinoma, Papillary/pathology
- Cystadenocarcinoma, Papillary/surgery
- Endometrial Neoplasms/mortality
- Endometrial Neoplasms/pathology
- Endometrial Neoplasms/surgery
- Female
- Humans
- Hysterectomy
- Middle Aged
- Neoplasm Invasiveness
- Neoplasm Recurrence, Local
- Neoplasm Staging
- Prognosis
- Survival Analysis
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Affiliation(s)
- F D Cirisano
- Department of Pathology, Duke University Medical Center, Durham, North Carolina 27710, USA
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7
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Cirisano FD, Robboy SJ, Dodge RK, Bentley RC, Krigman HR, Synan IS, Soper JT, Clarke-Pearson DL. Epidemiologic and surgicopathologic findings of papillary serous and clear cell endometrial cancers when compared to endometrioid carcinoma. Gynecol Oncol 1999; 74:385-94. [PMID: 10479498 DOI: 10.1006/gyno.1999.5505] [Citation(s) in RCA: 166] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE The aim of this study was to identify similarities and differences in epidemiologic and surgicopathologic staging results for papillary serous (PS) and clear cell (CC) endometrial cancers compared with endometrioid (EM) carcinoma of the endometrium. METHODS Clinical and surgicopathologic data were retrospectively collected on 574 clinical stage I-II endometrial cancer patients, including 53 PS and 18 CC (based on postoperative histology), undergoing hysterectomy at Duke University Medical Center between 1967 and 1990. All staging material was available and reexamined prior to this analysis, and FIGO surgical staging was retrospectively assigned. PS and CC histologic subtypes were compared both as a common category and as discrete categories versus EM, EM grade 1 (EM1), EM grade 2 (EM2), and EM grade 3 (EM3). Fisher's exact test was used to compare proportions with unordered categories (2x2 tables), while the chi(2) test for trend was used to compare proportions in 3x2 tables with ordered categories. Differences in medians were compared with the Wilcoxon rank-sum test. RESULTS PS tumors accounted for 8%, CC for 2%, and EM for 90% of cases. Overall, 14% of tumors were changed to a different postoperative histology including 64% of PS, 50% of CC, and 8% of EM. Postoperative histology changes were 4% for EM1 and 21% for EM3. PS, CC, and EM3 had more surgical sampling performed than for other EM. Rates for lymph node dissections were similar for EM3 (81%), PS (72%), and CC (67%) tumors, although metastases were more frequent for PS and CC compared with EM3. When PS tumors were confined to the endometrium, paraaortic metastases occurred in 13%. LVSI increased with EM grade and was highest for PS and CC. Upstaging to surgical stage III-IV occurred in 47% of PS, 39% of CC, and 12% of EM. The majority of PS and CC tumors were confined to the inner one-third of the myometrium, compared with EM tumors, where grade correlated with depth of myometrial invasion. Extrauterine metastases occurred in 55% of PS and 45% of CC tumors confined to the inner one-half, compared with 17% of EM3. CONCLUSION Frequent changes from preoperative to postoperative histology and grade may contribute to misassignment of preoperative and intraoperative risk as determined by depth of myometrial invasion for PS and CC patients. The higher frequency of extrauterine metastases in PS and CC tumors compared with EM3, despite similar surgical sampling rates, supports a more virulent behavior. The poor correlation between depth of myometrial invasion and risk for extrauterine metastases helps to explain poorer survival in PS and CC patients, in addition to more frequent upstaging. These results support routine extended surgical staging for women with preoperative or intraoperative diagnosis of PS and CC tumors. Intraoperative assessment of tumor grade and histology may be indicated and warrants further investigation.
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MESH Headings
- Adenocarcinoma, Clear Cell/epidemiology
- Adenocarcinoma, Clear Cell/pathology
- Adenocarcinoma, Clear Cell/surgery
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Endometrioid/epidemiology
- Carcinoma, Endometrioid/pathology
- Carcinoma, Endometrioid/surgery
- Cystadenocarcinoma, Papillary/epidemiology
- Cystadenocarcinoma, Papillary/pathology
- Cystadenocarcinoma, Papillary/surgery
- Endometrial Neoplasms/epidemiology
- Endometrial Neoplasms/pathology
- Endometrial Neoplasms/surgery
- Female
- Humans
- Middle Aged
- Neoplasm Staging
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Affiliation(s)
- F D Cirisano
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina, 27710, USA
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Connell PP, Rotmensch J, Waggoner S, Mundt AJ. The significance of adnexal involvement in endometrial carcinoma. Gynecol Oncol 1999; 74:74-9. [PMID: 10385554 DOI: 10.1006/gyno.1999.5415] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the prognostic significance of and predictive factors for adnexal involvement (AI) in patients with endometrial carcinoma. METHODS We retrospectively reviewed the pathological features and outcomes of endometrial carcinoma patients. The prognostic significance of AI was examined by univariate and multivariate analyses. Median follow-up was 30.7 months. RESULTS Of the 382 cases reviewed, 40 (10.5%) had AI. Patients with AI had a worse 5-year disease-free (DFS) survival (73.1 vs 37.1%, P < 0.0001) than patients without AI. However, patients with AI had multiple adverse features, including high grade disease, lymphovascular invasion, and additional sites of extrauterine disease. After controlling for these factors on multivariate analysis, AI lost its prognostic significance (P = 0.56). The 12 AI patients without other extrauterine disease had a favorable outcome (5-year DFS of 70.9%). Factors predictive of AI on logistic regression were metastatic disease, positive peritoneal washings, cervical involvement, and unfavorable histology. CONCLUSION Endometrial carcinoma patients with AI have relatively poor prognoses. However, AI per se has little, if any, independent prognostic significance. The poor outcomes seen in these patients appear to result from the preponderance of other adverse pathologic factors.
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Affiliation(s)
- P P Connell
- Section of Gynecologic Oncology, University of Chicago Hospitals, Chicago, Illinois 60637, USA
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Maggino T, Romagnolo C, Landoni F, Sartori E, Zola P, Gadducci A. An analysis of approaches to the management of endometrial cancer in North America: a CTF study. Gynecol Oncol 1998; 68:274-9. [PMID: 9570980 DOI: 10.1006/gyno.1998.4951] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to define the clinical-therapeutical approach to endometrial cancer now being followed in some of the most important centers of reference for gynecological cancer in North America by means of a questionnaire. STUDY DESIGN The questionnaire focused on four principal areas: (1) surgical staging and therapy; (2) adjuvant treatment; (3) treatment modifications; and (4) management of advanced stages (FIGO III-IV). RESULTS There were 48 evaluable responses (77%) received by the end of December 1994 which were considered for this analysis. Lymphadenectomy is utilized routinely in 26/48 centers (54.2%) and in selective clinical-pathological conditions in another 21/48 centers (43.5%). In the majority of centers (31/48; 64.6%) radical surgery is utilized for selected indications such as cervical involvement. Only 3/48 (6.2%) centers consider the vaginal approach totally inappropriate. The great majority (40/48; 83.3%) of the centers considered postsurgical adjuvant therapy to be necessary in FIGO Stage Ic. Brachytherapy is routinely performed in 3 centers (6.2%) in postsurgical management of Stage I endometrial cancer, while the majority of the centers (31/48; 64.6%) perform brachytherapy of the vaginal vault in certain clinical-pathological conditions. A wide variety of treatments are used for advanced stages (FIGO III-IV). CONCLUSIONS It emerges that some controversial aspects exist on endometrial cancer treatment, and these conflicting data need a large-scale multicenter randomized clinical trial.
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Affiliation(s)
- T Maggino
- Obstetrics and Gynecology Institute, University of Padova, Italy
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10
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Chao CK, Grigsby PW, Perez CA, Mutch DG, Herzog T, Camel HM. Medically inoperable stage I endometrial carcinoma: a few dilemmas in radiotherapeutic management. Int J Radiat Oncol Biol Phys 1996; 34:27-31. [PMID: 12118561 DOI: 10.1016/0360-3016(95)02110-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE The aggressiveness of radiation therapy for patients with medically inoperable endometrial carcinoma is controversial. Patients may die of their underlining medical disease before succumbing to cancer. We try to identify certain subgroup of patients who might benefit most from an aggressive approach and also investigate the impact of residual tumor present in dilatation and curettage (D&C) specimen obtained in second intracavitary implant (ICI). METHODS AND MATERIALS From 1965 to 1990, 101 patients were treated for clinical clinical Stage I endometrial carcinoma with RT alone due to medical problems. Ages ranged from 39 to 94 years (median 71 years). There were 18 patients with clinical Stage IA and 83 with clinical Stage IB disease. Histology included 44 well-differentiated, 37 moderately differentiated, and 20 poorly differentiated tumors. Radiation therapy consisted of external beam only in 3 patients, ICI alone in 26, whole pelvis plus ICI in 10, and whole pelvis plus split field plus ICI in 62. A second D&C was performed on 26 patients at the time of the second ICI. Minimum follow-up was 2 years (median, 6.3 years). RESULTS The 5-year actuarial disease-free survival (DFS) for the studied cohort is comparable to the expected survival of an age-matched population. Pelvic control was 100% for Stage IA and 88% for Stage IB with 5-year disease-free survivals of 80 and 84%, respectively. We also observed a greater disassociation of DFS and overall survial among patients older than 75 years (84 and 55%, respectively) than in younger patients (84 and 78%, respectively). This is mainly because older patients succumbed to their medical illness. Well-differentiated disease demonstrated the trend toward a better outcome than moderately or poorly differentiated lesions in Stage IB patients (p = 0.05), but not in Stage IA patients. Aggressive radiation therapy approach showed the trend toward a better result in Stage IB patients 75 years of age or younger. There were two failures among 19 patients with no tumor found in the D&C specimen at the time of second implant. In contrast, seven patients with residual tumor seen in the endometrial sample at the time of second implant remain disease free. CONCLUSIONS Radiation therapy alone is an effective treatment modality for medically inoperable Stage I endometrial carcinoma. Disease-free survival can be translated into longer overall survival in the younger age group, but not in older patients. The latter tend to die of their underlining medical illness. Tumor differentiation influenced the prognosis of Stage IB disease. No tumor seen in the endometrial sampling at the time of second implant did not correlate with a better disease control, and the treatment plan should not be modified on such information.
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Affiliation(s)
- C K Chao
- Radiation Oncology Center, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO 63110, USA
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11
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Rose PG, Baker S, Kern M, Fitzgerald TJ, Tak WK, Reale FR, Nelson BE, Hunter RE. Primary radiation therapy for endometrial carcinoma: a case controlled study. Int J Radiat Oncol Biol Phys 1993; 27:585-90. [PMID: 8226152 DOI: 10.1016/0360-3016(93)90383-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE Primary radiation therapy is generally considered inferior to a surgical approach for patients with endometrial carcinoma and is reserved for patients with a high operative risk. These patients are usually elderly, have multiple medical problems and frequently die of intercurrent disease. To evaluate the efficacy of primary radiation therapy a case controlled analysis comparing corrected survival of patients treated with primary radiation to patients treated with surgical therapy with or without radiation therapy was performed. METHODS AND MATERIALS Sixty-four patients treated with primary radiation therapy were retrospectively studied. A Kaplan-Meier product limit survival analysis was used to estimate survival among patients treated with primary radiation therapy. A case control study matched by clinical stage, tumor grade, and time of diagnosis was performed. The Mantel-Cox statistic was used to evaluated the equality of the survival curves. RESULTS Primary radiation therapy was used to treat 9.0% of the patients with endometrial carcinoma during the study period. Cardiovascular disease, diabetes, age greater than 80 and morbid obesity were the most common indications. Ninety percent of patients had either Stage I or II disease. Forty-eight of the 64 patients (75%) completed treatment which included both teletherapy and brachytherapy. Ten patients received brachytherapy only. Twelve complications, both acute and chronic, occurred in eleven patients (17%). Intercurrent disease accounted for 13 of the 36 (36%) of the deaths. Clinical stage of disease and histologic grade of the tumor were significant predictors of survival, p = 0.0001 and p = 0.013, respectively. The case controlled study of Stage I and II patients treated by primary radiation therapy matched to surgically treated controls showed no statistical difference in survival. Dilatation and curettage after the completion of radiation therapy was predictive of local control, p = 0.003. CONCLUSION Although surgery followed by tailored radiation therapy has become widely accepted therapy for Stage I and II endometrial carcinoma, even in patients who are a poor operative risk, the survival with primary radiation therapy is not statistically different.
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Affiliation(s)
- P G Rose
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester 01655
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12
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Lehoczky O, Bôsze P, Ungár L, Töttössy B. Stage I endometrial carcinoma: treatment of nonoperable patients with intracavitary radiation therapy alone. Gynecol Oncol 1991; 43:211-6. [PMID: 1752489 DOI: 10.1016/0090-8258(91)90022-w] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
From 1976 to 1981, 171 patients with stage I endometrial adenocarcinoma (FIGO, 1971) underwent intracavitary radiotherapy alone because of medical contraindications to surgery and external-beam irradiation. The mean age of patients was 71 years, with the majority of patients being in the age group of 70-79 years. The intracavitary therapy consisted of intrauterine insertions of radium implants in three consecutive courses according to the packing method of Heyman. The estimated dose delivered to point A and to point B was 80 and 20 Gy (3500-7000 mg-hr; mean, 5500 mg-hr), respectively. The corrected 5-year survival rate for stage Ia was 76% and for stage Ib 72%. Grade had a profound effect on survival; corrected 5-year survival for G1 was 77%, for G2 68%, and for G3 53%, respectively. The total failure rate was 24% (40/171). Most of the recurrences occurred in the pelvis (35/171): uterus, 22; vagina, 9; rectum, 2; and bladder, 1. One patient had both vaginal and uterine failure and five had distant metastases (four abdominal and one pulmonary). No difference was seen in the failure rates of stage Ia and stage Ib patients. No major complications (necessitating hospital care or delay of treatment) were seen. Our findings suggest that for patients with stage I endometrial cancer who are unfit for surgery, intracavitary low-dose-rate radiation therapy alone is an effective alternative treatment with a low risk of complications.
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Affiliation(s)
- O Lehoczky
- Department of Gynaecological Oncology, National Institute of Oncology, Budapest, Hungary
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13
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Morrow CP, Bundy BN, Kurman RJ, Creasman WT, Heller P, Homesley HD, Graham JE. Relationship between surgical-pathological risk factors and outcome in clinical stage I and II carcinoma of the endometrium: a Gynecologic Oncology Group study. Gynecol Oncol 1991; 40:55-65. [PMID: 1989916 DOI: 10.1016/0090-8258(91)90086-k] [Citation(s) in RCA: 909] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Between June 20, 1977 and February 5, 1983, the Gynecologic Oncology Group entered 1180 women with clinical stage I or II (occult) endometrial carcinoma into a surgical-pathological staging study. Eight hundred ninety-five patients with endometrioid or adenosquamous carcinoma were evaluable for this study which relates surgical-pathological parameters and postoperative treatment to recurrence-free interval and recurrence site. Proportional hazards modeling of time to recurrence was performed. For patients without metastasis determined by surgical-pathological staging the greatest determinant of recurrence was grade 3 histology adenocarcinoma grade 3, relative risk (RR) = 15; adenosquamous carcinoma grade 3, RR = 8.1; all adenocanthomas, RR = 1.0). Of 48 patients with histologically documented aortic node metastases, 47 had one or more of the following features: (1) grossly positive pelvic nodes, (2) grossly positive adnexal metastasis, or (3) outer one-third myometrial invasion. Pelvic radiation was administered to 48.0% and vaginal brachytherapy alone to 10.2% of patients postoperatively; 41.8% received no adjuvant radiation therapy. None of three recurrences in the vaginal implant group were vaginal or pelvic; 7.4% (7 of 95) of recurrences in the pelvic radiation therapy (RT) group were vaginal and 16.8% were pelvic; 18.2% (8 of 44) of recurrences in the no adjuvant radiation group were vaginal and 31.8% pelvic. Because of the high degree of selection bias no valid comparisons can be made of recurrence-free interval in these groups. The 5-year recurrence-free interval for patients with negative surgical-pathological risk factors (other than grade and myoinvasion) was 92.7%; involvement of the isthmus/cervix 69.8%; positive pelvic cytology 56.0%; vascular space invasion 55.0%; pelvic node or adnexal metastases 57.8%; and aortic node metastases or gross laparotomy findings 41.2%. It is not clear that cervix invasion per se diminishes survival, because it is more often associated with poor tumor differentiation (34.7% versus 24.0%, grade 3) and deep myoinvasion (47.0 vs 18.6%) than cases without cervix invasion. The relapse rate among cervix-positive and -negative cases with grade 3 lesions and deep myoinvasion is not dramatically different (48.8% vs 39.8%). The proportion of failures which were vaginal/pelvic (34.6% for the surgery only group compared to 12.5% of the RT group) appears to favor the use of adjuvant radiation for patients with more than one-third myoinvasion and grade 2 or 3 tumor. There were 97 patients in the study group with malignant cytology of which 29.1% had regional/distant failure, which compares to 10.5% of the cytology-negative patients.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- C P Morrow
- Division of Gynecologic Oncology, University of Southern California Medical School, Los Angeles
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Sause WT, Fuller DB, Smith WG, Johnson GH, Plenk HP, Menlove RB. Analysis of preoperative intracavitary cesium application versus postoperative external beam radiation in stage I endometrial carcinoma. Int J Radiat Oncol Biol Phys 1990; 18:1011-7. [PMID: 2347711 DOI: 10.1016/0360-3016(90)90435-m] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Two groups of patients with surgical Stage I endometrial carcinoma treated at the LDS Hospital in Salt Lake City are analyzed. Group 1 comprises 112 patients treated from 1974 through 1976, during which time preoperative intracavitary cesium was routinely used in all patients. Group 2 comprises 117 patients treated 1981 through 1983 under the treatment policy of hysterectomy without preoperative cesium. High risk patients from each group (grade 3 and/or deep myometrial invasion) generally received similar postoperative external beam pelvic radiotherapy (4500-5000 cGy). While 5-year actuarial disease-free survival rates were similar in each group (94% Group 1 vs 91% Group 2), multivariate analysis by the Cox Regression Method revealed that inclusion within treatment Group 2 carried independent adverse prognostic significance (p = 0.018). Other independent predictors of adverse 5-year disease-free survival included deep myometrial invasion and increasing histologic grade. Group 1 patients with grade 3 lesions had a superior 5-year actuarial disease-free survival (76% vs 53%) compared to those from Group 2. Group 1 patients with deep myometrial invasion also had a superior 5-year disease-free survival (84% vs 69%). The remaining low risk patients (grade 1 or 2, less than 1/3 myometrial invasion) had an excellent 5-year disease-free survival with or without preoperative cesium. Immediate preoperative intracavitary cesium was well tolerated, did not obscure pathologic findings and in our experience, reduced the probability of recurrence in high risk Stage I endometrial carcinoma patients.
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15
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Ahmad K, Kim YH, Deppe G, Malone J, Herskovic A, Ratanatharathorn V, Sakr WA, Medina A, Malviya V. Results of treatment in locally advanced carcinoma of the endometrium. Acta Oncol 1990; 29:203-9. [PMID: 2185804 DOI: 10.3109/02841869009126546] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The impact of treatment on survival was analyzed in 106 patients with carcinoma of the endometrium stage II (n = 61) and stage III (n = 45). There was no significant difference in survival in patients with stage II who were treated with radiation therapy alone or with combination of surgery and radiation therapy. Their five-year actuarial survival was 74.5% and 71.3% respectively (p = greater than 0.05). However, combined treatment was associated with significantly superior survival in patients with stage III disease where the survival was 57.3% versus 17.5% in patients who received irradiation alone (p = 0.01). Diagnosis of stage III disease based upon clinical (CS III) or pathological (PS III) findings was responsible for this difference in survival. Patients with CS III whose tumor could not be resected because of its extent carried poorer prognosis. Patients with stage II had excellent tumor control in pelvis as compared to patients with stage III. Treatment-related complications were minimal. Overall survival of patients with stage III was poor (33.8%) due to a high rate of pelvic and/or extrapelvic recurrences.
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Affiliation(s)
- K Ahmad
- Department of Gynecologic Oncology, Wayne State University, Detroit
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16
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Vaeth JM, Fontanesi J, Tralins AH, Chauser BM. External radiation therapy of stage I cancer of the endometrium: a need for reappraisal of this adjunctive modality. Int J Radiat Oncol Biol Phys 1988; 15:1291-7. [PMID: 3143691 DOI: 10.1016/0360-3016(88)90223-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
One hundred and eighty-five patients with Stage I cancer of the endometrium were irradiated preoperatively. All were irradiated to the whole pelvis by external beam only using supermegavoltage apparati. The total mid-pelvis dose ranged from 4500 cGy/5 weeks to 5500 cGy/6 1/2 weeks. Surgery followed usually in 6 weeks. Complications were minimal. Disease-free survival at Stage IA was 92.4% 5-year, 87.7% 10-year; Stage IB was 83.5% 5-year, 74.6% 10-year. Prognosis was related to stage, grade, depth of myometrial penetration, the presence of "residual" tumor at hysterectomy. External beam preoperative irradiation is recommended for all Stage I patients; Stage IB with higher grade pathology should have intracavitary irradiation supplemental to the external irradiation.
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Affiliation(s)
- J M Vaeth
- Dept. of Radiation Oncology, St. Mary's Hospital, San Francisco, CA
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17
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Bain RP, Greenberg RS, Chung KC. Racial differences in survival of women with endometrial cancer. Am J Obstet Gynecol 1987; 157:914-23. [PMID: 3674166 DOI: 10.1016/s0002-9378(87)80089-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The hypothesis that white women with endometrial cancer survive longer than black women with this disease was evaluated in a retrospective analysis of a population-based, prospective cohort study. All female residents of metropolitan Atlanta with a first diagnosis of primary endometrial cancer from 1978 through 1982 were eligible for inclusion. The 628 white and 105 black women were followed up through June 1984 to determine survivorship. Race was evaluated as a prognostic factor with univariate, multivariate, and excess death rate analyses. Overall, an estimated 89.2% of whites and 61.6% of blacks survived 3 years from the time of diagnosis. Although black women tended to have more advanced disease at the time of diagnosis and a higher proportion of undifferentiated malignancies, the racial difference in survival persisted after adjustment for these factors. When initial therapy was considered, race remained a significant prognostic determinant among women who did not receive radiation therapy.
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Affiliation(s)
- R P Bain
- Department of Community Health, Emory University School of Medicine, Atlanta, Georgia
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18
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Grigsby PW, Perez CA, Kuske RR, Kao MS, Galakatos AE. Results of therapy, analysis of failures, and prognostic factors for clinical and pathologic stage III adenocarcinoma of the endometrium. Gynecol Oncol 1987; 27:44-57. [PMID: 3570049 DOI: 10.1016/0090-8258(87)90229-0] [Citation(s) in RCA: 68] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A retrospective analysis was performed on 427 patients with clinical stage I, II, and III adenocarcinoma of the endometrium treated definitively with total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO) and pre- or postoperative irradiation at our institution from January 1960 through December 1981. Of 310 patients with clinical stage I, 21 (6.8%) and 9 of 90 (10%) clinical stage II patients were found to have pathologic stage III (CS I-II/PS III) tumors. In addition, 27 patients had clinical stage III (CS III) tumors at the time of diagnosis. At 5 years the overall and disease-free survival for all patients with clinical and/or pathologic stage III disease was 43.5 and 46.2%, respectively. The 5-year disease-free survival for CS I/PS III was 67.3% compared to 32.6% for CS II/PS III and 33.4% for CS III. Failure to control the disease in the pelvis occurred in 14.3% of the CS I/PS III patients and in 44.4 and 33.3% of the CS II/PS III and CS III patients, respectively. The appearance of distant metastasis was higher with increasing stage (19.1% for CS I/PS III, 33.3% for CS II/PS III, and 48.1% for CS III). Eighty percent of all failures occurred within 40 months. Grade of the tumor was associated with increasing pathologic stage but not with ability to control the disease in the pelvis. However, there was a tendency for higher grade lesions to fail more often at distant sites.
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19
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Grigsby PW, Kuske RR, Perez CA, Walz BJ, Camel MH, Kao MS, Galakatos A. Medically inoperable stage I adenocarcinoma of the endometrium treated with radiotherapy alone. Int J Radiat Oncol Biol Phys 1987; 13:483-8. [PMID: 3558039 DOI: 10.1016/0360-3016(87)90061-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Definitive therapy for Stage I adenocarcinoma of the endometrium consists of total abdominal hysterectomy and bilateral salpingo-oophorectomy. Pre- and/or post-operative radiotherapy (RT) is employed in selected patients with poor prognostic factors such as poorly differentiated tumors or deep myometrial invasion by tumor. The results are reported of RT alone in 69 patients with Stage I adenocarcinoma of the endometrium who presented with severe, acute, and chronic medical illnesses which prevented surgical management of their disease. Sixty-three patients (91.3%) were obese or hypertensive. Twenty-seven patients (39.1%) had diabetes mellitus, 16 (23.2%) had congestive heart failure, and the remaining patients had such conditions as stroke (17.4%), coronary artery disease (15.9%), and recent myocardial infarction (13.0%). The median age for this group of patients was 72.0 years compared to 60.0 years for a concurrent group of 304 patients with Stage I adenocarcinoma of the endometrium treated at our institution with combined surgery and RT. RT consisted of intracavitary insertions alone (11 patients), intracavitary plus low dose external beam therapy (9 patients), and intracavitary therapy plus high dose external beam therapy (49 patients, definitive RT). Younger patients and those with poorly differentiated disease were treated more aggressively. The 5- and 10-year overall survival for all patients was 76.8 and 33.3%, respectively. The 5- and 10-year disease-free survival was 88.1 and 82.4%, respectively. The 5-year overall and disease-free survival for the group of 49 patients treated with definitive RT was 85.4% and 88.7% with 15/49 (30.6%) having poorly differentiated tumors. For the definitive therapy group, the 5- and 10-year disease-free survival was 94.3, 92.3, and 78.0% for grades I, II, and III, respectively. Analysis of patterns of failure showed that none of the patients failed in the pelvis alone. Two out of 11 (18.2%) receiving intracavitary therapy alone and 3/49 (6.1%) receiving definitive RT failed in the pelvis with simultaneous distant metastasis (DM). Three patients in the definitive RT group failed with DM only. Severe complications occurred in 8 patients (16%), all of whom received definitive RT.
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Abstract
The authors present a retrospective review of 90 cases of Stage III endometrial carcinoma seen over a 10-year period at the Princess Margaret Hospital, Toronto. Overall 5-year survival was 45.5% and disease-free survival was 36.0%. Prognostic factors identified within Stage III were tumor grade, geographic distribution of disease, the presence of symptoms other than vaginal bleeding or discharge, and completeness of surgery. Isolated involvement of the ovary or fallopian tube emerges as a distinct syndrome with a good prognosis (5-year survival of 82.3%). Surgery is the treatment of choice for operable cases, but 13 of 36 patients with inoperable disease who completed radical radiotherapy were alive and free of disease at 5 years.
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Maruyama Y, Kryscio R, Wood C, van Nagell JR, Donaldson E, Hanson M, Yoneda J. Feasibility study: results of treatment of primary and recurrent adenocarcinoma of the corpus uteri with californium-252. Int J Radiat Oncol Biol Phys 1985; 11:1199-208. [PMID: 3997601 DOI: 10.1016/0360-3016(85)90070-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A trial of Cf-252 for the radiotherapy of primary or recurrent corpus adenocarcinoma was carried out at the University of Kentucky. The patients with primary tumors were of advanced age, poor general medical condition, and had multiple chronic medical illness, poorly differentiated tumors and/or metastatic Stage IVB disease. Fourteen patients with primary tumors were treated and all achieved complete local tumor control. The five year actuarial disease-free survival rate by the Kaplan-Meier method was 100% for Stage I-III disease, although 36% died of other, usually medical, causes. For eight patients treated with recurrent tumors, long term tumor control was 40% four year actuarial disease survival. Local control was 100% for vault recurrences of 3 cm diameter size, but only 6/8 (75%) cleared their pelvic tumors completely. Those that did not had tumors of massive size, distant metastatic disease and adenosquamous or poorly-differentiated (G3) pattern. One additional cut across, infected tumor was controlled for 26 months. Corpus carcinoma was highly sensitive to Cf-252 neutron radiation therapy.
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Abstract
Fifty-four patients with endometrial carcinoma were treated by radiation alone between 1962 and 1977, because of severe associated medical problems that contraindicated surgery. The overall 5-year absolute and determinate survival rates were 46% and 54%, respectively. The majority of patients who presented with Stage I, grade I disease were treated with only intracavitary radiation; this yielded a 75% 5-year survival rate. However, the combination of external and intracavitary radiation achieved the best results in the overall group. The stage of the disease, grade, age at diagnosis, and treatment techniques correlated well with failure rates. However, only the tumor grade and treatment techniques influenced failure patterns. The length of the uterine cavity did not have any prognostic influence in these patients.
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Nahhas WA, Zaino R, Mortel R. Residual carcinoma in the surgical specimen of patients with endometrial adenocarcinoma undergoing preoperative radiation therapy. A study of 80 patients and a literature review. Gynecol Oncol 1984; 18:165-76. [PMID: 6735261 DOI: 10.1016/0090-8258(84)90024-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Controversy continues to surround the significance of residual endometrial adenocarcinoma in the uterus following radiation therapy. Eighty patients with FIGO stage IA, IB, and II endometrial adenocarcinoma treated by preoperative radiotherapy were studied. No correlation was noted between the histologic grade of the lesion and the stage of disease. The frequency and the site of residual carcinoma were not related to the stage of disease but less-differentiated tumors persisted more frequently than grade I lesions. The modality of preoperative radiotherapy did not affect the frequency of residual tumor. Residual carcinoma within the uterus had no effect on the site or frequency of recurrence nor on patient survival.
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Abstract
The ability to predict myometrial invasion by endometrial adenocarcinoma is useful for preoperative treatment purposes. The presence of stromal invasion is one possible method of predicting myometrial invasion, but criteria for the presence of stromal invasion have been lacking. Recently, criteria for its detection were proposed. We evaluated the validity of the proposed criteria in two conditions: (1) atypical hyperplasia (119 cases) and (2) endometrial adenocarcinoma Stage I, grade 1 (83 cases). Adenocarcinoma without stromal invasion according to the criteria of Kurman and Norris was present in 43 cases and adenocarcinoma with stromal invasion was present in 40 cases. This series demonstrated the ability of prehysterectomy endometrial sampling to predict the probability of myometrial penetration. In addition, none of our patients without stromal invasion in the resected uterus had myometrial penetration and no metastases have occurred. In those showing stromal invasion in the excised uterus, the myometrium was invaded in 34 of 51 cases (67%). Since myometrial penetration was not present when there was no stromal invasion in the resected uterus, stromal invasion deserves further evaluation and should be considered in future classification of endometrial adenocarcinoma.
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Persson I, Adami HO, Malker B, Pettersson B. Long-term survival in endometrial cancer with special reference to age as a prognostic factor. Ups J Med Sci 1984; 89:159-70. [PMID: 6464244 DOI: 10.3109/03009738409178476] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Long-term survival was evaluated in 13 586 patients with cancer of the endometrium, constituting 97% of all cases diagnosed in Sweden 1960-1978. Survival rates corrected for the expected mortality revealed that age at diagnosis is an important predictor of prognosis, with a constant trend towards a more favourable course in younger women. Thus, the cumulative relative 15-year survival rates +/- 95% confidence limits were 90 (86.1-93.7)%, 89 (87.4-91.3)%, 72 (68.9-74.3)%, 50 (44.9-54.7)% and 32 (18.3-45.6)% at ages 35-44, 45-54, 55-64, 65-74 and 75+ years respectively. Patients younger than 55 years deviated from the general pattern by having an excellent survival and virtually no excess mortality after 7 years of observation.
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26
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Abstract
Depth of myometrial invasion is accepted as one of the most important prognostic factors in carcinoma of the endometrium. In an effort to define the significance of adenomyosis containing adenocarcinoma as it relates to myometrial invasion, 52 cases of Stage I adenocarcinoma with coexisting adenomyosis were identified. A subset of 11 cases was noted to have adenocarcinoma in adenomyosis, invasive to a depth greater than would have been appreciated had this entity not been identified. These 11 cases had a 100% 5-year survival, suggesting that adenocarcinoma in adenomyosis does not indicate a more ominous prognosis. The depth of invasion into the myometrium proper is the significant prognostic factor. The pathologist must be able to differentiate these two distinct entities to accurately assess prognosis.
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Abstract
Optimal management of patients with gynecologic malignancies requires a multidisciplinary approach with close cooperation between the primary care physician, the gynecologic oncologist and the radiation therapist. In order to obtain maximum survival rates with minimal morbidity, treatment should be based on a detailed knowledge of tumor localization, potential sites of occult spread, and tumor-host interactions. A careful delineation of patterns of recurrence will permit the identification of patients at increased risk for treatment failure and will aid in the design of alternative treatment protocols tailor-made to control potential site(s) of tumor spread. The technological advances in radiation oncology and their influence on survival rates are presented, with illustrations taken from the literature and from the recent results of the Patterns of Care Study for treatment of carcinoma of the cervix. The role of radiation therapy in the treatment of carcinomas of the cervix, uterus, and the epithelial tumors of the ovary are reviewed, emphasizing treatment protocols based on consideration of technical, tumor, and host factors. Ongoing clinical research trials and potential areas for further improvement in the management of gynecologic malignancies are discussed.
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Ortner A. Epithelial compartment volume density: a proposal of a prognosis score in endometrial adenocarcinoma. Gynecol Oncol 1983; 15:190-200. [PMID: 6832634 DOI: 10.1016/0090-8258(83)90074-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The point count method was used to calculate the relative volume density of the epithelial, stromal, and luminal compartments of endometrial adenocarcinoma, according to stereological principles. All three compartments could be correlated with survival in a significant way. The relative volume density of the epithelial compartment further correlated with the histologic grade of the tumor, but not with the clinical stage of disease or age of the patient. Providing the pathologist with a 40% relative volume density of the epithelial compartment as a decision line, this parameter may be useful as a prognostic factor. A prognosis scoring system on a pretherapeutic and postsurgical-pathologic level is proposed and its utility applied to the study group.
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29
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Phillips GL, Prem KA, Adcock LL, Twiggs LB. Vaginal recurrence of adenocarcinoma of the endometrium. Gynecol Oncol 1982; 13:323-8. [PMID: 7095571 DOI: 10.1016/0090-8258(82)90070-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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30
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31
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Abstract
Controversy continues as to how and when radiation therapy can best be combined with surgery in order to improve treatment results in patients, with endometrial cancer. Various prognostic factors--tumor grade, depth of myometrial invasion, size of the uterine cavity, and the presence of nodal or parametrial spread--must all be considered when planning therapy. Well-differentiated Stage IA endometrial cancers hav an excellent prognosis when treated by surgery alone. Evidence suggests, however, that all other Stage I tumors benefit from combined radiation and surgical treatment. Patients with advanced stages of disease are candidates for combined surgery and radiation or radiation alone, owing to the high frequency of pelvic node involvement. Areas of active investigation include the addition of systemic therapy in patients with Stage III disease and the evaluation of extended field radiation in patients with histologically confirmed high pelvic or paraaortic nodal involvement.
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32
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Nahhas WA, Whitney CW, Stryker JA, Curry SL, Chung CK, Mortel R. Stage II endometrial carcinoma. Gynecol Oncol 1980; 10:303-11. [PMID: 7461494 DOI: 10.1016/0090-8258(80)90098-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Danoff BF, McDay J, Louka M, Lewis GC, Lee J, Kramer S. Stage III Endometrial carcinoma: analysis of patterns of failure and therapeutic implications. Int J Radiat Oncol Biol Phys 1980; 6:1491-5. [PMID: 7462052 DOI: 10.1016/0360-3016(80)90005-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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34
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Abstract
An understanding of the patterns of spread and prognostic factors influencing survival is necessary to develop rational treatment programs for patients with endometrial cancer. The most important risk factors include the stage of tumor, status of pelvic lymph nodes, depth of myometrial penetration, tumor grade, cell type, and patient age. Because of the inherent inaccuracies of staging based on pelvic examination and the inability to assess the status of lymph nodes or myometrial penetration clinically, errors in management often result when radiation therapy is delivered prior to operation. Therefore, a rationale is offered for primary operative management of patients with Stage I disease, with consideration of adjunctive radiation therapy following operation based on extend of disease and a thorough evaluation of the high-risk factors. It is suggested that patients with more advanced stages of disease be considered for pretreatment operative evaluation. Data are presented which refute theoretical objections to this approach.
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35
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Bruckman JE, Bloomer WD, Marck A, Ehrmann RL, Knapp RC. Stage III adenocarcinoma of the endometrium: two prognostic groups. Gynecol Oncol 1980; 9:12-7. [PMID: 7353798 DOI: 10.1016/0090-8258(80)90003-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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36
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Menczer J, Modan M, Ezra D, Serr DM. Prognosis in pre- and postmenopausal patients with endometrial adenocarcinoma. Maturitas 1980; 2:37-43. [PMID: 7402085 DOI: 10.1016/0378-5122(80)90058-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The prognosis in 41 pre- and 143 postmenopausal patients with endometrial adenocarcimona during two time periods were compared. A significantly shorter interval from 1st symptom to diagnosis was found in postmenopausal patients. The percent of patients diagnosed in stage I did not differ significantly between the two groups, but there was a significant, although small, excess of postmenopausal patients diagnosed in stages III-IV. A significantly more favourable survival in premenopausal patients was found and the same trend was observed when the effect of age, stage at diagnosis and operability were taken into consideration. The possibility that this could be related to hormonal and immunological factors is raised. A significantly better survival of patients diagnosed during the second period was observed and is attributed to improved planning and methods of treatment.
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37
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Berman ML, Ballon SC. Treatment of endometrial cancer. Cancer Treat Rev 1979; 6:165-75. [PMID: 394835 DOI: 10.1016/s0305-7372(79)80068-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Abstract
The clinical data of 22 patients with clear cell adenocarcinoma of the endometrium treated at the University of North Carolina Memorial Hospital are reported. In addition, the data with particular reference to survival, site of recurrence, and treatment are combined with information from two previous reports of clear cell adenocarcinoma of the endometrium to better define survival. It is noted that the patients with clear cell adenocarcinoma of the endometrium were older and had an overall poorer survival than is reported for adenocarcinoma of the endometrium (nonclear cell). Patients with Stage I clear cell carcinoma of the endometrium, however, had a similar five-year survival to Stage I adenocarcinoma of the endometrium. The paper also examines treatment methods and correlates these with site of recurrence as well as survival.
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Candiani GB, Mangioni C, Marzi MM. Surgery in endometrial cancer: age, route, and operability rate in 854 stage I and II fresh consecutive cases: 1955--1976. Gynecol Oncol 1978; 6:363-72. [PMID: 689486 DOI: 10.1016/0090-8258(78)90043-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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40
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Tavares MA, Patricio MB, Vilhena M, Da Silva JN. Management and results of endometrial carcinoma treated at Instituto Português de Oncologia de Francisco Gentil. Cancer 1977; 39:675-80. [PMID: 402190 DOI: 10.1002/1097-0142(197702)39:2<675::aid-cncr2820390246>3.0.co;2-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The experience of 260 patients with endometrial carcinoma was reviewed. The influence of factors such as age, stage of disease, grade and degree of myometrial penetration on the survival was presented, showing that survival decreases in elderly patients, in patients with advanced stage of disease, when the tumor is undifferentiated, and when the tumor deeply penetrates the myometrium. The methods of therapy, fall into three main groups: surgery, radiotherapy, and combined therapy, the latter yielding the best 5-year survival rate, in all stages. The incidence of vaginal recurrences was low, probably due to the fact that 68.8% of the patients were treated by a combined therapeutic modality.
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41
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Marriage and childbearing in relation to the occurrence of endometrial cancer. Eur J Obstet Gynecol Reprod Biol 1977. [DOI: 10.1016/0028-2243(77)90015-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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42
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Abstract
Ten percent of all patients with endometrial carcinoma have Stage III disease at the time of presentation. The management, the features of their disease, and their prognosis are quite different than those of patients with Stage I disease. This report is based on 37 patients with Stage III carcinomas. For their treatment, a program of definitive radiation therapy was applied. Eleven patients had a prior total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO). On the basis of the tumor extension, three main patterns were identified: 1) downward into the vagina or the vagina and the cervix; 2) lateral into the parametrium and the pelvic wall; and 3) to the ovaries. This classification carries therapeutic and prognostic significance. Ovarian extension has the best prognosis when treated by TAH and BSO followed by postoperative radiotherapy. Extension to the vagina or to the vagina and the cervix can be treated successfully by a combination of external beam and local radium placements. Patients with pelvic wall extension have the poorest prognosis. They comprise maore than 50% of all cases with Stage III tumors and have exhibited persistent or recurrent disease even when treated at high dose levels. The cumulative survival rates for the entire stage were 50% at the end of the first year, 32% at the end of the second year, and 25% at the end of the fifth year.
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45
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47
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48
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