RESUMEN
INTRODUCTION: The optimal postoperative adjuvant treatment for stage III endometrial cancer (EC) is controversial. The aim of the study was to evaluate the impact of cytoreductive surgery (CRS) and adjuvant chemoradiotherapy (CRT) on relapse-free survival (RFS) and overall survival (OS) in stage III EC. METHODS: Data on 36 patients with stage III EC were reviewed. A review of the literature was performed. RESULTS: Median follow-up was 31 months (range 3-195). All patients underwent radical surgery with lymph nodes assessment in 29 (80.6%). The histologic specimen revealed 27 (75%) type I and 9 (25%) type II cancers staged IIIA, IIIB, IIIC1, and IIIC2 in 9 (25%), 3 (8.3%), 17 (47.2%), and 7 (19.5%) patients, respectively. At the end of surgery, 32 (88.9%) had no residual tumor. Eighteen (50%) patients were treated with CRT (50% with sandwich approach, 50% with concurrent chemotherapy [CT]), 4 (11.1%) patients received radiotherapy (RT), and 14 (38.9%) had multiagent CT. Four patients (11.1%) with a residual tumor larger than 1 centimeter after surgery died of disease. The 5-year median recurrent free survival (RFS) for CRT, RT, and CT was 69.1%, 37.5%, and 23.8%, respectively (p = 0.05); the 5-year OS for CRT, RT, and CT was 83%, 35.7%, and 25%, respectively (p = 0.023). Multivariate analyses showed residual tumor as independent predictor for recurrence and death. CRT showed a borderline significance on OS. CONCLUSIONS: Our study demonstrated that optimal cytoreduction is the most significant prognostic factor and adjuvant CRT seems to be associated with a significant decreased risk of recurrence in stage III EC.
Asunto(s)
Procedimientos Quirúrgicos de Citorreducción , Neoplasias Endometriales/cirugía , Ganglios Linfáticos/cirugía , Recurrencia Local de Neoplasia/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Quimioradioterapia Adyuvante/efectos adversos , Supervivencia sin Enfermedad , Neoplasias Endometriales/tratamiento farmacológico , Neoplasias Endometriales/patología , Femenino , Estudios de Seguimiento , Humanos , Ganglios Linfáticos/efectos de los fármacos , Ganglios Linfáticos/patología , Persona de Mediana Edad , Recurrencia Local de Neoplasia/tratamiento farmacológico , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Factores de Riesgo , Tasa de SupervivenciaRESUMEN
OBJECTIVE: Hyperthermic intraperitoneal chemotherapy (HIPEC) has been proposed as a treatment in ovarian cancer. A recently published RCT demonstrated that HIPEC prolongs disease-free survival (DFS) and overall survival (OS) in ovarian cancer. The aim of the study was to investigate oncologic results of cytoreductive surgery+HIPEC compared with cytoreductive surgery alone in advanced primary ovarian cancer with a particular attention to the pattern of recurrence. METHODS: This is a retrospective case control study with a propensity score (PS) matching of the patients. All the patients treated for primary advanced ovarian cancer who underwent interval surgery with or without HIPEC were collected; a PS was calculated in order to match cases to controls. RESULTS: Among 77 eligible patients 56 patients were included in the study. Preoperative patients' characteristics were homogeneous. No difference in morbidity and mortality after surgery were recorded. DFS was not different among the 2 groups (13.2 vs. 13.9 months, p=0.454) but OS was better in patients treated with HIPEC with no median reached vs. 35.5 months (p=0.048). Patients treated with cytoreductive surgery alone were more likely to have a peritoneal recurrence (43% vs. 14%). CONCLUSION: HIPEC seems to affect the relapse pattern with lesser peritoneal recurrence. This difference in relapse pattern seems to affect the OS with better results in patients treated with HIPEC. Further studies are needed to confirm these findings.
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Carcinoma Epitelial de Ovario/terapia , Procedimientos Quirúrgicos de Citorreducción/métodos , Hipertermia Inducida/métodos , Neoplasias Ováricas/terapia , Puntaje de Propensión , Anciano , Carcinoma Epitelial de Ovario/mortalidad , Estudios de Casos y Controles , Supervivencia sin Enfermedad , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Ováricas/mortalidad , Recurrencia , Estudios RetrospectivosRESUMEN
OBJECTIVE: The concurrent use of radiotherapy (RT) and chemotherapy (CT) as adjuvant treatment after surgery in high-risk endometrial cancer has been generally considered cautiously. Recently some of us have reported preliminary data on the efficacy and tolerability of concomitant CT and RT. In this paper, we update our experience. METHODS: A total of 47 patients aged >18 years and <80 years with histological diagnosis of high-risk endometrial endometrioid carcinomas entered the study. Inclusion criteria were stages IC G3, IIB, IIIA (patients with positive washing without other unfavourable prognostic factors were omitted), IIIB and IIIC. The radiation plan consisted of a total dose of 50.4 Gy, given in five fractions per week (1.8 Gy: daily dose) for 6 weeks. Paclitaxel (P) at a dose of 60 mg/m(2) was infused intravenously in 250 mL of normal saline for 1 h once weekly during RT for 5 weeks. Three further cycles of Paclitaxel, at a dose of 80 mg/m(2), have been given weekly at the end of RT. RESULTS: There was no life-threatening toxicity. The overall 5-year relapse-free survival was 81.8% (95% CI, 65.2-90.9). The 5-year percent overall disease-specific survival was 88.4% (95% CI, 71.1-95.6). CONCLUSIONS: These results, based on a larger series, support our previous data: Paclitaxel plus RT may represent an effective and well-tolerated treatment in high-risk endometrial cancer patients.
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Carcinoma Endometrioide/tratamiento farmacológico , Carcinoma Endometrioide/radioterapia , Neoplasias Endometriales/tratamiento farmacológico , Neoplasias Endometriales/radioterapia , Paclitaxel/administración & dosificación , Adulto , Anciano , Antineoplásicos Fitogénicos/administración & dosificación , Antineoplásicos Fitogénicos/efectos adversos , Carcinoma Endometrioide/patología , Carcinoma Endometrioide/cirugía , Quimioterapia Adyuvante/efectos adversos , Supervivencia sin Enfermedad , Neoplasias Endometriales/patología , Neoplasias Endometriales/cirugía , Femenino , Humanos , Persona de Mediana Edad , Estadificación de Neoplasias , Paclitaxel/efectos adversos , Estudios Prospectivos , Radioterapia Adyuvante/efectos adversos , Factores de Riesgo , Tasa de SupervivenciaRESUMEN
We report a case of persistent gestational trophoblastic disease (GTD) in which a selective uterine artery embolization instead of invasive surgery achieved both the control of pelvic hemorrhage and of disease.