To identify patients with endometrial cancer at risk for hematogenous,lymphatic,or perito neal recurrence(or combinations of them)who might potentially benefit from target -based therapies.During a 13-year period,915p...To identify patients with endometrial cancer at risk for hematogenous,lymphatic,or perito neal recurrence(or combinations of them)who might potentially benefit from target -based therapies.During a 13-year period,915patients had endometrial cancer man aged with hysterectomy and standard adjuvant therapy.On th e basis of our previous regression analyses,depth of myome trial invasion predicted the risk for hematogenous recurrence;positive lymph nodes and cervical stromal invasion predi cted lymphatic recur-rence;stage IV disease or combination of nonendometrioid histology,cervical stromal invasion,positive lymph nodes,and positive peritoneal cytology wa s predictive of peritoneal recurrence.Median follow -up was 66months.Applying the above criteria to the population of 915patients,24%were considered at risk for hematogenous recur -rence,18%for lymphatic recurrence,and 16%for peritoneal recurrence.The respective relapse rates at 5years were28%for patients who were at risk for h ematogenous re-currence,31%for lymphatic recurre nce,and 42%for peritoneal recurrence.This contra sted with less than a 5%recurrence rate in the correspondin g subgroups not at risk for relapse(P <0.001).Collectively,of the 915pa-tients,324(35%)were considered at risk for recurren ce in one or more of the above three sites.Overall,89%of all recurrences were identified in this at -risk group.Impor-tantly,46%of the patients considered at risk subsequently had recurrence in one or more of the th ree sites,compared with only 2%of patients not at risk fo r relapse(P<0.001).Patients at risk for relapse had a 46%probability of experiencing recurrence within 5years despite manage-ment with standard therapy.New targ et -based algorithms for the 35%of endometrial cancer patients deemed at risk should be incorporated in the develo pment of future prospective multimodality clinica l trials predicated on site(s)of recurrence.展开更多
Our aim was to determine the outcomes associated with use of whole- abdominal radiation therapy (WART) in women with ovarian cancer, to identify predictors of response, and to assess associated toxicity. From 1981 thr...Our aim was to determine the outcomes associated with use of whole- abdominal radiation therapy (WART) in women with ovarian cancer, to identify predictors of response, and to assess associated toxicity. From 1981 through 2000, 171 women received WART at our institution after ovarian cancer surgery. Relevant clinical information was extracted through retrospective chart review. One hundred nine patients received WART after positive second- look laparotomy (SLL), and 62 were treated after secondary debulking (SD) for recurrent disease. The median dose to the whole abdomen was 25.5 Gy (range, 1.0- 30.5 Gy). Therapy included a pelvic boost in 120 patients (70% ) and a para- aortic boost in 21 patients (12% ). The planned radiation course was completed in 123 patients (72% ). In the SLL group, 5- year survival was 29% with a median follow- up of 98.4 months. The 5- year progression- free survival (PFS)was 41% in those with microscopic disease. There was one treatment- related death (1% ). For the SD group, median PFS was 11 months and associated with treatment- related mortality in 5% . Overall, treatment- related small bowel obstruction occurred in 26 patients (15% ). In patients with a positive SLL, WART should be considered only for those with microscopic residual disease. Treatment- related small bowel obstruction can be expected in 15% of these patients. Use of WART for recurrent disease appears to be related to serious bowel toxicity in 5% with an associated short disease- free interval; the therapeutic index of WART may not be acceptable in patients with recurrent disease regardless of the degree of cytoreduction.展开更多
文摘To identify patients with endometrial cancer at risk for hematogenous,lymphatic,or perito neal recurrence(or combinations of them)who might potentially benefit from target -based therapies.During a 13-year period,915patients had endometrial cancer man aged with hysterectomy and standard adjuvant therapy.On th e basis of our previous regression analyses,depth of myome trial invasion predicted the risk for hematogenous recurrence;positive lymph nodes and cervical stromal invasion predi cted lymphatic recur-rence;stage IV disease or combination of nonendometrioid histology,cervical stromal invasion,positive lymph nodes,and positive peritoneal cytology wa s predictive of peritoneal recurrence.Median follow -up was 66months.Applying the above criteria to the population of 915patients,24%were considered at risk for hematogenous recur -rence,18%for lymphatic recurrence,and 16%for peritoneal recurrence.The respective relapse rates at 5years were28%for patients who were at risk for h ematogenous re-currence,31%for lymphatic recurre nce,and 42%for peritoneal recurrence.This contra sted with less than a 5%recurrence rate in the correspondin g subgroups not at risk for relapse(P <0.001).Collectively,of the 915pa-tients,324(35%)were considered at risk for recurren ce in one or more of the above three sites.Overall,89%of all recurrences were identified in this at -risk group.Impor-tantly,46%of the patients considered at risk subsequently had recurrence in one or more of the th ree sites,compared with only 2%of patients not at risk fo r relapse(P<0.001).Patients at risk for relapse had a 46%probability of experiencing recurrence within 5years despite manage-ment with standard therapy.New targ et -based algorithms for the 35%of endometrial cancer patients deemed at risk should be incorporated in the develo pment of future prospective multimodality clinica l trials predicated on site(s)of recurrence.
文摘Our aim was to determine the outcomes associated with use of whole- abdominal radiation therapy (WART) in women with ovarian cancer, to identify predictors of response, and to assess associated toxicity. From 1981 through 2000, 171 women received WART at our institution after ovarian cancer surgery. Relevant clinical information was extracted through retrospective chart review. One hundred nine patients received WART after positive second- look laparotomy (SLL), and 62 were treated after secondary debulking (SD) for recurrent disease. The median dose to the whole abdomen was 25.5 Gy (range, 1.0- 30.5 Gy). Therapy included a pelvic boost in 120 patients (70% ) and a para- aortic boost in 21 patients (12% ). The planned radiation course was completed in 123 patients (72% ). In the SLL group, 5- year survival was 29% with a median follow- up of 98.4 months. The 5- year progression- free survival (PFS)was 41% in those with microscopic disease. There was one treatment- related death (1% ). For the SD group, median PFS was 11 months and associated with treatment- related mortality in 5% . Overall, treatment- related small bowel obstruction occurred in 26 patients (15% ). In patients with a positive SLL, WART should be considered only for those with microscopic residual disease. Treatment- related small bowel obstruction can be expected in 15% of these patients. Use of WART for recurrent disease appears to be related to serious bowel toxicity in 5% with an associated short disease- free interval; the therapeutic index of WART may not be acceptable in patients with recurrent disease regardless of the degree of cytoreduction.
