Objective To explore if the addition of adjuvant chemotherapy with paclitaxel and carboplatin to radiotherapy confers an advantage for overall survival （OAS）, and progression free survival （PFS）; to assess the inc...Objective To explore if the addition of adjuvant chemotherapy with paclitaxel and carboplatin to radiotherapy confers an advantage for overall survival （OAS）, and progression free survival （PFS）; to assess the incidence of relapses over standard pelvic radiotherapy; and to evaluate the related toxicity in high-risk stage I-II endometrial carcinoma Methods Medical records were reviewed to identify high-risk stage I-1I endometrial carcinoma cases treated in the Clinical Oncology and Nuclear Medicine department between 2002 and 2008 with adjuvant radiotherapy alone （arm Ⅰ）（57 patients） or with sequential carboplatin （AUCS-6） and paclitaxel （135-175 mg/m^2） with radiotherapy （arm Ⅱ） （51 patients）. Radiotherapy was performed through the four-field box technique at doses of 45-50 Gy （1.8 Gy/day × 5 days/week）. Results The toxicity was manageable and predominantly hematologic with a grade 3 neutropenia and thrombocytopenia in 9.8% and 6% of the patients in arm Ⅰ and arm Ⅱ, respectively, without febrile neutropenia. All patients experienced hair loss. Chernoradiotherapy arm was associated with a lower incidence rate of relapse （9.8% vs. 22.7%）. After a median follow-up period of 48 months, the 5-year OAS and PFS rates for chemoradiotherapy-treated patients were significantly more favorable than those who did not receive chemotherapy （P=0.02 and 0.03, respectively）. In arm I, the OAS and PFS rates were 73.7% and 66.7% compared with those in arm II, whose rates were 90.2% and 84.3%. Conclusions Adjuvant chemoradiation with paclitaxel and carboplatin improved the survival rates and decreased the recurrence rates in patients with high-risk stage Ⅰ-Ⅱ endometrial carcinoma. Chemotherapy was associated with an acceptable rate of toxicity. However, a prospective study with a larger number of patients is needed to define a standard adjuvant treatment for high-risk stage Ⅰ-Ⅱ endometrial carcinoma.展开更多
BACKGROUND Distant metastasis occasionally occurs in patients who have been diagnosed with colorectal cancer(CRC), but it occurs in a few patients with stage I CRC. The vagina as a metastasis site has also been report...BACKGROUND Distant metastasis occasionally occurs in patients who have been diagnosed with colorectal cancer(CRC), but it occurs in a few patients with stage I CRC. The vagina as a metastasis site has also been reported, albeit rarely. Most reported cases of vaginal metastasis(VM) report their origin from advanced CRC. We encountered a patient who was diagnosed with isolated VM originating from stage I colon cancer(T2N0) and herein present the case of this patient.CASE SUMMARY A 63-year-old woman visited the outpatient clinic because of a positive result from a stool occult blood test. She underwent laparoscopic anterior resection and was pathologically diagnosed with stage I(T2N0) sigmoid colon cancer. Neither lymphovascular invasion nor perineural invasion was observed. Ten months following the surgery, isolated vaginal metastases were detected on gynecologic examination. The examination was performed due to vaginal spotting. A transvaginal wide excision was performed, and no other adjuvant treatment was provided after discussion with a multidisciplinary team and the patient.Subsequently, a new VM was discovered after 33 mo. An additional transvaginal excision was performed. To date, there has been no evidence of further disease progression. From the time of diagnosis of VM, the patient’s overall survival has been 54 mo.CONCLUSION VM can occur as a result of early-stage colorectal cancer. Surgeons should consider the possibility of VM following complaints of gynecologic symptoms following surgery.展开更多
Objective: To compare intra-operative and post-operative complications as well as recurrence in women withendometrial cancer undergoing surgical stagingwith robotic-assisted laparoscopic hysterectomy (RALH)versus tota...Objective: To compare intra-operative and post-operative complications as well as recurrence in women withendometrial cancer undergoing surgical stagingwith robotic-assisted laparoscopic hysterectomy (RALH)versus total abdominal hysterectomy (TAH). Methods: A retrospective review was performed of 416 patients who underwent surgical staging for endometrial adenocarcinoma from January 1, 2008 to December 31, 2010. Demographics,intraand post-operative complications, surgical-pathologic data, subsequent treatments, and recurrence were compared in women treated with TAH versus RALH. A Student’st-test, Mann Whitney U analysis, or chi-squared analysis were used for statistical analysis. Results: One hundred thirty seven and 279 patients underwent TAH and RALH, respectively. Post-operative complications were lower in the RALH group (16.8% vs 8.2%, p = 0.009) and mean hospital stay for the TAH group versus the RALH group was 3 days versus 1 day (p < 0.001). Demographics and intra-operative complications were similar (p = 0.94). Uterine weight (108 gvs103 g, p = 0.36), pelvic lymph nodes retrieved (9 vs 9, p = 0.18), and presence of lymph-vascular involvement (11.7% vs 10.8%, p = 0.38) were similar between groups, as were aggressive histologic subtypes (p = 0.52) and grade (p = 0.15). Recurrence occurred in 4.4% of the TAH group and 4.3% of the RALH group (p = 0.97) with death from disease occurring in 1.5% of the TAH group and 2.2% of the RALH group (p = 0.64). Conclusions: RALH for endometrial adenocarcinoma is associated with fewer post-operative complications and a shorter hospital stay than TAH. Recurrence and death due to disease are not compromised by this minimally invasive approach.展开更多
The International Federation of Gynecology and Obstetrics (FIGO) changed the surgical staging criteria for endometrial cancer in 2009, namely combining FIGO 1988 Stage IA and IB in FIGO 2009 Stage IA, eliminating cerv...The International Federation of Gynecology and Obstetrics (FIGO) changed the surgical staging criteria for endometrial cancer in 2009, namely combining FIGO 1988 Stage IA and IB in FIGO 2009 Stage IA, eliminating cervical glandular involvement from Stage II, and removing peritoneal cytology as criteria from Stage IIIA (3). This review of the literature sheds light on the continued debate among authorities on the utility of peritoneal cytology in surgical staging of endometrial cancer. At the time FIGO removed peritoneal cytology from the staging criteria in 2009, there was little to no evidence to support its removal. In fact, FIGO continues to recommend obtaining peritoneal cytology, which is in contradiction to their staging criteria. While a few small studies support the idea that peritoneal cytology does not preclude a worse prognosis, a number of large scale studies with at least 300 patients demonstrate a clear association between survival and the presence of malignant peritoneal cytology (11 - 12, 15 - 19). In one of the largest studies, investigators reviewed 14,704 from the SEER’s database, demonstrating that malignant peritoneal cytology is associated with decreased survival across Stage I/II disease even when controlled for histology, grade, and other risk factors. Malignant peritoneal cytology should be considered when counseling patients on the risk of recurrence and overall survival of endometrial cancer. However, the role of adjuvant treatment in this setting remains unclear.展开更多
Uterine cervical cancer is the second most common gynecological malignancy. It is estimated that over 35% of tumors are diagnosed at locally advanced disease, stage ⅠB2-ⅡB with an estimated 5-year overall survival o...Uterine cervical cancer is the second most common gynecological malignancy. It is estimated that over 35% of tumors are diagnosed at locally advanced disease, stage ⅠB2-ⅡB with an estimated 5-year overall survival of 60%. During the last decades, the initial treatment for these women has been debated and largely varies through different countries. Thus, radical concurrent chemoradiation is the standard of care in United Sated and Canada, and neoadjuvant chemotherapy followed by radical surgery is the first line of treatment in some institutions of Europe, Asia and Latin America. Until today, there is no evidence of which strategy is better over the other. This article describe the evidence as well as the advantages and disadvantages of the main strategies of treatment for women affected by uterine cervical cancer stage ⅠB2-ⅡB.展开更多
Objective The International Federation of Gynecology and Obstetrics(FIGO)released a new stagingfor endometrial cancer(EC),which revised the FIG02009 staging to include histopathological andmolecular features.The purpo...Objective The International Federation of Gynecology and Obstetrics(FIGO)released a new stagingfor endometrial cancer(EC),which revised the FIG02009 staging to include histopathological andmolecular features.The purpose of this study was to validate the prognostic accuracy of the new staging and discuss its clinical applicability.Methods In this single-centre retrospective study,540 patients with primary surgically treated early-stage EC were enrolled and staged according to FIG02009/2023.Kaplan-Meier survival analysis was used to compare for prognostic differentiation.Cox regression was used to identify potential prognostic indicators.Results A total of 81 patients underwent staging shifts,allstage elevation.The prognosis difference between new stages I and Il was more significant.The new staging was more predictive of death postoperatively.Lesion maximum diameter(LMD)was one of the independent risk factors associated with prognosis.Taking LMD=5.70 cm as the cut-off value could further differentiate patients with divergent prognoseswithin FIG02023stage IIC.Conclusion FIG02023 stagingdemonstrated greater prognostic accuracy.In addition,LMD may be another critical factor affecting prognosis.展开更多
文摘Objective To explore if the addition of adjuvant chemotherapy with paclitaxel and carboplatin to radiotherapy confers an advantage for overall survival （OAS）, and progression free survival （PFS）; to assess the incidence of relapses over standard pelvic radiotherapy; and to evaluate the related toxicity in high-risk stage I-II endometrial carcinoma Methods Medical records were reviewed to identify high-risk stage I-1I endometrial carcinoma cases treated in the Clinical Oncology and Nuclear Medicine department between 2002 and 2008 with adjuvant radiotherapy alone （arm Ⅰ）（57 patients） or with sequential carboplatin （AUCS-6） and paclitaxel （135-175 mg/m^2） with radiotherapy （arm Ⅱ） （51 patients）. Radiotherapy was performed through the four-field box technique at doses of 45-50 Gy （1.8 Gy/day × 5 days/week）. Results The toxicity was manageable and predominantly hematologic with a grade 3 neutropenia and thrombocytopenia in 9.8% and 6% of the patients in arm Ⅰ and arm Ⅱ, respectively, without febrile neutropenia. All patients experienced hair loss. Chernoradiotherapy arm was associated with a lower incidence rate of relapse （9.8% vs. 22.7%）. After a median follow-up period of 48 months, the 5-year OAS and PFS rates for chemoradiotherapy-treated patients were significantly more favorable than those who did not receive chemotherapy （P=0.02 and 0.03, respectively）. In arm I, the OAS and PFS rates were 73.7% and 66.7% compared with those in arm II, whose rates were 90.2% and 84.3%. Conclusions Adjuvant chemoradiation with paclitaxel and carboplatin improved the survival rates and decreased the recurrence rates in patients with high-risk stage Ⅰ-Ⅱ endometrial carcinoma. Chemotherapy was associated with an acceptable rate of toxicity. However, a prospective study with a larger number of patients is needed to define a standard adjuvant treatment for high-risk stage Ⅰ-Ⅱ endometrial carcinoma.
文摘BACKGROUND Distant metastasis occasionally occurs in patients who have been diagnosed with colorectal cancer(CRC), but it occurs in a few patients with stage I CRC. The vagina as a metastasis site has also been reported, albeit rarely. Most reported cases of vaginal metastasis(VM) report their origin from advanced CRC. We encountered a patient who was diagnosed with isolated VM originating from stage I colon cancer(T2N0) and herein present the case of this patient.CASE SUMMARY A 63-year-old woman visited the outpatient clinic because of a positive result from a stool occult blood test. She underwent laparoscopic anterior resection and was pathologically diagnosed with stage I(T2N0) sigmoid colon cancer. Neither lymphovascular invasion nor perineural invasion was observed. Ten months following the surgery, isolated vaginal metastases were detected on gynecologic examination. The examination was performed due to vaginal spotting. A transvaginal wide excision was performed, and no other adjuvant treatment was provided after discussion with a multidisciplinary team and the patient.Subsequently, a new VM was discovered after 33 mo. An additional transvaginal excision was performed. To date, there has been no evidence of further disease progression. From the time of diagnosis of VM, the patient’s overall survival has been 54 mo.CONCLUSION VM can occur as a result of early-stage colorectal cancer. Surgeons should consider the possibility of VM following complaints of gynecologic symptoms following surgery.
文摘Objective: To compare intra-operative and post-operative complications as well as recurrence in women withendometrial cancer undergoing surgical stagingwith robotic-assisted laparoscopic hysterectomy (RALH)versus total abdominal hysterectomy (TAH). Methods: A retrospective review was performed of 416 patients who underwent surgical staging for endometrial adenocarcinoma from January 1, 2008 to December 31, 2010. Demographics,intraand post-operative complications, surgical-pathologic data, subsequent treatments, and recurrence were compared in women treated with TAH versus RALH. A Student’st-test, Mann Whitney U analysis, or chi-squared analysis were used for statistical analysis. Results: One hundred thirty seven and 279 patients underwent TAH and RALH, respectively. Post-operative complications were lower in the RALH group (16.8% vs 8.2%, p = 0.009) and mean hospital stay for the TAH group versus the RALH group was 3 days versus 1 day (p < 0.001). Demographics and intra-operative complications were similar (p = 0.94). Uterine weight (108 gvs103 g, p = 0.36), pelvic lymph nodes retrieved (9 vs 9, p = 0.18), and presence of lymph-vascular involvement (11.7% vs 10.8%, p = 0.38) were similar between groups, as were aggressive histologic subtypes (p = 0.52) and grade (p = 0.15). Recurrence occurred in 4.4% of the TAH group and 4.3% of the RALH group (p = 0.97) with death from disease occurring in 1.5% of the TAH group and 2.2% of the RALH group (p = 0.64). Conclusions: RALH for endometrial adenocarcinoma is associated with fewer post-operative complications and a shorter hospital stay than TAH. Recurrence and death due to disease are not compromised by this minimally invasive approach.
文摘The International Federation of Gynecology and Obstetrics (FIGO) changed the surgical staging criteria for endometrial cancer in 2009, namely combining FIGO 1988 Stage IA and IB in FIGO 2009 Stage IA, eliminating cervical glandular involvement from Stage II, and removing peritoneal cytology as criteria from Stage IIIA (3). This review of the literature sheds light on the continued debate among authorities on the utility of peritoneal cytology in surgical staging of endometrial cancer. At the time FIGO removed peritoneal cytology from the staging criteria in 2009, there was little to no evidence to support its removal. In fact, FIGO continues to recommend obtaining peritoneal cytology, which is in contradiction to their staging criteria. While a few small studies support the idea that peritoneal cytology does not preclude a worse prognosis, a number of large scale studies with at least 300 patients demonstrate a clear association between survival and the presence of malignant peritoneal cytology (11 - 12, 15 - 19). In one of the largest studies, investigators reviewed 14,704 from the SEER’s database, demonstrating that malignant peritoneal cytology is associated with decreased survival across Stage I/II disease even when controlled for histology, grade, and other risk factors. Malignant peritoneal cytology should be considered when counseling patients on the risk of recurrence and overall survival of endometrial cancer. However, the role of adjuvant treatment in this setting remains unclear.
文摘Uterine cervical cancer is the second most common gynecological malignancy. It is estimated that over 35% of tumors are diagnosed at locally advanced disease, stage ⅠB2-ⅡB with an estimated 5-year overall survival of 60%. During the last decades, the initial treatment for these women has been debated and largely varies through different countries. Thus, radical concurrent chemoradiation is the standard of care in United Sated and Canada, and neoadjuvant chemotherapy followed by radical surgery is the first line of treatment in some institutions of Europe, Asia and Latin America. Until today, there is no evidence of which strategy is better over the other. This article describe the evidence as well as the advantages and disadvantages of the main strategies of treatment for women affected by uterine cervical cancer stage ⅠB2-ⅡB.
基金National Key Research and Development Program of China(2022YFC2704405).
文摘Objective The International Federation of Gynecology and Obstetrics(FIGO)released a new stagingfor endometrial cancer(EC),which revised the FIG02009 staging to include histopathological andmolecular features.The purpose of this study was to validate the prognostic accuracy of the new staging and discuss its clinical applicability.Methods In this single-centre retrospective study,540 patients with primary surgically treated early-stage EC were enrolled and staged according to FIG02009/2023.Kaplan-Meier survival analysis was used to compare for prognostic differentiation.Cox regression was used to identify potential prognostic indicators.Results A total of 81 patients underwent staging shifts,allstage elevation.The prognosis difference between new stages I and Il was more significant.The new staging was more predictive of death postoperatively.Lesion maximum diameter(LMD)was one of the independent risk factors associated with prognosis.Taking LMD=5.70 cm as the cut-off value could further differentiate patients with divergent prognoseswithin FIG02023stage IIC.Conclusion FIG02023 stagingdemonstrated greater prognostic accuracy.In addition,LMD may be another critical factor affecting prognosis.
