The Prognostic Significance of the Depth of Cervical Stromal Invasion in Women with FIGO Stage II Uterine Endometrioid Carcinoma

Purpose/Objective(s): To explore the prognostic significance of the depth of cervical stromal invasion (CSI) on survival endpoints in women with FIGO stage II uterine endometrioid adenocarcinoma. Materials/Methods: A total of 117 patients were included in this retrospective review. Between 1990 and 2021, all patients with FIGO stage II endometrial cancer (EC) underwent hysterectomy and oophorectomy at our institution, with or without lymph node dissection. Patients with synchronous ovarian or breast cancer, as well as those who had undergone adjuvant systemic chemotherapy for EC, were excluded from the study. Pathologic slides were retrieved for these patients and were reviewed by a gynecologic pathologist to determine stromal thickness and the depth of CSI. The depth of CSI was then measured as a percentage of invasion (% CSI) and used in the analysis as a continuous or dichotomous variable (\u3c 50% vs \u3e = 50%). Patients\u27 demographics, pathologic, and treatment characteristics were analyzed using univariate and multivariate analysis to calculate recurrence-free (RFS) and disease-specific (DSS) rates. Results: The median age for the study cohort was 65 years (range, 34–96), and the median follow-up was 131 months (range, 9–334). A total of 90 patients (77%) had lymph node dissection, with a median of 8 examined lymph nodes (range 0-18). Adjuvant radiation therapy (RT) with pelvic or vaginal cuff HDR brachytherapy, or a combination of the two, was completed in 92 patients (79 percent). The median % CSI was 27% (range, 1-100) with 68% of patients having ≥ 50% CSI. While there was a trend for a worse 5-year RFS and DSS for women with ≥ 50% CSI (69% vs. 83%, p = 0.093) and (78% vs. 91%, p = 0.034), respectively, the depth of CSI was not statistically significant as an independent predictor of 5-year RFS, DSS, or OS. The depth of CSI was not associated with a difference in the recurrence pattern (vaginal cuff, pelvic, paraaortic, or distant). In multivariate analysis, FIGO grade was the only predictor of 5-year OS. FIGO grade and the presence of lympho-vascular space invasion (LVSI) were independent predictors of 5-year RFS and DSS. Conclusion: Deep cervical stromal invasion does not appear to be an independent predictive factor for survival endpoints in women with stage II uterine endometroid cancer, according to our findings. The presence of LVSI and tumor grade were both independent predictors of recurrence-free and disease-specific survival. Pooled data analysis may be needed to validate our study findings

Recurrence Risk Stratification for Women with FIGO Stage I Uterine Endometrioid Carcinoma Who Underwent Surgical Lymph Node Evaluation

Purpose/Objective(s): To estimate the recurrence risk based on the number of prognostic factors in women with FIGO stage I uterine endometrioid carcinoma (EC) in a large cohort of patients who underwent surgical staging including surgical lymph node evaluation (SLNE) and were managed with no adjuvant therapy. Materials/Methods: We queried our in-house prospectively maintained uterine cancer database for patients with FIGO stage I EC underwent surgical staging including SLNE between 1/1990-12/2020. Patients with synchronous ovarian and breast cancer diagnosis were excluded as well as those who received adjuvant therapy of any form. Patient\u27s demographics and pathologic variables were analyzed. We used multivariate analysis (MVA) with Stepwise Model Selection to determine risk factors for 5-year recurrence-free survival (RFS). Study population was then stratified based on the number of risk factors identified (0, 1 or 2). The resultant groups were compared for RFS, disease-specific survival (DSS) and overall survival (OS) using log-rank test and Kaplan-Meier curves. Additionally, independent predictors of DSS and overall OS were estimated. Results: 706 patients were identified who met our inclusion criteria with a median age of 60 years (range, 30-93) and a median follow-up of 120 months. All patients had at least pelvic SLNE with a median number of examined lymph node (LN) of 8 (range, 1-66): 66 patients (11%) had a sentinel LN sampling and 43% had paraaortic SLNE. 639 patients (91%) were stage IA and lymphovascular space invasion (LVSI) was detected in 6% (n=41). Recurrence was diagnosed in 44 patients (6%). Independent predictors of 5-year RFS include age ≥ 60 years (p=0.038), grade 2 vs. 1 (p=0.003), and grade 3 vs 1 (p\u3c0.001). 5-year RFS for group-0 (age \u3c 60 years and grade 1) was 98% vs. 92% for group-1 (either: age ≥ 60 years or grade 2/3) vs 84% for group-2 (both: age ≥ 60 years and grade 2/3), respectively (p\u3c0.001). 5- year DSS for the three groups was (100% vs 98% vs 95%, p=0.012) and 5-year OS was (98% vs 90% vs 81%, p\u3c0.001), respectively. On MVA, stage IB vs IA was deterministic for DSS (p=0.02); whereas age ≥ 60 years (p\u3c0.001) and grade 3 vs grade 1 (p=0.004) were predictors for worse OS. Conclusion: In patients with stage I endometrioid carcinoma who had surgical staging including SLNE and no adjuvant therapy, only age ≥ 60 years and high tumor grade were independent predictors of cancer recurrence and hence can be used to quantify individualized recurrence risk. Surprisingly, LVSI was not an independent prognostic factor in this study cohort with SLNE

Survival Outcomes and Patterns of Recurrence After Adjuvant Vaginal Cuff Brachytherapy and Chemotherapy in Early-Stage Uterine Serous Carcinoma

Background: Uterine serous carcinoma (USC) is a relatively rare histology that portends a poor prognosis. The optimal adjuvant therapy for early-stage USC remains controversial; however, adjuvant vaginal cuff brachytherapy (VB) and chemotherapy is a commonly utilized strategy. Objectives: We sought to characterize predictors of survival endpoints and determine recurrence patterns in women with early-stage USC who received adjuvant VB and chemotherapy. Methods: We queried our prospectively maintained database for patients with 2009 FIGO stages I-II USC who underwent adequate surgical staging at our institution and received adjuvant chemotherapy with carboplatin and paclitaxel along with VB. We excluded women with synchronous malignancies. Overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) were assessed by Kaplan-Meier and log-rank tests. Univariate (UVA) and multivariate analyses (MVA) were performed to identify statistically significant predictors of survival endpoints. Variables with P\u3c0.1 on UVA were included in a MVA and any variable with P\u3c0.05 was considered statistically significant. Results: We identified 77 women who met our inclusion criteria who underwent surgical staging between 1991 and 2018. The median follow-up time was 36 months (range 6-125). The median age was 66 years. Of the cohort, 70% were FIGO stage IA, 17% were stage IB, and 13% were stage II. The median number of dissected lymph nodes (LN) was 22. There were 10 women (13%) diagnosed with a recurrence with a median time to recurrence of 12.0 months. The main site of initial recurrence was distant in seven patients (70%) with the remaining recurrences being pelvic/para-aortic. The 5-year RFS for patients who experienced a distant recurrence was 87% (95% Confidence Interval [CI] 0.75-0.94). For the entire cohort, 5-year OS, DSS, and RFS were 83% (95% CI 0.68-0.91), 92% (95% CI 0.78-0.97), and 83% (95% CI 0.71-0.91), respectively. The sole predictor of 5-year OS on UVA was receipt of omentectomy (P=0.09). The predictors of 5-year DSS on UVA were presence of positive peritoneal cytology (P=0.03), number of LN examined (Hazard Ratio [HR] 1.10, 95% CI 1.00-1.21, P=0.05), and number of para-aortic LN examined (HR 1.16 [95% CI 1.01-1.32], P=0.03). The sole independent predictor of DSS was the presence of positive peritoneal cytology (HR 0.03 [95% CI 0.00-0.72], P=0.03). Predictors of five-year RFS on UVA were robotic vs open surgery technique (P=0.06), presence of positive peritoneal cytology (P=0.01), percent myometrial invasion (HR 5.59 [95% CI 0.84-37.46], P=0.08), and presence of lymphovascular space invasion (LVSI) (P=0.05). Conclusions: Five-year survival outcomes were promising in this cohort of women with early-stage USC treated with adjuvant chemotherapy and VB; however, this study shows that the predominant pattern of relapse in this population is distant, suggesting the need to optimize systemic therapy. Possible predictors of worse outcomes include positive peritoneal cytology, deep myometrial invasion, and presence of LVSI. Multi-institutional pooled analyses are warranted to confirm our study results

Volumetric and Voxel-Wise Analysis of Dominant Intraprostatic Lesions on Multiparametric MRI

Introduction: Multiparametric MR imaging (mpMRI) has shown promising results in the diagnosis and localization of prostate cancer. Furthermore, mpMRI may play an important role in identifying the dominant intraprostatic lesion (DIL) for radiotherapy boost. We sought to investigate the level of correlation between dominant tumor foci contoured on various mpMRI sequences. Methods: mpMRI data from 90 patients with MR-guided biopsy-proven prostate cancer were obtained from the SPIE-AAPM-NCI Prostate MR Classification Challenge. Each case consisted of T2-weighted (T2W), apparent diffusion coefficient (ADC), and K(trans) images computed from dynamic contrast-enhanced sequences. All image sets were rigidly co-registered, and the dominant tumor foci were identified and contoured for each MRI sequence. Hausdorff distance (HD), mean distance to agreement (MDA), and Dice and Jaccard coefficients were calculated between the contours for each pair of MRI sequences (i.e., T2 vs. ADC, T2 vs. K(trans), and ADC vs. K(trans)). The voxel wise spearman correlation was also obtained between these image pairs. Results: The DILs were located in the anterior fibromuscular stroma, central zone, peripheral zone, and transition zone in 35.2, 5.6, 32.4, and 25.4% of patients, respectively. Gleason grade groups 1-5 represented 29.6, 40.8, 15.5, and 14.1% of the study population, respectively (with group grades 4 and 5 analyzed together). The mean contour volumes for the T2W images, and the ADC and K(trans) maps were 2.14 +/- 2.1, 2.22 +/- 2.2, and 1.84 +/- 1.5 mL, respectively. K(trans) values were indistinguishable between cancerous regions and the rest of prostatic regions for 19 patients. The Dice coefficient and Jaccard index were 0.74 +/- 0.13, 0.60 +/- 0.15 for T2W-ADC and 0.61 +/- 0.16, 0.46 +/- 0.16 for T2W-K(trans). The voxel-based Spearman correlations were 0.20 +/- 0.20 for T2W-ADC and 0.13 +/- 0.25 for T2W-K(trans). Conclusions: The DIL contoured on T2W images had a high level of agreement with those contoured on ADC maps, but there was little to no quantitative correlation of these results with tumor location and Gleason grade group. Technical hurdles are yet to be solved for precision radiotherapy to target the DILs based on physiological imaging. A Boolean sum volume (BSV) incorporating all available MR sequences may be reasonable in delineating the DIL boost volume

Vaginal Recurrence More than 17 Years after Hysterectomy and Adjuvant Treatment for Uterine Carcinoma with Successful Salvage Brachytherapy: A Case Report

Purpose: Although the majority of recurrences occur within the first 3 years of hysterectomy for endometrioid carcinoma, we report herein a successful salvage vaginal brachytherapy in a patient with endometrioid uterine carcinoma which recurred more than 17 years after initial treatment. Materials and Methods: A 61-year-old female was diagnosed with endometrioid adenocarcinoma of the uterus and treated with TAH-BSO, followed by adjuvant external beam radiation therapy (EBRT) to the whole pelvis. After remaining free of any recurrent or metastatic disease for more than 17 years, she was diagnosed with isolated vaginal cuff recurrence and successfully treated with a salvage high-dose-rate intracavitary vaginal brachytherapy. Results: The patient remained disease free until her death from unrelated causes 7 years later. Conclusion: To the best of our knowledge, this case represents the longest time to recurrence of endometrial cancer in someone who had been treated with TAH-BSO and adjuvant pelvic EBRT. This case highlights that even with adjuvant therapy, late recurrences may occur, and successful salvage brachytherapy is very effective

Efficient P2P data dissemination in integrated optical and wireless networks with Taguchi method

The Quality of Service (QoS) resource consumption is always the tricky problem and also the on-going issue in the access network of mobile wireless part because of its dynamic nature of network wireless transmissions. It is very critical for the infrastructure-less wireless mobile ad hoc network that is distributed while interconnects in a peer-to-peer manner. Toward resolve the problem, Taguchi method optimization of mobile ad hoc routing (AODVUU) is applied in integrated optical and wireless networks called the adLMMHOWAN. Practically, this technique was carry out using OMNeT++ software by building a simulation based optimization through design of experiment. Its QoS network performance is examined based on packet delivery ratio (PDR) metric and packet loss probabilities (PLP) metric that consider the scenario of variation number of nodes. During the performing stage with random mobile connectivity based on improvement in optimized front-end wireless domain of AODVUU routing, the result is performing better when compared with previous study called the oRia scheme with the improvement of 14.1% PDR and 43.3% PLP in this convergence of heterogeneous optical wireless network

The Prognostic Impact of Time Interval Between Hysterectomy and Initiation of Adjuvant Radiation Treatment in Women With Early-Stage Endometrial Carcinoma

Purpose/Objective(s): Adjuvant radiation therapy (ART) is indicated for women with endometrial carcinoma (EC) who are at high risk for recurrence. However, due to various reasons, some patients do not receive ART in a timely manner. In this study, we evaluated the prognostic impact of the time interval (TI) between hysterectomy and starting date of ART. Materials/Methods: After institutional review board approval, we queried our prospectively-maintained institutional database for women with uterine endometrioid EC of 2009 FIGO stages I-II who received ART without chemotherapy after surgical staging. The patients were classified into two groups, based on whether they received ART ≤8 weeks (group A) or \u3e8 weeks (group B) after hysterectomy. We then compared the two groups with regards to the following survival endpoints: recurrence-free survival (RFS), disease-specific survival (DSS) and overall survival (OS). Univariate and multivariate analyses were also performed. Results: A total of 460 patients were identified. Median follow-up duration was 70.5 months. The median age for the entire cohort was 66.0 years. The cohort consisted of 176 patients with FIGO stage IA (38%), 207 (45%) with stage IB and 77 (17%) with stage II. Group A consisted of 354 (77%) patients, and group B had 106 (23%). The median TIs from hysterectomy to ART were 6 weeks and 10 weeks for groups A and B, respectively. There was no statistically significant difference between the groups in terms of baseline demographic and disease characteristics including age, race, grade, FIGO stage, extent of myometrial invasion, presence of lymphovascular space invasion and radiation treatment modality. A total of 52 patients experienced recurrences. Patients in group A (vs. group B) experienced significantly less recurrences overall (9% vs. 18%; p = 0.01). Rate of vaginal recurrence was significantly lower in group A (9% vs. 42%, p = 0.01). Univariate analysis showed that having RT ≤8 weeks was associated with significantly improved 5-year RFS rate, which was 89% and 80% for groups A and B (p = 0.04), respectively. The rates of 5-year OS (86% vs. 85% for groups A and B, respectively) and 5-year DSS (93% vs. 93% for groups A and B, respectively) were similar. In addition, multivariate analysis showed a statistical trend for improved 5-year RFS when receiving RT ≤8 weeks (p = 0.07). Conclusion: Our study suggests that delaying adjuvant radiation treatment beyond 8 weeks post-hysterectomy is associated with significantly more cancer recurrences for women with early-stage endometrial cancer

Segmentation of the Prostatic Gland and the Intraprostatic Lesions on Multiparametic Magnetic Resonance Imaging Using Mask Region-Based Convolutional Neural Networks

Purpose: Accurate delineation of the prostate gland and intraprostatic lesions (ILs) is essential for prostate cancer dose-escalated radiation therapy. The aim of this study was to develop a sophisticated deep neural network approach to magnetic resonance image analysis that will help IL detection and delineation for clinicians. Methods and Materials: We trained and evaluated mask region-based convolutional neural networks to perform the prostate gland and IL segmentation. There were 2 cohorts in this study: 78 public patients (cohort 1) and 42 private patients from our institution (cohort 2). Prostate gland segmentation was performed using T2-weighted images (T2WIs), although IL segmentation was performed using T2WIs and coregistered apparent diffusion coefficient maps with prostate patches cropped out. The IL segmentation model was extended to select 5 highly suspicious volumetric lesions within the entire prostate. Results: The mask region-based convolutional neural networks model was able to segment the prostate with dice similarity coefficient (DSC) of 0.88 ± 0.04, 0.86 ± 0.04, and 0.82 ± 0.05; sensitivity (Sens.) of 0.93, 0.95, and 0.95; and specificity (Spec.) of 0.98, 0.85, and 0.90. However, ILs were segmented with DSC of 0.62 ± 0.17, 0.59 ± 0.14, and 0.38 ± 0.19; Sens. of 0.55 ± 0.30, 0.63 ± 0.28, and 0.22 ± 0.24; and Spec. of 0.974 ± 0.010, 0.964 ± 0.015, and 0.972 ± 0.015 in public validation/public testing/private testing patients when trained with patients from cohort 1 only. When trained with patients from both cohorts, the values were as follows: DSC of 0.64 ± 0.11, 0.56 ± 0.15, and 0.46 ± 0.15; Sens. of 0.57 ± 0.23, 0.50 ± 0.28, and 0.33 ± 0.17; and Spec. of 0.980 ± 0.009, 0.969 ± 0.016, and 0.977 ± 0.013. Conclusions: Our research framework is able to perform as an end-to-end system that automatically segmented the prostate gland and identified and delineated highly suspicious ILs within the entire prostate. Therefore, this system demonstrated the potential for assisting the clinicians in tumor delineation

Prediction of signal attenuation due to duststorms using mie scattering

The present trend in radio design calls for the use of frequencies above 40 GHz for short links carrying wide-band digital communication signals. In order to utilize the new frequency band efficiently, signal attenuation studies due to duststorms is needed urgently for desert areas. This paper presents a mathematical model which has been developed to predict the signal attenuation due to duststorm. The proposed model enables the convenient calculation of the signal path attenuation based on Mie solution of Maxwell's equations for the scattering of electromagnetic wave by dust particles. The predicted values from the proposed mathematical model are compared with the measured values observed in Saudi Arabia and Sudan and show relatively close agreement

Air born dust particles effects on microwave propagation in arid-area

Dust storms can degrade visibility and increase atmospheric attenuation. Therefore, microwave (MW) propagation is severely affected by dust storms in many parts of the world. Air-born dust particles may affect electromagnetic waves during a dust storm. In this paper air- born dust particles effects are studied based on measured visibility. Recent analytical and numerical models results are compared to the measured at 14 GHz. Consequently, measured attenuation is significantly greater than the predicted using recent analytical and numerical models. Dust storms can degrade visibility and increase atmospheric attenuation. Therefore, microwave (MW) propagation is severely affected by dust storms in many parts of the world. Air-born dust particles may affect electromagnetic waves during a dust storm. In this paper air- born dust particles effects are studied based on measured visibility. Recent analytical and numerical models results are compared to the measured at 14 GHz. Consequently, measured attenuation is significantly greater than the predicted using recent analytical and numerical models