Postoperative radiotherapy improves local control and survival in patients with uterine leiomyosarcoma

Abstract Background To examine the role of radiotherapy (RT) in uterine leiomyosarcomas (LMS) and to determine the patient population who may benefit from RT. Methods From 1998–2008, 69 patients with primary uterine LMS underwent hysterectomy with or without pelvic radiotherapy to a median dose of 45 Gy. Univariate analysis was performed using the Kaplan-Meier method and cumulative-incidence function, and multivariate analyses using Fine and Gray or Cox proportional hazard models. Results Following surgery, 32 out of 69 patients received RT. There was no evidence of any correlation between patient, disease and treatment characteristics and the use of RT. Median follow-up was 57 months. RT was associated with reduced local recurrence (3y LR 19% vs. 39%; Gray’s p = 0.019) and improved overall survival (3y OS 69% vs. 35%; log-rank p = 0.025) on univariate analysis. Multivariate analysis demonstrated that RT reduced LR (HR: 0.28, CI: 0.11-0.69, p = 0.006) and increased OS (HR: 0.44, CI: 0.23-0.85, p = 0.014) independent of other clinical and pathologic factors. Positive surgical margins increased the odds of LR (HR: 5.6, CI: 2.3-13.4, p = 0.00012). Large tumor size and advanced stage (II-IV) were associated with the development of distant metastases and inferior OS. Conclusions Postoperative pelvic RT reduces LR and improves OS of patients with uterine LMS

First reported case of Robinsoniella peoriensis Pyometra and Bloodstream infection: A case report and review of the literature

We report on a 47-year-old woman with jejunal adenocarcinoma and concurrent endometrial cancer, admitted with sepsis. Uterine fluid and blood cultures were positive for Robinsoniella peoriensis. This is the first case report of Robinsoniella peoriensis in Canada. We encourage clinicians to publish their experience treating gynecologic infections caused by Robinsoniella peoriensis. Failure to recognize this pathogen as causative for pyometra, may result in insufficient antimicrobial treatment, and death. Robinsoniella peoriensis, a gram-positive, spore-forming, anaerobic bacillus was originally recovered from swine manure storage pits and classified as a novel species in 2009. It is in from the phylum Firmicutes within the family Lachnospiraceae. The organism produces small, nonhemolytic colonies (0.5–1.5 mm) fermenting glucose, lactose, and maltose without nitrate reduction or indole production. Previously, this organism has been implicated in wound infections, bacteremia, and endocarditis. Herein we report a case of pyometra, and bacteremia caused by Robinsoniella peoriensis in a 47-year-old woman with concurrent small bowel and uterine cancer. We aim to perform a literature review of case reports and case series of human infection with Robinsoniella peoriensis. The following databases will be searched for MeSH terms and keywords related to Robinsoniella peoriensis on: Ovid MEDLINE, Ovid- EMBASE, PubMed (non-MEDLINE records only), Cochrane Central Register of Control Trials and Cochrane Database of Systematic Reviews. Our search strategy also included Google Scholar to identify any grey literature not published in traditional databases. No limits will be placed on the search results. Results will be managed using Endnote citation management software and screened using Covidence. We will include case reports and case series on Robinsoniella peoriensis infection in humans