A matched study of surgically treated stage IB adenosquamous carcinoma and adenocarcinoma of the uterine cervix

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72055/1/j.1525-1438.1993.03040245.x.pd

Identification of prognostic factors and risk groups in patients found to have nodal metastasis at the time of radical hysterectomy for early-stage squamous carcinoma of the cervix

In a retrospective study conducted at the University of Alabama at Birmingham, the University of Michigan, and the Mayo Clinic, 185 patients with previously untreated FIGO stage IB and IIA squamous cell carcinoma of the cervix were found to have nodal metastasis at the time of radical hysterectomy and pelvic lymphadenectomy. Of these patients, 103 received adjuvant pelvic irradiation. Cancer recurred in 76 patients; the median time to recurrence was 3.1 years. The prognostic significance of patient age, clinical stage, lesion diameter, number and location of nodal metastases, and use of adjuvant radiation therapy was determined by multivariate analysis. Only patient age (P = 0.0006), lesion diameter (P P = 0.0004) were noted to be significant factors in determining overall survival. Rates of recurrence were also related to these factors. Employment of these significant variables led to identification of four risk groups. In general, patients with small cervical lesions (diameter 4 cm) and more than two involved nodes fell into the high-risk category. All other patients were categorized into intermediate-risk groups. Ten-year survival was 92% in the low-risk group (n = 13), 70% in the low-intermediate-risk group (n = 66), 56% in the high-intermediate-risk group (n = 66), and 13% in the high-risk group (n = 20). This risk group classification identifies subgroups of early-stage cervical carcinoma patients found to have nodal metastasis at the time of radical hysterectomy that warrant appropriately selected adjuvant therapy.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/27695/1/0000081.pd

Endometrial stromal sarcoma: treatment and patterns of recurrence.

Our objective was to investigate recurrence patterns and conduct an outcome analysis of patients with endometrial stromal sarcoma (ESS).A retrospective review yielded 30 patients with ESS (20 low-grade, 10 high-grade) who underwent primary surgical resection from 1982 to 2005. Median follow-up was 42 months.All patients underwent hysterectomy, whereas pelvic (P) and paraaortic (PA) lymphadenectomy were performed in 12 and 7 patients, respectively. A median of 26 pelvic lymph nodes and 9 PA lymph nodes were removed. Pelvic or PA lymphatic disease was noted in 25% and 29% of patients, respectively. Extrauterine disease was identified in 11 (45%) of 24 patients undergoing exploratory laparotomy; 6 had no residual disease after cytoreductive surgery. None of these 6 patients experienced abdominal failure, but 1 had a hematological recurrence. Thrombotic complications were noted in 13% of patients. The 5-year overall survival was 65%. Overall survival was influenced by grade (79% vs 40%, P = 0.03) and extrauterine disease (77% vs 32%, P = 0.01). No patient who underwent a systematic lymphadenectomy had a lymphatic recurrence, irrespective of nodal status. There were 7 (23%) hematological recurrences; 2 in surgical stage I ESS. Two patients with low-grade ESS remain without evidence of disease 130 and 210 months after secondary cytoreduction. In contrast, no patient with high-grade ESS survived a recurrence.There is high prevalence of extrauterine and nodal disease in ESS. Patients are at high risk for thrombotic complications. If aggressively staged, the predominant failure risk for stage I patients is hematogenous, suggesting the need for improved systemic treatments

Pancreaticoduodenectomy in optimal primary cytoreduction of epithelial ovarian cancer: A case report and review of the literature

• Aggressive multi-organ resection of epithelial ovarian cancer (EOC) at the time of primary cytoreduction improves patient survival. • We describe pancreaticoduodenectomy (Whipple procedure) as an efficacious tool for optimal cytoreduction in bulky upper abdominal EOC

Role of cytoreduction in stage III and IV uterine papillary serous carcinoma.

OBJECTIVE: Uterine papillary serous carcinoma (UPSC) frequently presents in advanced stages. The aim of this study was to assess the role of cytoreduction in stage IIIC-IV UPSC. METHODS: Retrospective review was conducted of UPSC from 1982 through 2005. Surgical treatment consisted of hysterectomy, removal of adnexae, and pelvic and paraaortic lymphadenectomy, with or without tumor cytoreduction. Median follow-up was 21 months. RESULTS: Of the 125 UPSC patients, analysis of stage IIIC-IV patients (n=70; stage IIIC 12, stage IV 58) was performed. Optimal cytoreduction was achieved in 42 of 70 (60%) patients, and optimal cytoreduction with no visible residual disease in 26 of 70 (37%) patients. Patients with no visible residual disease after cytoreduction had a better median survival (51 months) compared to optimally cytoreduced albeit with residual disease (14 months), and suboptimally cytoreduced patients (12 months) (p-value=0.002). Of the 45 patients who received CT, the median survival of patients with no residual disease vs. patients with residual disease was 52 months vs. 16 months (p DISCUSSION: Cytoreduction to no gross residual disease and the use of CT are associated with a significant survival benefit for patients with stage IIIC-IV UPSC. This effect persisted even in patients who underwent radical resections

Role of systematic lymphadenectomy and adjuvant therapy in stage I uterine papillary serous carcinoma.

OBJECTIVE: To assess surgical staging with systematic lymphadenectomy (LND) and adjuvant therapy in patients with stage I uterine papillary serous carcinoma (UPSC). METHODS: A single-institution, retrospective review was conducted of all surgically treated patients with primary UPSC between 1982 and 2005. RESULTS: 42 patients (IA=15, IB=21, IC=6) were stage I. 81% (n=34) underwent LND (median 40 nodes), 69% omentectomy, and 45% peritoneal biopsies. Median follow-up was 39 months. The 5-year overall survival (OS) and progression free survival (PFS) rates were 85% and 78%. The substage 5-year OS was: IA 100%, IB 89%, IC 60%. No lymphatic recurrences (LR) were observed in 34 patients who had LND compared to 1 LR in 8 who did not undergo LND (p=NS). No recurrences were detected among the 15 patients with stage IA UPSC, irrespective of post-operative therapy. None of the 20 IB and IC patients who received radiation therapy (RT) had vaginal recurrences (VR) compared to 2 of the 7 (29%) who did not receive RT (p=0.02). A systematic LND (\u3e20 lymph nodes) was performed in 19 stage IB and IC patients. No hematological or peritoneal recurrence (HPR) was detected in the 6 patients who received chemotherapy. In contrast, HPR were observed in 3 (23%) of 13 patients who did not receive chemotherapy. DISCUSSION: Observation is an option for patients with stage IA UPSC confirmed by systematic LND. Patients with comprehensively staged IB and IC UPSC are candidates for chemotherapy and vaginal brachytherapy to prevent HPR and VR

Clear cell carcinoma of the cervix: a multi-institutional review in the post-DES era.

OBJECTIVE: To conduct an outcome analysis of patients with cervical clear cell carcinoma (CCCC) in the post-DES era. METHODS: A retrospective review was conducted at 3 major gynecologic cancer centers of all primary CCCC between 1982 and 2004. RESULTS: CCCC was confirmed in 34 patients. Median age was 53 years. DES exposure was confirmed in 2 (6%) patients. A history of smoking was elicited in 22%, and of abnormal Pap smear 18% patients. Primary surgical resection was performed in all stage I or IIA patients (n=26); they displayed superior 3-year overall survival (OS) compared to advanced stage (n=8) patients (91% vs. 22%, p DISCUSSION: This series provides insight into the management of early stage CCCC in the post-DES era. Although these patients may be at slightly higher risk of nodal spread, clear cell histology by itself does not appear to portend a worse prognosis than squamous cell carcinoma of the cervix in the absence of traditional risk factors. Our data suggest that patients with low risk early stage CCCC may be managed with radical surgery alone, without the need for adjuvant chemotherapy or radiation