High-dose epirubicin in patients with advanced or recurrent uterine sarcoma

Twenty patients with advanced or recurrent uterine sarcoma who had not received prior chemotherapy, were treated with epirubicin 120 mg m⁻² intravenously every 3 weeks. Four patients (20%) achieved complete response (pathologically confirmed in three cases) and three (15%) achieved partial response. The overall response rate was 35% (95% CI: 15–59). no response was observed for pelvic lesions in previously irradiated areas. Three patients (15%) exhibited stable disease, while 10 (50%) had progressive disease. The median number of courses was six in responders and two in non-responders. The median survival was 48 months (range 19–50+ months) in responders and 6 months (range 2–18 months) in non-responders. Adverse effects consisted primarily of myelosuppression, nausea and vomiting. No patients experienced life-threatening toxicity. High-dose epirubicin appears to be active in patients with advanced or recurrent uterine sarcoma.     

介入治疗83例剖宫产瘢痕部妊娠临床效果分析

目的:评价介入治疗对剖宫产瘢痕部妊娠的临床效果。方法:回顾性分析83例因剖宫产子宫瘢痕部妊娠(CSP)行双侧子宫动脉化疗栓塞术介入治疗(UAE治疗)的临床效果。结果:①83例CSP患者术前B超诊断:早孕胚胎继续发育型52例;早孕胚胎停止发育型27例;流产出血型4例。经UAE后,79例在术后24~48 h行刮宫术,妊娠终止,术后1~2个月转经。3例继续妊娠,改用其他方法治疗;1例流产不全后子宫大出血,改行开腹手术。②术前胚胎继续发育型者52例,经UAE治疗后48 h复查B超,胎心消失49例,胚胎灭活率为94.23%,3例仍然存活,占5.77%;胚胎早期停止发育型和流产出血型共31例全部妊娠终止。结论:UAE治疗是治疗CSP可靠、有效的方法,但对胚胎继续发育型的CSP有治疗失败的风险。     

CA 125 in serum and tumor from patients with uterine sarcoma

Serial serum samples of 33 patients with primary sarcoma of the uterus were analyzed for CA 125 and frozen tissue sections of tumor from 23 patients were tested for this antigen. Before treatment, 12 of 30 evaluable patients showed serum CA 125 levels> 16 Uml⁻¹ (40%). There was no relationship between serum CA 125 level and the histologic subtype. Patients with serum CA 125> 16 Uml⁻¹ showed extrauterine tumor sites in 67% of the cases versus 33% in patients with normal CA 125 determinations ( P = 0.026). In (FIGO) stages I and II, elevated serum CA 125 levels prior to surgery were associated with a poor prognosis ( P = 0.043). Patients with recurrent or progressive disease demonstrated serum CA 125 levels> 16 Uml⁻¹ in 14 of the 20 cases (70%). Sarcoma cells were completely negative for CA 125, whereas positivity was observed in the epithelial component of mixed Müllerian tumors. The source of the elevated serum CA 125 levels in patients with uterine sarcoma may be stimulated mesothelial cells.     

Induction of labor: Comparison of a cohort with uterine scar from previous cesarean section vs. a cohort with intact uterus

Objective. To compare the risk of uterine rupture between a cohort of women with previous low-transverse cesarean section (CS) and a cohort with intact uterus.

Methods. All women with a singleton pregnancy and previous low-transverse CS requiring induction of labor from January 1, 1992 to December 30, 2001 (n = 310) were compared with a cohort of women with intact uterus undergoing induction of labor during the same study period (n = 5420). Protocols of induction using prostaglandin E₂ gel and oxytocin infusion were consistent within groups, but differed between the previous CS and the intact uterus group.

Results. Uterine rupture occurred in 0.3% in the previous CS group vs. 0.03% in the intact uterus group (p = 0.37). Logistic regression analysis showed no significant difference in rate of uterine rupture between the previous CS vs. intact uterus group (p = 0.16) after controlling for maternal age, parity, gestational age at delivery, Bishop score on admission, use of prostaglandin and oxytocin, and birth weight. Our study had adequate power to detect a 0.38% difference in rate of uterine rupture between the two groups (α = 0.05, β = 0.80).

Conclusion. Induction of labor is not associated with significantly higher rates of uterine rupture among women with previous low-transverse CS compared with women with intact uterus provided a consistent protocol with strict intervention criteria is adopted.     

Second primary malignancies among women with uterine sarcoma

Objective

Uterine sarcomas (US) are rare malignancies with unclear aetiology. Studies on uterine sarcomas in the setting of second primary malignant tumours can provide clues to aetiology and identify side effects of different treatments.

Methods

A cohort of 8606 cases of US was extracted from the data from 13 cancer registries and followed for second primary cancers within the period 1943-2000. Standardized incidence ratios (SIRs) were calculated, and Poisson regression analyses were performed.

Results

There were 499 cancer cases observed after a first diagnosis of US (SIR 1.26, 95%CI 1.16-1.38). SIRs were elevated for cancers of the mouth and pharynx (2.16, 95%CI 1.15-3.69), colorectum (1.60, 95%CI 1.28-1.98), lung (1.73, 95%CI 1.27-2.29), breast (1.25, 95%CI 1.05-1.49), urinary bladder (1.74, 95%CI 1.02-2.79), kidney (2.00, 95%CI 1. 24-3.06), thyroid gland (2.74, 95%CI 1.42-4.79), and soft tissue sarcoma (5.23, 95%CI 2.51-9.62). The risk of breast cancer increased along with increasing age of US diagnosis (p trend 0.040). The risk of kidney cancer increased along with decreasing age of US diagnosis (p trend 0.004) and short time since the US diagnosis (p trend 0.018).

Conclusions

Our study demonstrated increased risk of certain cancers following a diagnosis of US. The elevated risk for breast cancer may indicate shared hormonal aetiology, while the increased risk of colorectal and bladder cancers after US may be caused by radiation therapy of US. The clustering of smoking-related cancers after US is worth exploring in the future.     

Placenta percreta with subsequent uterine rupture at 15 weeks of gestation after two previous cesarean sections

A 25-year-old gravida 3 para 2 woman was referred to our hospital at 15 weeks' gestation with an acute abdomen and free fluid in the peritoneal cavity. On admission she was somnolent. She had a history of two cesarean sections. Fetal cardiac activity was detectable by ultrasound preoperatively. Intraoperatively, a lower uterine-segment rupture was identified in the area of the presumed prior uterine incision. The great blood loss with consecutive coagulopathy required an emergency hysterectomy and multiple blood transfusions. The placenta was located on the lower anterior uterine wall. Intervening decidual cells between placenta and maternal scar tissue were absent in the area of the prior uterine incision. Placental villous tissue deeply invaded and perforated the scar tissue. Histological examination revealed a placenta percreta. Placenta percreta with subsequent uterine rupture is a rare but dramatic complication after previous cesarean section. This should be kept in mind as the rate of elective cesarean sections is rising continuously. Our patient recovered completely.     

Adjuvant chemotherapy with cisplatin, ifosfamide, and doxorubicin followed by radiotherapy in localized uterine sarcomas: results of a case-control study with radiotherapy alone

Uterine sarcoma is a poor prognosis disease, with a high risk of metastatic relapse. We conducted a study of adjuvant chemotherapy with cisplatin, ifosfamide, and doxorubicin followed by radiotherapy (n=18). The results were then compared in a matched case-controlled study to radiotherapy alone (n=16) or no therapy at all (n=2). Chemotherapy consisted in three cycles of adriamyein-platinum-ifosfamide (API) (doxorubicin 60 mg /m2 on day 1; cisplatin 100 mg /m2 on day 2; ifosfamide 5 g /m2 on day 1+mesna 5 g /m2 on day 1+granulocyte colony-stimulating factor; q 3 weeks). Drug doses were reduced (20% for ifosfamide and cisplatin) four times (four patients) due to hematologic toxicity. Compared to a case-control study of adjuvant radiotherapy alone, results were not decreased by the addition of a toxic chemotherapy. CONCLUSION: Adjuvant API chemotherapy followed by radiotherapy is a feasible protocol; a multicenter phase III study comparing radiotherapy alone versus API chemotherapy followed by radiotherapy just began in France.     

Phase II study of mitomycin,doxorubicin, and cisplatin in the treatment of advanced uterine leiomyosarcoma: a Gynecologic Oncology Group study

OBJECTIVE: Because of preliminary observations favoring the use of mitomycin, doxorubicin, and cisplatin (MAP) chemotherapy in leiomyosarcomas, the Gynecologic Oncology Group (GOG) decided to conduct a phase II clinical trial of this combination regimen in patients with advanced disease. METHODS: Patients with histologically confirmed uterine leiomyosarcoma who had not previously received cytotoxic drugs were considered for participation in this clinical trial. Eligible patients had measurable disease, GOG performance status 0-2, and adequate bone marrow, renal, and hepatic function according to standard criteria. Mitomycin 8 mg/m(2) and doxorubicin 40 mg/m(2) were each given by iv injection followed immediately by cisplatin 60 mg/m(2) in 1 liter of 0.45% saline plus mannitol 25 g. Patients who remained free from tumor progression or intolerable toxicity received at least three, to a maximum of six, cycles of MAP. RESULTS: Forty-one patients were registered, of whom 4 were determined ineligible (wrong cell type, 2; wrong site of origin, 1; inadequate pathology material, 1). Thirty-five of the 37 were evaluable for response after receiving from one to six (median three) cycles of MAP. Three patients (9%) achieved a complete response and 5 (14%) exhibited a partial response. The most common adverse effects were leukopenia (33 patients) and thrombocytopenia (30 patients). Pulmonary toxicity was seen in 10 patients and was a factor in the clinical deterioration and death of 2. CONCLUSION: MAP is active against advanced uterine leiomyosarcomas, but not remarkably so. Despite its low therapeutic index, this novel, possibly interactive, combination may serve as a forerunner to regimens that more efficiently exploit the enhancement of sarcoma cell kill under hypoxic conditions.     

2D versus 3D transabdominal sonography for the measurement of lower uterine segment thickness in women with previous cesarean delivery

Objective

To evaluate the intermethod reliability of using 3D versus 2D transabdominal sonography in the measurement of lower uterine segment (LUS) thickness in women with previous cesarean delivery, in addition to determining the interobserver reliability of 2D and 3D transabdominal sonography in LUS measurement.

Methods

Between February and July 2010 at Queen Mary Hospital, Hong Kong, 40 pregnant women with a history of previous cesarean delivery at 36-39 weeks of pregnancy underwent LUS measurement via 2D and 3D transabdominal sonography by 2 observers. The 3D examination was performed on the multiplanar display of the longitudinally acquired LUS volume. Inner myometrial thickness (MT) and full thickness (FT) were measured at the thinnest portion and perpendicular to the contour of the LUS.

Results

The 2D and 3D LUS measurements obtained by the 2 observers were comparable (intraclass correlation coefficient [ICC]: MT, 0.81 and 0.98, respectively; FT, 0.76 and 0.98, respectively). For transabdominal LUS measurement, 2D MT provided the best interobserver reliability (ICC: 2D MT, 0.95; 2D FT, 0.91; 3D MT, 0.82; 3D FT, 0.77).

Conclusion

Compared with the 2D approach, 3D transabdominal sonography does not seem to improve the reliability of LUS measurement. 2D measurement of MT seems to be most reliable between different observers.     

腹腔镜下可逆性子宫动脉阻断联合宫腔镜下吸宫术在剖宫产疤痕妊娠治疗中的应用:附10例病例报告

目的:探讨经腹腔镜可逆性子宫动脉阻断联合宫腔镜下吸宫术在剖宫产疤痕妊娠治疗中的临床价值。方法:对确诊为剖宫产疤痕妊娠、采用腹腔镜可逆性子宫动脉阻断联合宫腔镜下吸宫术治疗的10例患者临床资料进行回顾性分析。结果:10例患者手术均顺利完成,无中转开腹,无术后并发症。手术时间65~120 min,平均86±4 min;术中出血量60~110 mL,平均85±7 mL。患者术后6~12 h离床活动;术后24 h检测血β-hCG下降幅度均超过50%;术后住院时间2~4 d,平均3 d;血β-hCG于术后2~4周降至正常范围。结论:腹腔镜可逆性子宫动脉阻断联合宫腔镜下吸宫术治疗剖宫产疤痕妊娠是一种安全、有效、损伤小、恢复快、相对微创的治疗方式,具有一定的推广意义。     

Complete response to docetaxel and carboplatin combination chemotherapy for a stage IV uterine papillary serous carcinoma: a case report

We report a case of a stage IV uterine papillary serous carcinoma (UPSC) with multiple organ metastases. The patient was treated with docetaxel and carboplatin combination chemotherapy. After five courses, uterine tumor, Douglas tumor, lymphadenopathy, and distant metastases on magnetic resonance imaging or computed tomography scan were completely resoluted. Moreover, endometrial biopsy showed no carcinoma tissues after six courses. We suggest that this regimen may be effective for treatment of advanced-stage UPSC.     

Salvage chemotherapy with a combination of paclitaxel, ifosfamide, and cisplatin for the patients with recurrent carcinoma of the uterine cervix

The aim of this study was to assess the efficacy and toxicities of a combination of paclitaxel, ifosfamide, and cisplatin (TIP) for recurrent carcinoma of the uterine cervix. Fifty-three patients with recurrent cervical carcinoma were treated with ifosfamide 1500 mg/m(2) intravenously over 3 h on days 1-3, paclitaxel 135 mg/m(2) as a 3-h intravenous infusion, and cisplatin 50 mg/m(2) intravenously over 30 min on day 1. The chemotherapy was repeated every 3 weeks until there was disease progression or unacceptable toxicity. Forty-five patients received at least three courses of treatment and were evaluable for their response. Twenty-one patients (46.7%) showed objective responses, including 4.4% complete responses and 42.2% partial responses. The median time to progression and the overall survival for all the patients were 8.0 months (95% confidence interval [CI], 7.1-8.9 months) and 19.0 months (95% CI, 11.9-26.1 months), respectively. The median duration of response was 9.0 months. Patients who had previously been treated with another chemotherapy after tumor recurrence showed a moderate response rate (29.4%) but a shorter time to progression (6 vs 8 months, P= 0.0421) and a shorter survival (11 vs 39 months, P= 0.0018). Patients with good performance status showed a higher response rate (63.6% vs 30.4%, P= 0.026) and a longer time to progression (9 vs 7 months, P= 0.0049). Patients with recurrent disease only outside the previous radiotherapy (RT) field exhibited a slightly higher response without statistical significance (60.0% vs 36.0%, P= 0.109). Grade 3 or 4 toxicities included neutropenia in 13% of patients and neurotoxicity in 5%. Three deaths during treatment were observed, but two of them were due to disease progression. We conclude that the combination chemotherapy with TIP yields a high response rate with acceptable toxicity for patients with recurrent cervical carcinoma, including those patients who have failed to respond to prior platinum-based chemotherapy.     

Efficacy of PET/CT to exclude leiomyoma in patients with lesions suspicious for uterine sarcoma on MRI

Objective

To analyze the efficacy of positron emission tomography/computed tomography (PET/CT) for the diagnosis of uterine sarcoma.

Management of abnormal uterine hemorrhage with atypical endometrial hyperplasia by transcervical resection of endometrium

The aim of the study was to assess the feasibility and effect of treating atypical endometrial hyperplasia (AEH) with transcervical resection of endometrium (TCRE). Five cases of AEH incapable of hysterectomy for various reasons were treated with TCRE. All patients were followed up for 3-4 years postoperation to evaluate the thickness of endometrium, uterine cavity, and prognosis of the disease. All the patients provided informed consent for TCRE. In all five cases treated with TCRE, case 1 was for senility, hypertension, diabetes mellitus, and obesity; case 4 for senility, obsolete cerebral infarction, and hemiplegia; case 5 for uremia and chronic dysfunction of coagulation after renal transplantation; cases 2 and 3 for rejection of hysterectomy. All cases were followed up for more than 3 years after operation. Four had amenorrhea and one had dropping menses. The thickness of endometrium was no more than 5 mm in all the cases. TCRE is one available microinvasive surgery alternative to hysterectomy for AEH patients contraindicated to hysterectomy.     

Villoglandular papillary adenocarcinoma of the uterine cervix responding to neoadjuvant chemotherapy with docetaxel and cisplatin: a case report

Villoglandular papillary adenocarcinoma (VGPA) of the uterine cervix is a rare neoplasm, and its treatment has rarely been reported. We report a patient with VGPA stage IIA responding to neoadjuvant chemotherapy with docetaxel (60 mg/m2 as an intravenous infusion) and cisplatin (70 mg/m2 as an intra-arterial infusion). At 3 weeks after completing one course of this regimen, the tumor size was reduced from 5.3 x 4.0 cm to 2.0 x 2.0 cm (81.1% reduction), revealed by computed tomography. Accordingly, the patient underwent radical hysterectomy, and there have been no signs of recurrence. Thus, the combination of docetaxel and cisplatin is suggested to be useful for neoadjuvant chemotherapy of cervical adenocarcinoma.     

Artifactual fetal electrocardiographic detection using internal monitoring following intrapartum fetal demise during VBAC trial

Absent or erratic fetal electrocardiographic signal can result in artifactual electronic fetal heart rate recording. We report a case where detection of maternal heart rate through internal fetal scalp monitor may have masked intrauterine fetal demise secondary to acute uterine rupture during a VBAC trial.