The efficacy of complex decongestive physiotherapy (CDP) and predictive factors of response to CDP in lower limb lymphedema (LLL) after pelvic cancer treatment

Objective

The aim of this study was to estimate the efficacy of an intensive CDP program, as well as to identify the predictors associated with lymphedema severity and response to CDP in lower limb lymphedema (LLL) after pelvic cancer therapy.

Methods

We performed a retrospective review of post-pelvic cancer LLL patients that were treated with a CDP program between January 2004 and March 2011.

Results

Twenty-seven (61.4%) of the total 44 patients had cervical cancer, 9 (20.5%) had endometrial cancer, and 8 (18.2%) had ovarian cancer. The mean age was 62.2 years, 18 (40.9%) patients received radiotherapy and a mean of 12.6 sessions of daily CDP, and mean lymphedema duration was 34.8 months. The interval from pelvic cancer treatment to LLL development was 63.4 months. Lymphedema severity, baseline and post-CDP percentage of excess volume (PEV) were 32.9% ± 18.4% and 18.8% ± 16.7%. Baseline PEV was not correlated with duration of lymphedema, number of CDP sessions, age or radiotherapy, and was significantly different to post-CDP PEV (p < 0.001). CDP efficacy, percentage reduction of excess volume (PREV), was − 55.1%, and was correlated with baseline PEV, but not with the number of CDP sessions, duration of lymphedema, or age. PEV (p < 0.001) was the only predictive factor for CDP efficacy.

Conclusions

The key to predicting successful lymphedema treatment of LLL is the initial PEV. The intensive CDP program was effective and successful. We should encourage and refer patients to undergo treatment for LLL, even when the LLL is mild.     

Meperidine versus valethamate bromide in shortening the duration of active labor

Objective

To compare the efficacy and safety of meperidine hydrochloride and valethamate bromide against placebo in shortening the duration of active labor.

Method

We randomly assigned 160 nulliparous women with a singleton pregnancy at term who needed induction of labor to one of 3 treatments: 50 mg of meperidine (n = 53), 16 mg of valethamate bromide (n = 53), or a normal saline solution as placebo (n = 54). All medications were given by slow intravenous infusion. Labor duration was the main outcome measure.

Results

The intervals between infusion and complete cervical dilation and between infusion and delivery were significantly reduced (P < 0.001 and P < 0.01) in the meperidine group (103.0 ± 64.5 minutes and 119.8 ± 70.2 minutes), in contrast to the placebo group (173.9 ± 74.8 minutes and 192.2 ± 82.8 minutes). However, differences were not significant between the 2 treatment groups (139.6 ± 63.1 minutes and 160.6 ± 71.9 minutes), or between the valethamate bromide and the placebo group.

Conclusion

Meperidine, but not valethamate bromide, significantly shortened the duration of active labor in nulliparous women with a singleton pregnancy at term.     

Uterosacral-cardinal ligament stretching prior to vaginal hysterectomy increases uterine descent: a novel technique

Objective

To examine the effect of uterosacral-cardinal ligament complex stretching prior to vaginal hysterectomy on uterine descent.

Study design

A prospective trial of 25 consecutive women undergoing vaginal hysterectomy. Pre-operative, apical, anterior and posterior wall POP-Q measurements were recorded for each patient before and after uterosacral-cardinal ligament complex stretching during general anesthesia.

Results

Uterosacral-cardinal ligament complex stretching yielded a significant increase in mean stage of uterine and anterior wall descent (2.6 ± 0.6 vs. 3.2 ± 0.6 cm, p < 0.001, and 2.5 ± 0.8 vs. 2.9 ± 0.8 cm, respectively, p < 0.004). There was no significant change in posterior wall prolapse measurements (1.3 ± 0.7 vs. 1.4 ± 0.8 cm, p = 0.05).

Conclusion

Uterosacral-cardinal ligament complex stretching prior to vaginal hysterectomy increase uterine descent.     

Abdominal electromyography may predict the response to tocolysis in preterm labor

Objective

To determine whether abdominal electromyography can predict the response to tocolysis in pregnant women in preterm labor.

Study design

This study was carried out at the Department of Obstetrics and Gynecology, Menofyia University Hospital in Egypt. Fifty pregnant women in preterm labor who fulfilled the inclusion criteria were enrolled. Baseline abdominal electromyography was performed. Tocolysis in the form of hexoprenaline sulphate infusion was started for all women and electromyography was repeated after 24 h in responders but only after 6 h in non responders. The receiver operating characteristics curve was drawn to calculate specificity of the electromyography at 100% sensitivity. Results were tabulated and statistically analyzed.

Results

Forty women responded to tocolysis by delaying delivery for more than 48 h. There was a significant reduction in the frequency of uterine contractions after tocolysis (3.76 ± 0.92 versus 2.32 ± 2.05 contractions per 10 min; P < 0.001). Similar significant reductions affected the duration and amplitude of uterine action potentials (25.08 ± 9.74 versus 14.4 ± 17.16 s; P < 0.001, 40.8 ±  25.89 versus 28.32 ± 29.38 mV; P < 0.001). At a sensitivity of 100% and using ROC curve, abdominal electromyography of amplitude of 82 mV lasting for 30 s or more had a specificity of 90%, positive and negative predictive values of 67% and 95%, and a diagnostic accuracy of 88% in predicting preterm labor.

Conclusion

Abdominal electromyography may predict the response to tocolysis in preterm labor.     

Urodynamic findings in women with pelvic organ prolapse and obstructive voiding symptoms

Objective

To determine whether obstructive voiding symptoms in women with advanced pelvic organ prolapse (POP) were associated with objective bladder outflow tract obstruction.

Methods

We reviewed preoperative data from patients with advanced POP who underwent surgical correction at the Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel, between December 1, 2005, and November 30, 2007. Obstructive voiding symptoms were recorded from Pelvic Floor Distress Inventory-20 questionnaires.

Results

Of the 81 women aged 44-80 years who were included in the study, 40 (49.4%) reported incomplete bladder emptying preoperatively. There was no significant difference between these women and asymptomatic women in terms of demographic and clinical parameters such as age, parity, and stage of prolapse. Furthermore, there was no significant difference with regard to postvoid residual bladder volume (52.8 ± 65.8 vs 41.6 ± 41.2 mL), maximal (23.8 ± 11 vs 21.9 ± 9.6 mL/second) and average (10.3 ± 6.2 vs 9.3 ± 4 mL/second) urinary flow velocities, prevalence of increased postvoid residual volume (10.0% vs 4.8%), or obstructive urinary flow (17.5% vs 7.3%).

Conclusion

Almost half of all women with advanced POP experienced incomplete bladder emptying; however, this symptom did not correlate with objective urodynamic bladder outflow tract obstruction.     

Dual-console robotic surgery compared to laparoscopic surgery with respect to surgical outcomes in a gynecologic oncology fellowship program

Objective

Minimally invasive surgical techniques decrease surgical morbidity and recovery time. Studies demonstrate similar surgical outcomes comparing robotic to laparoscopic surgery. These studies have not accounted for the incorporation of fellow education. With the dual-console da Vinci Si Surgical System®, a two surgeon approach could be performed. We sought to compare surgical outcomes at a gynecologic oncology fellowship program of traditional laparoscopic to robotic surgeries using the dual-console system.

Methods

We identified patients who underwent laparoscopic or robotic surgery performed by a gynecologic oncologist from November 2009-November 2010. Robotic surgeries were conducted using the dual-console, utilizing a two surgeon approach. Surgeries involved a staff physician with a gynecologic oncology fellow. Statistical analysis was performed using student t-test and chi-squared analysis.

Results

A total of 222 cases were identified. Cases were analyzed in groups: all cases identified, all cancer cases, and endometrial cancer cases only. When analyzing all cases, no statistical difference was noted in total operating room time (172 vs. 175 min; p = 0.6), pelvic lymph nodes removed (10.1 vs. 9.6; p = 0.69), para-aortic lymph nodes dissected (3.7 vs. 3.8; p = 0.91), or length of stay (1.5 vs. 1.3 days; p = 0.3). There was a significant difference in total surgical time (131 vs.110 min; p < 0.0001) and EBL (157 vs.94 ml; p < 0.0001), favoring robotic surgery. When analyzing all cancer cases, the advantage in total surgical time for robotic surgery was lost. Complications were similar between cohorts.

Conclusion

Incorporating fellow education into robotic surgery does not adversely affect outcomes when compared to traditional laparoscopic surgery.     

Transcatheter arterial chemoembolization versus systemic methotrexate for the management of cesarean scar pregnancy

Objective

To evaluate the effectiveness/safety of systemic methotrexate (MTX) treatment versus transcatheter arterial chemoembolization using different embolic agents for termination of cesarean scar pregnancy (CSP).

Methods

Women with CSP were randomized to receive intravenous infusion of MTX (group 1, n = 13), or chemoembolization with MTX and either gelatin sponge (GS; group 2, n = 15) or polyvinyl alcohol (PVA; group 3, n = 16) particles. Uterine suction curettage followed all procedures. Bleeding volume, time until resolution of serum β-hCG, and length of hospital stay were recorded as outcome endpoints.

Results

Bleeding volume was smaller in groups 2 (mean ± SD, 73 ± 20 mL) and 3 (63 ± 22 mL) than in group 1 (952 ± 471 mL) (P < 0.001). Time until resolution of β-hCG was shorter in groups 2 (29 ± 16 days) and 3 (30 ± 19 days) than in group 1 (57 ± 25 days) (P < 0.01). Length of hospital stay was shorter in groups 2 (13 ± 4 days) and 3 (12 ± 3 days) than in group 1 (36 ± 8 days) (P < 0.01).

Conclusion

Transcatheter arterial chemoembolization was more effective than systemic MTX treatment for termination of CSP. Large cohort studies are warranted to compare effectiveness between PVA and GS particles.     

Primary repair of rectovaginal fistulas complicating pelvic surgery by gracilis myocutaneous flap

Objectives

Complex rectovaginal fistulas repair are extremely challenging. Various surgical options have been suggested; nevertheless, none had been universally accepted as the procedure of choice. This prospective study discusses a novel surgical technique using gracilis myocutaneous flap interposition.

Methods

Eleven patients had fistulas post-resection of pelvic malignancy (n = 10) and rectal endometriosis (n = 1). Primary treatment was pelvic resection; nevertheless, 6 cases had adjuvant chemo-irradiation, 2 cases had post-operative irradiation and 2 patients had chemotherapy only. Fistulas mean diameter was 2 ± 0.24 cm (1-3) and 8 patients (72.7%) had their fistulas in the middle vaginal third.Repair was wide debridement of fistulas margins followed by gracilis myocutaneous flap interposition with synchronous diverting stomas. Success was defined as healing of fistula after stomal closure.

Results

Five patients were repaired by single gracilis myocutaneous flaps, 2 cases by simple gracilis muscle and 4 cases by double gracilis myocutaneous flaps. Patients had a mean follow-up time of 34.8 ± 5.03 months (12-67) and all patients had definitive healing of their fistulas (100%). Median time to stoma closure was 2 months (1-5). Four women (36.4%) had at least one early postoperative complications including temporary leak (n = 3), vaginal sepsis (n = 1), partial skin paddle necrosis (n = 1) and donor limb deep venous thrombosis (n = 1). Late morbidities were seen in 3 cases (27.3%) including vaginal stricture, anorectal anastomotic stricture and anastomotic tumor recurrence.

Conclusion

Rectovaginal septum repair requires adequate debridement of necrotic devascularized tissues, tissue transposition and reconstruction of vaginal wall. Gracilis myocutaneous flaps are ideal for this issue.     

Open cornual resection versus laparoscopic cornual resection in patients with interstitial ectopic pregnancies

Objective

To compare laparotomy and laparoscopic management of interstitial ectopic pregnancies.

Study design

The medical records of 109 patients diagnosed with interstitial ectopic pregnancies at the Korea University Medical Center, the Republic of South Korea, between January 1998 and October 2009 were reviewed retrospectively. Eighty-eight women were treated by open cornual resection or laparoscopic cornual resection. A case-controlled study was performed. The outcomes were operative time, length of hospital stay, estimated blood loss, blood transfusion, and complication. Nominal variables were analyzed by the Fisher's exact test or the χ² test.

Results

The frequency of cornual ectopic pregnancies was 4.31% at this medical center. In patients with a cornual resection, primary laparotomy was performed in 49 women and laparoscopy was performed in 39 women. Laparoscopy was converted to laparotomy in five patients. There were no statistically significant differences between the two groups for the mean operation time, estimated blood loss, blood loss of more than 1000 mL, blood transfusion requirements, and complications. The mean number of postoperative hospital days was shorter in the laparoscopy group than in the laparotomy group (4.53 ± 1.44 days versus 5.89 ± 1.86 days, respectively; P < 0.001).

Conclusion

Laparoscopic cornual resection is a safe and less invasive procedure with a reasonable complication rate and shorter hospital stay.     

The use of quality control performance charts to analyze cesarean delivery rates nationally

Objective

To examine the use of quality control performance charts to analyze cesarean rates nationally.

Methods

Information on cesarean rates was obtained for all 19 Irish maternity hospitals receiving state funding in 2009. All women who underwent cesarean delivery of a live or stillborn infant weighing 500 g or more between January 1 and December 31 were included. Deliveries were classified as elective or emergency. Individual hospitals were not identified in the analysis.

Results

The mean rates per hospital of elective and emergency cesarean were 12.9 ± 2.6% (n = 9337) and 13.8 ± 3.0% (n = 9989), respectively—giving an overall mean rate of 26.7 ± 4.2% (n = 19326) per hospital. Cesarean rates were normally distributed. Using a quality control performance chart with a cutoff 2 standard deviations from the mean, 1 hospital was above the normal range for both total and elective cesareans, indicating that its pre-labor obstetric practices warrant clinical review. Another hospital had a mean emergency cesarean rate above the normal range, indicating that its labor ward practices warrant review.

Conclusion

Quality control performance charts can be used to analyze cesarean rates nationally and, thus, to identify hospitals at which obstetric practices should be reviewed.     

Location of aortic node metastases in locally advanced cervical cancer

Background

To assess the location of aortic node metastasis in patients with locally advanced cervical cancer undergoing extraperitoneal aortic lymphadenectomy to define the extent of the aortic lymphadenectomy.

Material and methods

Between August 2001 and December 2010, 100 consecutive patients with primary locally advanced cervical cancer underwent extraperitoneal laparoscopic aortic and common iliac lymphadenectomy. The location of aortic node metastases, inframesenteric or infrarenal was noted.

Results

The mean number ± standard deviation (SD) of aortic nodes removed was 15.9 ± 7.8 (range 4-62). The mean number ± SD of inframesenteric (including common iliac) nodes removed was 8.8 ± 4.5 (range 2-41) and the mean number ± SD of infrarenal nodes removed was 7.8 ± 4.1 (range 2-21). Positive aortic nodes were observed in 16 patients, and in 5 (31.2%) of them the infrarenal nodes were the only nodes involved, with negative inframesenteric nodes.

Conclusion

Inframesenteric aortic nodes are negative in the presence of positive infrarenal nodes in about one third of patients with locally advanced cervical cancer and aortic metastases.     

Comparison of sublingual misoprostol, intravenous oxytocin, and intravenous methylergometrine in active management of the third stage of labor

Objective

To compare the efficacy and adverse effects of sublingual misoprostol, intravenous oxytocin, and intravenous methylergometrine in active management of the third stage of labor (AMTSL).

Methods

A double-blind randomized trial of 300 women with a healthy singleton pregnancy allocated into 4 groups to receive either: 400 µg or 600 µg of sublingual misoprostol, 5 IU of intravenous oxytocin, or 200 µg of intravenous methylergometrine. The primary outcome measure was blood loss in the third and fourth stage of labor; secondary measures were duration of the third stage of labor, changes in hemoglobin levels, and adverse effects.

Results

Patients who received 600 µg of misoprostol had the lowest blood loss (96.05 ± 21.1 mL), followed by 400 µg of misoprostol (126.24 ± 49.3 mL), oxytocin (154.7 ± 45.7 mL), and methylergometrine (223.4 ± 73.7 mL) (P < 0.01). Shortest mean duration of the third stage of labor (5.74 minutes) was with 600 µg of misoprostol, while methylergometrine had the longest (6.83 minutes) (P < 0.05). Pyrexia was observed in the misoprostol groups, and raised blood pressure in the methylergometrine group (P < 0.001). The 24-hour postpartum hemoglobin level was similar among the groups (P > 0.05).

Conclusion

Administration of 600 µg of sublingual misoprostol was more effective than 400 µg of misoprostol, intravenous oxytocin, and intravenous methylergometrine for AMTSL.     

Induction of labor with vaginal misoprostol plus oxytocin versus oxytocin alone

Objective

To compare the effect of an oxytocin infusion alone or preceded by an intravaginal application of misoprostol for labor induction in women with term pregnancies and a low Bishop score.

Methods

This study randomized 100 multiparous women with singleton pregnancies over 38 weeks and a Bishop score less than 6 to receive either a single 50-µg dose of misoprostol intravaginally 3 hours before initiation of the oxytocin infusion or only an oxytocin infusion. The time from induction to delivery, the route of delivery, and maternal and fetal outcomes were analyzed.

Results

The mean time from induction to delivery was 9.36 ± 1.97 hours in the misoprostol plus oxytocin group and 11.08 ± 3.23 in the oxytocin alone group (P = 0.002). The rates of vaginal delivery, 1- and 5-minute Agpar scores, placental abruption, and postpartum hemorrhage were similar between the 2 groups, as were the rates of admission to the neonatal intensive care unit. There were no cases of perinatal asphyxia.

Conclusion

A 50-µg intravaginal application of misoprostol before starting the oxytocin infusion is a more effective method of labor induction than an oxytocin infusion alone for our study population.     

Single-port laparoscopic myomectomy using transumbilical GelPort access

Objective

To describe our initial experience with single-port laparoscopic myomectomy (SP-LM) using transumbilical GelPort access and the surgical technique used, and to evaluate the safety and feasibility of this procedure.

Study design

A prospective observational study was performed at a university teaching hospital from January 2009 to December 2009. Fifteen patients with symptomatic subserosal or superficial intramural myomas (≤8 cm) underwent SP-LM.

Results

The mean age and body mass index were 35.0 ± 8.6 years and 22.6 ± 2.6 kg/m². Two patients had a history of previous abdominal surgery, consisting of one and two cesarean deliveries. The mean operating time, hemoglobin change, return of bowel activity, and length of hospital stay were 81 ± 21.5 min, 1.1 ± 0.5 g/dL, 34.3 ± 5.9 h, and 3.1 ± 0.5 days, respectively. In one patient (6.7%), SP-LM was converted to two-port LM. There were no surgical or wound complications in any patient, and the histopathological result was leiomyoma in all the cases.

Conclusion

SP-LM is feasible in selected patients with symptomatic myoma.     

Effect of the interval between onset of sustained fetal bradycardia and cesarean delivery on long-term neonatal neurologic prognosis

Objective

To examine the effect of the interval between onset of sustained fetal bradycardia and cesarean delivery on long-term neonatal neurologic prognosis.

Method

A retrospective observational case-series performed with patients who had sudden-onset and sustained (< 100 beats per minute) fetal bradycardia during labor. Fetal heart rate was monitored closely until cesarean delivery. The effect of the interval between the onset of bradycardia and delivery on neonatal neurologic prognosis was examined.

Results

Among 2267 deliveries in 2002-2003 at Kitasato University Hospital, 19 pregnancies met the inclusion criteria. Episodes of fetal bradycardia were due to umbilical cord prolapse (n = 5), placental abruption (n = 4), uterine rupture (n = 3), maternal respiratory failure (n = 1), and other causes (n = 6). Mean onset of fetal bradycardia to delivery interval (BDI) was 20.5 ± 8.9 minutes. Mean decision-to-cesarean delivery interval was 11.4 ± 3.9 minutes. BDI was negatively correlated with umbilical arterial pH at delivery. There were 3 postnatal deaths. Neurologic assessment at the age of 2 years revealed that 15 of 16 children were neurologically normal. When the BDI was less than 25 minutes, all term pregnancies led to normal neonatal neurologic development.

Conclusion

In the event of sustained intrapartum fetal bradycardia, delivery by emergency cesarean within 25 minutes improved long-term neonatal neurologic outcome.     

Oral misoprostol reduces vaginal bleeding following surgical evacuation for first trimester spontaneous abortion

Objective

To assess the effectiveness and tolerability of misoprostol to reduce the amount and duration of vaginal bleeding following surgical evacuation for first trimester spontaneous abortion.

Methods

A total of 160 patients who underwent surgical evacuation for first trimester spontaneous abortion between 8 and 12 weeks of pregnancy were randomized into 2 groups to receive either 200 µg of oral misoprostol immediately after evacuation followed every 6 hours for 48 hours or no misoprostol. Pain scores, duration and amount of bleeding, and endometrial thickness were assessed over 10 days.

Results

Women who received misoprostol had significantly fewer bleeding days after evacuation (4.11 ± 2.69 vs 5.89 ± 3.06; P < 0.001), fewer patients reported vaginal bleeding lasting 10 days or more (3.8% vs 15.0%; P = 0.014), and endometrial thickness 10 days after evacuation was less (6.25 ± 2.38 vs 7.23 ± 1.94; P = 0.05). Pain scores were comparable in both groups (1.54 ± 0.65 vs 1.63 ± 0.83; P = 0.40) after 10 days.

Conclusion

Oral misoprostol is effective in reducing the prevalence and amount of vaginal bleeding after surgical evacuation for first trimester spontaneous abortion.     

Conizacion con asas diatermias en lesiones premalignas de cuello uterino

Objective

To compare the effectiveness of uterine conization in high-grade cervical squamous intraepithelial lesions (HSIL) by means of surgical electrical excision with Trucone loop or Leep loop.

Subjects and methods

We performed a comparative study that included 150 patients, aged between 20 and 45 years, with a diagnosis of HSIL. All patients underwent uterine conization with diathermy loop. The patients were separated into two groups according to the type of loop used.

Results

Both loops were effective in the management of HSIL but significant differences were found in favor of the Trucone loop in surgical time (X: 3.7 ± 0.52, p < 0.01), lesser margin involvement (100% free margins, p < 0.05) and a lower frequency of residual lesions (94.7%, p > 0.01).

Conclusions

Both diathermy loops were effective in the treatment of HSIL but the frequency of complications and residual lesions was lower with the Trucone loop.     

Endometrial ablation with the NovaSure system in Iran

Objective

To evaluate the rate of response to treatment with the NovaSure endometrial ablation device among Iranian women with menorrhagia.

Methods

Twenty 35-50-year-old women with menorrhagia who were referred to Arash Hospital, Tehran, Iran, in 2008 were enrolled. They underwent endometrial ablation via the NovaSure system and were followed-up for 2 years.

Results

The incidence of amenorrhea was 30.0% at the end of the 2-year follow-up period. Hypomenorrhea was reported by 40.0% of women. The mean number of days of bleeding per month decreased significantly, from 30.0 ± 6.4 days before treatment to 3.1 ± 2.6 days after 2 years (P < 0.001). The severity of bleeding decreased significantly within 2 years after treatment (P < 0.001). In total, 85.0% of women were satisfied and 90.0% had responded to treatment—as defined by amenorrhea, hypomenorrhea, or return to normal menstruation.

Conclusion

The NovaSure system is effective and should be considered by gynecologists for the treatment of menorrhagia.     

Effect of isosorbide mononitrate for cervical ripening before surgical termination of pregnancy in the first trimester

Objective

To evaluate the efficacy of isosorbide mononitrate (IMN) for cervical ripening prior to first trimester surgical termination of pregnancy.

Methods

A prospective, double-blind, randomized, placebo-controlled trial. Women scheduled for surgical termination of a nonviable fetus before 12 weeks of gestation from October 2008 to June 2009 were enrolled and randomly assigned to receive either 20 mg vaginally of IMN (n = 24) or a placebo (n = 24) 4 hours before suction evacuation. Cervical dilation before evacuation was assessed with 10-mm Hegar dilators followed by smaller sizes that were measured until the instrument passed freely through the internal os. Cervical dilation, adverse effects, termination complications, and patient satisfaction were the main outcomes.

Results

Mean cervical dilation was not significantly different between the IMN and placebo groups (6.29 ± 0.99 mm vs 5.71 ± 1.04 mm; P = 0.05). Mean operative time did not differ between the groups (16 ± 0.07 min vs 18 ± 0.06 min; P = 0.55), nor did patient satisfaction measured by visual analogue scale (7.04 ± 1.68 vs 6.54 ± 1.22; P = 0.24).

Conclusion

IMN was comparable to placebo in terms of efficacy and patient satisfaction for cervical priming prior to first-trimester termination of pregnancy.     

A phase II evaluation of docetaxel and carboplatin followed by tumor volume directed pelvic plus or minus paraaortic irradiation for stage III endometrial cancer

Objective

To determine the feasibility and efficacy of administering docetaxel and carboplatin chemotherapy followed by tumor directed radiation in patients with advance stage endometrial cancer.

Methods

Patients with surgical stage III or IV (confined to the pelvis) endometrial cancer were eligible. Treatment consisted of six cycles of docetaxel (75 mg/m²) and carboplatin (AUC 6) followed by irradiation to the involved field (50.4 Gy pelvis ± 43.5 Gy paraaortic) ± brachytherapy. Kaplan-Meier (KM) methods estimated overall survival (OS) and progression free survival (PFS).

Results

Forty-five patients were enrolled, 34 (76.0%) completed the prescribed therapy. Median age 63.5 (35-85 years). Stage IIIA 8 (17.8%), IIIB 1 (2.2%) and IIIC 36 (80.0%). 39/45 (86.7%) had endometroid histology. Serious grade 4 toxicities included 14 non-hematologic and 2 hematologic. Sixteen patients died following treatment, 6 from recurrent progressive cancer, with a median follow-up of 35.6 months (0.4-74.8). KM estimates and standard error (SE) for OS at 1 year were 84.5%, (5.4%), at 3 years, 65.8%, (7.2%) and at 5 years, 56.7%, (7.9%). Median overall survival was 74.5 months. Fourteen patients recurred with KM estimates and standard error (SE) for PFS at 1 year 77.8%, (6.2%) and 3 year 54.4%, (6.7%). Median progression free survival was 36.9 months.

Conclusions

Docetaxel and carboplatin followed by tumor directed irradiation for advanced stage endometrial cancer has acceptable toxicity and efficacy that allows for this regimen to be considered a viable treatment option for these patients.