Adjuvant treatment for stage IIIC endometrial cancer: options and controversies.

Endometrial cancer is the most common gynecologic malignancy. Locally advanced and high risk endometrial cancer encompasses a heterogeneous group of patients and optimal treatment for various sub-groups of these patients remains controversial. Stage IIIC is the most common sub-stage of patients with locally advanced endometrial carcinoma. This article reviews retrospective and prospective data of various adjuvant treatment approaches involving chemotherapy, radiation therapy, or combined modality therapy, including the recently proposed "sandwich" regimens that have yielded encouraging results. Areas of controversy are also discussed to assist clinicians in identifying the most effective adjuvant treatment regimens for patients with locally advanced disease. On-going randomized trials are briefly discussed.

Visual complications after stent-assisted endovascular embolization of paraophthalmic and suprasellar variant superior hypophyseal aneurysms: the Duke Cerebrovascular Center experience in 57 patients.

OBJECTIVE: To review retrospectively experience with stent-assisted coiling of ophthalmic segment internal carotid artery (ICA) aneurysms to report outcome data and identify the rate of associated visual complications. METHODS: The Duke endovascular database was retrospectively reviewed to identify all ICA aneurysms treated with stent-assisted embolization between November 2002 and October 2009. Only aneurysms arising from the ophthalmic segment of the ICA and originating from the paraophthalmic or suprasellar variant superior hypophyseal artery were included. These aneurysms have the potential to create visual disturbances related to mass effect on the optic nerve or chiasm or to disrupt the ophthalmic artery. Chart review was performed to obtain clinical information, immediate incidence, and follow-up of aneurysm remnants and any visual complications. RESULTS: There were 63 aneurysms (48 paraophthalmic and 15 suprasellar variant superior hypophyseal) identified in 57 patients. The ophthalmic artery was preserved in all but two (3.5%) cases, neither of which resulted in visual deficits. One (1.8%) patient experienced transient acute visual disturbances, and two (3.5%) patients had delayed, persistent deficits. CONCLUSIONS: Stent-assisted embolization of ophthalmic segment ICA aneurysms is technically achievable and in our series did not appear to result in increased visual complications compared with coil embolization alone or surgical treatment.

Stent-assisted coil emboilization of ruptured intracranial aneurysms: A retrospective multicenter review.

BACKGROUND: The purpose of this study is to retrospectively review our experience with stent-assisted embolization of patients with an acutely ruptured cerebral aneurysm. METHODS: Medical records and imaging were reviewed for 36 patients who underwent stent-assisted embolization of a ruptured cerebral aneurysm. RESULTS: Seventeen patients (47%) received a preprocedural loading dose of clopidogrel and five patients (14%) received an intraprocedural dose of clopidogrel. The remaining 14 patients (36%) were treated with antiplatelet therapy following the procedure. Six (17%) stent related intraprocedural thromboembolic complications were encountered; four of these resolved (one partial, three complete) following treatment with abciximab and/or heparin during the procedure. Five of the six thromboembolic events occurred in patients who were not pretreated with clopidogrel (P = 0.043). Two patients in this series (6%) had a permanent thrombotic complication resulting in mild hemiparesis in one patient, and hemianopsia in the second. No procedure related hemorrhagic complications occurred in any patient. One patient had a spontaneous parenchymal hemorrhage contralateral to the treated aneurysm discovered 10 days after treatment. Twenty-eight patients (78%) had a Glasgow Outcome Score of 4 or better at discharge. Seven of 21 patients (33%) with angiographic follow-up required further treatment of the coiled aneurysm. CONCLUSION: Stent-assisted coil embolization is an option for treatment of ruptured wide neck ruptured aneurysms and for salvage treatment during unassisted embolization of ruptured aneurysms but complications and retreatment rates are higher than for routine clipping or coiling of cerebral aneurysms. Pretreatment with clopidogrel appears effective in reducing thrombotic complications without significant increasing risk of hemorrhagic complications.

Thromboembolic complications after Neuroform stent-assisted treatment of cerebral aneurysms: the Duke Cerebrovascular Center experience in 235 patients with 274 stents.

BACKGROUND: The Neuroform Stent has facilitated the endovascular treatment of wide-necked cerebral aneurysms. It is unknown which factors pose risks of thromboembolic events after stent placement. OBJECTIVE: This series is the largest single-center study reporting on the incidence of and factors influencing thromboembolic complications after Neuroform stent placement. METHODS: A total of 235 patients were treated with 274 Neuroform stents. The thromboembolic event rate was determined by imaging or clinical evidence of cerebrovascular accident within 90 days of stent placement; for patients with incomplete follow-up through chart review, telephone interviews were conducted. Analyses were performed to investigate patient factors that may be associated with stroke. RESULTS: Most aneurysms were unruptured; 30 patients (12.8%) presented with acute subarachnoid hemorrhage. Twelve patients of the 224 with follow-up (5.4%, 95% confidence interval: 2.4%-8.3%) demonstrated imaging or clinical evidence of a new thromboembolic event within 90 days of stent placement. There was a 3.1% thromboembolic rate for unruptured aneurysms and a 20% rate in patients with subarachnoid bleed. Hemorrhage was significantly associated with having a thromboembolic event (P = .002). There was a trend toward an increased thromboembolic event rate for patients with hypertension (P = .07). Larger stent caliber was significantly associated with a decreased thromboembolic event rate (P = .032). CONCLUSION: Our results suggest that the thromboembolic event rate associated with Neuroform stent use is low in unruptured aneurysms. In ruptured aneurysms, the complication rate is high, possibly partly related to restricted use of antiplatelet therapy. Stent size and hypertension may be associated with the risk of stroke, but additional studies are needed to confirm their significance.