Surgical treatment of recurrent endometrial carcinoma.

BACKGROUND: Surgery does not have a definite role in the treatment of patients with recurrent endometrial carcinoma, except for those with central pelvic recurrences. The authors describe their experience with surgery in patients with abdominal endometrial recurrences. METHODS: Between 1988 and 2000, 75 patients with abdominal and pelvic endometrial recurrences underwent secondary rescue surgery. Patients were classified according to the presence or absence of residual tumor after surgery. Therapy after rescue surgery was undertaken at the discretion of the medical oncologist. The progression-free interval and overall survival were defined as the time from secondary rescue surgery to the specific event and were evaluated by the Kaplan-Meier method and the log-rank test. A Cox proportional hazards regression model was used to compare survival with covariates. RESULTS: Fifty-six patients (74.7%) underwent optimal debulking. Major surgical complications were observed in 23 patients (30.7%). Only 1 postoperative death was observed, although the mortality rate for surgical complications after the postoperative period was 8%. Patients who underwent optimal debulking had a significantly better cumulative survival rate compared with patients who had residual disease (36% vs. 0% at 60 months; P < 0.05). Residual disease, chemotherapy after rescue surgery, and central pelvis-vagina as the only site of recurrence were associated significantly with survival. CONCLUSIONS: The authors found that this approach was very challenging in terms of the procedures involved, the incidence of major surgical complications, and the high mortality rate. It was useful in increasing overall survival, provided that patients were free of macroscopic disease. Careful selection of patients is needed to minimize mortality.

Comparison of ultrasonography, hysteroscopy, and biopsy in the diagnosis of endometrial lesions in postmenopausal tamoxifen-treated patients.

BACKGROUND: At present, no proven recommendations can be made for the surveillance of tamoxifen-treated women. The aim of the present study was to evaluate ultrasonography and hysteroscopy in this setting. METHODS: Three hundred and ten postmenopausal patients using tamoxifen underwent vaginal ultrasonography, hysteroscopy, and endometrial biopsy; 274 were asymptomatic and 49 had abnormal bleeding. Ultrasonographic endometrial thickness and echotexture were recorded. Hysteroscopic endometrial appearance, presence of focal endometrial lesions and polyps were also recorded. General or selective endometrial biopsy was performed. Ultrasonographic and hysteroscopic follow up was provided. RESULTS: At ultrasonography, mean endometrial thickness was 10.8 mm. At hysteroscopy, cystic atrophy and suspect focal lesions were detected in 49.2% and 5.3% of women, respectively. Polyps were present in 44.8% of women; 38.9% of these polyps were missed at ultrasonography, whereas 11.4% were suspected but were not found at hysteroscopy. At biopsy, non-atypical hyperplasia and atypical changes were found in 4.8% and 1.3% of patients, respectively. Three carcinomas were found, all in asymptomatic women. Logistic regression analysis showed that only suspect focal lesions at hysteroscopy were significantly associated with abnormal histology. With a 6-mm cut-off value for endometrial thickness, negative and positive predictive values for ultrasonography in detecting hyperplastic or neoplastic changes were 96% and 8%, respectively; the corresponding values for hysteroscopy were 96% and 65%. No additional carcinoma was found at follow up. CONCLUSIONS: No single ultrasonographic feature (echotexture and borders) is significantly associated with the detection of endometrial hyperplasia or carcinoma; hysteroscopy, although not predictive unless revealing a focal lesion, is more accurate in detecting polyps and hyperplastic changes.

Nutrient intake and ovarian cancer: an Italian case-control study.

OBJECTIVE: The role of selected macronutrients, cholesterol, and fatty acids in the etiology of epithelial ovarian cancer was analyzed using data from a case-control study carried out in five Italian areas between January 1992 and December 1999. METHODS: Cases comprised 1,031 women with incident, histologically confirmed epithelial ovarian cancer, admitted to the major teaching and general hospitals of the study areas. Controls comprised 2,411 women admitted for acute, non-neoplastic conditions to the same network of hospitals. Information on dietary habits was elicited using a validated food-frequency questionnaire including 78 food groups and recipes. Odds ratios (OR) and their corresponding 95% confidence intervals (CI) were computed by subsequent quintiles of nutrient intake. RESULTS: Direct associations with ovarian cancer emerged for starch intake (OR = 1.4 in the highest vs the lowest quintile of intake; 95% CI 1.1-1.8), while inverse associations emerged for monounsaturated (OR=0.7; 95% CI 0.5-0.9), and polyunsaturated (OR = 0.7; 95% CI 0.5-0.9) fatty acids. Among fatty acids, oleic (OR = 0.7; 95% CI 0.5-0.9), linoleic (OR = 0.7; 95% CI 0.5-0.9), and linolenic (OR = 0.8; 95% CI 0.6-1.0) acids were inversely related to ovarian cancer. When, however, six macronutrients were included in the same model, only the adverse effect of high starch intake remained significant. Results were consistent in separate strata of menopausal status, parity, and energy intake. CONCLUSIONS: Starch was directly associated, and unsaturated fatty acids were inversely associated, with ovarian cancer risk.