ABSTRACT
Objective@#To determine the safety and efficacy of dose-dense (dd) paclitaxel (PTX) and carboplatin (CBDCA) in treating advanced or recurrent endometrial cancer. @*Methods@#Women aged 20–75 years with histologically confirmed endometrial cancer, the International Federation of Gynecology and Obstetrics (FIGO) stage III disease with some residual tumor, FIGO stage IV disease, recurrence after front-line curative treatment, or recurrence after second-line chemotherapy or radiotherapy were enrolled in this study. PTX (80 mg/m2) was administered intravenously (IV) to every participant on days 1, 8, and 15, and CBDCA (area under the curve of 5) was administered IV on day 1 once every 3 weeks until the disease progressed, unacceptable adverse events occurred, or consent was withdrawn. The primary endpoint was the response rate (RR), while the secondary endpoints were progression-free survival, overall survival, and adverse effects. @*Results@#Forty-eight participants were enrolled, and 46 were eligible to receive treatment. The patients' median age was 61 years (range, 43–76 years). Twenty-two participants had experienced recurrence, and the remaining patients had primary advanced endometrial cancer. There were 10 cases of serous carcinoma, 3 cases of endometrioid carcinoma G3, 2 cases of carcinosarcoma, and 2 cases of clear-cell carcinoma according to histology. Twenty-nine participants (63.0%) received ≥6 cycles of chemotherapy. The RR (complete, 13 cases; partial, 20 cases) was 71.3% (95% confidence interval: 59.0%–84.5%). @*Conclusion@#The dd PTX with CBDCA is feasible and available as a treatment option for advanced or recurrent endometrial cancer.
ABSTRACT
OBJECTIVE: We conducted a retrospective, multi-institutional, collaborative study to accumulate cases of neuroendocrine carcinoma of the endometrium, to clarify its clinicopathologic features, treatment, prognosis and prognostic factors to collate findings to establish future individualized treatment regimens. To our knowledge, this is the largest case study and the first study to statistically analyze the prognosis of this disease. METHODS: At medical institutions participating in the Kansai Clinical Oncology Group/Intergroup, cases diagnosed at a central pathologic review as neuroendocrine carcinoma of the endometrium between 1995 and 2014 were enrolled. We retrospectively analyzed the clinicopathologic features, treatment, prognosis and prognostic factors of this disease. RESULTS: A total of 65 cases were registered from 18 medical institutions in Japan. Of these, 42 (64.6%) cases were diagnosed as neuroendocrine carcinoma of the endometrium based on the central pathological review and thus included in the study. Advanced International Federation of Gynecology and Obstetrics stages (stage III and IV) and pure type small cell neuroendocrine carcinoma cases had a significantly worse prognosis. Upon multivariate analysis, only histologic subtypes and surgery were significant prognostic factors. Pure type cases had a significantly worse prognosis compared to mixed type cases and complete surgery cases had a significantly better prognosis compared to cases with no or incomplete surgery. CONCLUSION: Our findings suggest that complete surgery improves the prognosis of neuroendocrine carcinoma of the endometrium. Even among cases with advanced disease stages, if complete surgery is expected to be achieved, clinicians should consider curative surgery to improve the prognosis of neuroendocrine carcinoma of the endometrium.
Subject(s)
Female , Carcinoma, Large Cell , Carcinoma, Neuroendocrine , Carcinoma, Small Cell , Endometrial Neoplasms , Endometrium , Gynecology , Japan , Medical Oncology , Multivariate Analysis , Obstetrics , Prognosis , Retrospective StudiesABSTRACT
In order to evaluate the clinical usefulness of Sairei-to in the treatment of toxemia of pregnancy and to study its influence on the waveform of the umbilical arterial blood flow, a standard curve of the pulsatility index (PI) was constructed for 90 patients in their 19th through 41st weeks of normal pregnancy. A dose of 9.0g/day of Sairei-to was then given to 13 patients with edema (mild toxemia) and 3 patients with severe toxemia. These cases were observed for clinical improvement and changes in the PI. The results were as follows: 1) of the 13 patients with mild toxemia, edema improved in 12 cases (92%), along with a decrease in the PI of all of these cases as a result of administration of this Kampo formula, 2) Regarding the 3 patients with severe toxemia, the clinical usefulness of Sairei-to was not clear. In 2 of these cases, arrest of the endodiastolic velocity was observed 6 to 7 days after the start of administration, making it necessary to perform emergency cesarean sections. These findings suggest that in mild toxemia of pregnancy, due to the hydragogue effect of Sairei-to, alleviation of edema and improvement of the insufficiency of placental blood flow, demonstrated by a decrease in PI, could be expected. In severe toxemia, on the other hand, irreversible change had already occurred in the placenta, and consequently, no positive improvement in the insufficiency of placental blood flow could be expected with the administration of Sairei-to. Thus, administration served only to supplement other treatment methods in this group.