Assessing the effects of lymphadenectomy and radiation therapy in patients with uterine carcinosarcoma: a SEER analysis.

OBJECTIVE: The purpose of this analysis is to determine the pathologic prognostic factors and treatment outcome of patients with carcinosarcoma of the uterus. METHODS: A retrospective analysis of data from the Surveillance, Epidemiology, and End Results program of the National Cancer Institute between January 1, 1988 and November 1, 2003 was conducted. A total of 1855 with AJCC Stages I-III disease were identified who received primary surgical treatment. Overall survival curves were constructed using Kaplan-Meier curves. Cox proportional hazards model was used to identify factors predictive of overall survival. RESULTS: AJCC stage of all patients was as follows: 65% Stage I (n=1099), 14% Stage II (n=245), 21% Stage III (n=353). 57% (n=965) patients underwent LND. The median number of lymph nodes removed was 12 (SD=10.2); 119 (14%) patients had positive lymph nodes. Five-year overall survival (OS), disease free survival, and median survival were significantly improved for patients receiving lymph node dissection (LND) as compared to patients that received no LND, irrespective of radiotherapy. Adjuvant radiation therapy had no improvement on overall survival regardless of LND. There was no overall survival benefit to the addition of radiotherapy regardless of whether patients underwent a lymph node dissection or not. Age, race, marital status, lymph node dissection and stage were predictive of survival on multivariate analysis. CONCLUSIONS: Lymphadenectomy is significantly associated with improved overall survival in patients with Stage I-III uterine carcinosarcoma compared to no lymphadenectomy. The use of adjuvant radiotherapy conferred no overall survival benefit.

Outcomes after breast conservation treatment with radiation in women with prior nonbreast malignancy and subsequent invasive breast carcinoma.

PURPOSE: Little information has been reported regarding outcomes after treatment for patients with early-stage invasive breast cancer and a prior nonbreast malignancy. This report analyzes the outcomes in patients with Stage I and II breast cancer after breast conservation treatment (BCT) with a prior nonbreast malignancy. METHODS AND MATERIALS: The study cohort comprised 66 women with invasive breast cancer and a prior nonbreast malignancy. All patients were treated with breast conservation surgery followed by definitive breast irradiation between 1978 and 2003. Median ages at diagnosis of invasive breast cancer and prior malignancy were 57 and 50 years, respectively. The median interval between the prior malignancy and breast cancer was 7.0 years. Median and mean follow-up times after BCT were 5.3 and 7.0 years. RESULTS: The 5-year and 10-year overall survival rates were 94% (95% confidence interval [CI], 82-98%) and 78% (95% CI, 59-89%), respectively. There were 4 patients (6%) with local failure and 10 patients (15%) with distant metastases. The 10-year rate of local failure rate was 5% (95% CI, 2-16%) and freedom from distant metastases was 78% (95% CI, 61-88%). No obvious differences in survival or local control were noted compared with the reported results in the literature for patients with invasive breast cancer alone. CONCLUSIONS: Both overall survival and local control at 5 and 10 years were comparable to rates observed in early-stage breast cancer patients without a prior malignancy. Prior nonbreast malignancy is not a contraindication to BCT, if the primary cancer is effectively controlled.

Interpretation of intra-operative PTH changes in patients with multi-glandular primary hyperparathyroidism (pHPT).

BACKGROUND: The correct interpretation of intraoperative parathyroid hormone (IOPTH) levels in patients with primary hyperparathyroid patients (pHPT) with multiglandular disease (MGD) can impact the success rate of initial parathyroid exploration, but it remains an understudied topic. METHODS: In all, 592 of 823 patients were explored by a single surgeon with biochemical evidence of pHPT (1997-2007) and underwent parathyroidectomy using IOPTH. We investigated the incidence of MGD in patients with an appreciable (>50%) decrease in IOPTH levels and in patients whose levels failed to normalize after single gland excision. RESULTS: The mean age of patients was 56.7 years, and 74% of patients were women. Thirty-one patients had PTH levels that decreased by greater than 50% from baseline 10-15 min after single gland excision, but the levels failed to normalize. Of these, 9 patients (29%) had MGD (8 double adenomas, 1 hyperplasia). The incidence of MGD in the remainder of IOPTH patients was 13.9% (78 of 561 patients). Within the subgroup of 31 patients, those with single adenomas did not differ from patients with MGD in baseline IOPTH levels and weights of first adenoma excised, although they demonstrated greater serum creatinine concentrations and a decrease in mean IOPTH. CONCLUSION: Commonly accepted decreases in IOPTH levels (>50%) for patients who undergo minimally invasive parathyroidectomy may lead to an appreciable number of missed parathyroid adenomas or hyperplastic disease.