Prognostic factors in endometrial cancer patients with bone metastasis.

OBJECTIVES: This study aims to examine the pattern and prognosis of osseous involvement and the role of orthopedic surgery in patients with endometrial cancer (EC) and to evaluate the quality of life, local tumor control, and survival of patients. PATIENTS AND METHODS: Between January 2011 and December 2018, a total of 14 patients (median age: 60.5 years; range, 55 to 73 years) who were surgically treated for osseous metastasis of EC and followed for minimum 12 months were retrospectively analyzed. All patients were evaluated for their primary malignancy, characteristics of bone metastasis, and type of treatment related to musculoskeletal involvement. For evaluating the functional outcomes, the Visual Analog Scale (VAS) for pain and Eastern Cooperative Oncology Group (ECOG) performance status scale were used in the pre- and postoperative period. RESULTS: The median follow-up was 34.5 (range, 9 to 89) months. All patients had advanced-stage disease (FIGO Stage III-IV). Four patients had solitary and 10 patients had multiple bone metastases. The mean VAS score and ECOG performance status grades improved (p<0.001 and p<0.05, respectively). The median survival after detection of bone metastasis was 61 (range, 41 to 82) months. CONCLUSION: Endometrial cancer patients with musculoskeletal pain should be investigated for the possibility of bone metastasis to tailor a prompt treatment and to achieve a better prognosis. Appropriate surgical treatment of bone metastasis may improve both pain and performance status in carefully selected patients.

Clinical outcomes and survival following treatment of bone metastases from uterine leiomyosarcoma: A report of 6 cases.

OBJECTIVE: This study aimed to analyze the patient-reported outcomes and survival following surgical treatment of bone metastases from (uLMS) uterine leiomyosarcoma. METHODS: A retrospective review of six patients undergoing surgical procedures for metastatic uLMS over seven years was conducted at a single center. All patients were reviewed for their primary malignancy and characteristics of bone metastasis during follow-up. Clinical presentation of bone metastasis, modality, and the type of treatment related to musculoskeletal involvement were also analyzed. The visual analog pain scale (VAS) and Eastern Cooperative Oncology Group (ECOG) performance status scale were used pre-and postoperatively to evaluate the patient-reported outcome. RESULTS: Four patients had solitary bone metastases, whereas multiple bone metastases were diagnosed in two. Of those who had solitary bone metastasis, all of them were treated with wide resection. One of the two patients with multiple bone metastases was also treated with wide resection, and the other was treated with intralesional curettage. Four patients died from primary disease, and two were alive without evidence of disease recurrence. The median survival time following a diagnosis of bone metastasis was 15.0 months (95% CI, 0.6 to 29.4 months). The mean VAS scores for all six patients improved. However, the improvement in ECOG performance status was seen in only four patients. CONCLUSION: Although the prognosis of uLMS patients with bone metastasis seems poor, wide resection of the solitary bone metastasis may help prolong the overall survival. Performing orthopedic surgeries for the bone metastasis from uLMS in case of intractable pain after palliative radiotherapy, impending or pathological fracture, or solitary disease has been shown to decrease the pain significantly and improve the performance status in the majority. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.