A Comparison of Dye Versus Fluorescence Methods for Sentinel Lymph Node Mapping in Endometrial Cancer.

OBJECTIVE: Sentinel nodes (SNs) have been observed in several reports from Japan and overseas in cases with endometrial cancer; however, no consensus has been reached regarding the types of tracers or the method of their injection. A combination of the radioisotope (RI) and dye method is considered to be desirable. We assessed SN mapping using either dye or near-infrared fluorescence imaging to clarify a suitable method in cases of endometrial cancer. METHODS: Patients were enrolled from 92 patients diagnosed with endometrial cancer and having no extrauterine metastasis by the preoperative imaging between 2009 and 2014 at our institution. To identify the SNs, we performed 3 methods using either dye or fluorescence solutions in conjunction with a RI method. In the dye method, we injected indocyanine green in the uterine subserosa, visually identifying SNs as stained green. In the fluorescence method, a dilute indocyanine green solution (0.5 mg, fluorescence A or 0.25 mg, fluorescence B, each per 10 mL of solvent) was injected and the SN identified by the HyperEye Medical System. RESULTS: The SN detection rates were 100%, 100%, and 96% using dye and fluorescence A or B solution, respectively. Pelvic SNs were detected by the 3 methods in 98%, 100%, and 96% of cases and para-aortic SNs in 65%, 88%, and 74%, respectively. Fluorescence A solution was somewhat better than dye in detecting para-aortic SNs, although not significantly so (P = 0.07). The sensitivity and negative predictive values for detecting SNs with metastases with the dye method were 92% and 98% compared with 100% and 100%, respectively, for both fluorescence solutions. CONCLUSIONS: Although both dye and fluorescence methods performed well, no method perfectly identified para-aortic SNs. The concomitant use of the RI method is required to detect para-aortic SNs.

Retrospective Analysis on the Feasibility and Efficacy of Docetaxel-Cisplatin Therapy for Recurrent Endometrial Cancer.

AIM: There is poor evidence regarding effective treatment for recurrent endometrial cancer. We treated patients with recurrent endometrial cancer with docetaxel-cisplatin (DP) therapy as second-line or third-line chemotherapy. We aimed to evaluate the feasibility and efficacy of DP therapy for patients with recurrent endometrial cancer. PATIENT AND METHODS: We included 26 patients diagnosed with recurrent endometrial cancer, who underwent DP chemotherapy at our Institution. Docetaxel at 70 mg/m(2)and cisplatin at 60 mg/m(2)were administered by intravenous injection every 3 weeks. We retrospectively analyzed the clinicopathological factors associated with the response rate (RR) and prognosis. We also analyzed the adverse effects of DP therapy. RESULTS: Median follow-up was 33.8 months and the median number of therapy cycles was six. Grade 3 or 4 adverse effects included leukopenia (66%), neutropenia (81%), anemia (9%), diarrhea (12%), general fatigue (12%), liver dysfunction (4%), peripheral neuropathy (4%), and hyponatremia (4%). RR was 58% and the median progression-free survival (PFS) was 7.5 months. The group with a treatment-free interval of 6 months or more tended to have better PFS than that with less than 6 months (p=0.01). The group with a platinum-free interval of 6 months or more had significantly better PFS than that with less than 6 months (p=0.09). Although the history of taxane usage was not relevant to prognosis, a taxane-free interval of 12 months or more was associated with a tendency for better PFS (p=0.06). CONCLUSION: DP therapy was fully feasible and demonstrated efficacy for patients with recurrent endometrial cancer.

Hysteroscopic transcervical resection is useful to diagnose myometrial invasion in atypical polypoid adenomyoma coexisting with atypical endometrial hyperplasia or endometrial cancer with suspicious myometrial invasion.

AIM: Management of atypical polypoid adenomyoma (APAM) is complicated because it can sometimes coexist with atypical endometrial hyperplasia (AEH) or endometrioid adenocarcinoma. It is often difficult to assess myometrial invasion in APAM complicated with endometrial cancer. We encountered three patients who, contrary to magnetic resonance imaging, did not have myometrial invasion on hysteroscopic transcervical resection (TCR) and therefore could have fertility preserved, and consequently could become pregnant. METHODS: We removed the polypoid lesion and a 3-5 mm-thick layer of the normal inner membrane at the root of the polypoid lesion, and then performed total curettage. Several pathological diagnostic procedures were then carried out on each of these resected specimens. Thereafter, high-dose medroxyprogesterone acetate (MPA) was initiated. RESULTS: All three patients underwent hysteroscopic transcervical tumor resection. The pathological diagnoses were as follows: patient 1, G1 endometrioid adenocarcinoma (EMG1) + APAM; patients 2,3, AEH + APAM. No findings of myometrial invasion in the resected root specimen were observed in any patient. In all cases, high-dose MPA was initiated. After the disappearance of tumors, each patient achieved pregnancy. Complications such as placenta accreta were not observed at the time of delivery. CONCLUSION: In patients with APAM and AEH or EMG1, TCR may aid accurate diagnosis when myometrial invasion is unclear on diagnostic imaging.

A retrospective study on combination therapy with ifosfamide, adriamycin and cisplatin for progressive or recurrent uterine sarcoma.

There is currently insufficient evidence to recommend a specific chemotherapeutic regimen as standard treatment for uterine sarcomas. In this study, we investigated the toxicity and effectiveness of ifosfamide, adriamycin and cisplatin (IAP therapy) in patients with progressive and recurrent uterine sarcoma. A total of 11 patients with progressive or recurrent uterine sarcoma containing leiomyosarcoma (LMS), undifferentiated endometrial sarcoma (UES) or adenosarcoma, who were diagnosed at our institution, were retrospectively investigated. We recorded the adverse events, response rate and progression-free survival in these cases. The histological types included LMS (54.5%), adenosarcoma (27.3%) and UES (18.2%). Grade ≥3 leukopenia or neutropenia were observed in all the cases, febrile neutropenia developed in 45.5% of the patients and grade 4 thrombocytopenia developed in 3 cases (27.3%). With IAP therapy, the response rate was 36.4% and the disease control rate was 90.9%. Therefore, IAP therapy may be a viable option as chemotherapy for uterine sarcoma.