Postoperative radiotherapy in the treatment of uterine sarcomas: long-term results and analysis of prognostic factors.

PURPOSE: To evaluate the role of postoperative radiotherapy (RT) in local control and survival and to identify treatment-related prognostic factors in uterine sarcomas. METHODS: Sixty patients with uterine sarcomas treated with postoperative RT were retrospectively analyzed. Median age was 49.5 years (range 24-78). The stage distribution was as follows: stage I: 60%, II: 11.7%, and III: 28.3%. All patients were treated with pelvic irradiation (dose range 45.6-54.6 Gy). Pelvic control (PC), distant metastasis-free survival (DMFS), disease-free survival (DFS), and overall survival (OS) were calculated. Age, stage, histology, tumor size, type of surgery, residual disease, time interval between surgery and RT were selected as possible prognostic factors for PC and OS. Age, total treatment time, pelvic dose, dose per fraction, and acute side effects were analyzed as probable prognostic factors for late complications. RESULTS: Median follow-up was 84 months. The 10-year PC, DMFS, DFS and OS rates were 84, 67.3, 64 and 61.5%, respectively. Univariate analysis showed that age, residual disease, type of surgery and stage were significant factors for PC; residual disease, type of surgery and stage were significant factors for DMFS; stage was found as the only significant factor for DFS and OS. Total treatment time, pelvic dose, dose per fraction, and acute side effects were significant factors for late complications. CONCLUSION: Although our results suggest improved PC, the role of postoperative RT should be tested in prospective randomized trials.

Determining predominating histologic component in malignant mixed müllerian tumors: is it worth it?

Malignant mixed müllerian tumors (MMMT) are highly aggressive tumors, usually diagnosed in advanced stage. Cases of MMMT derive from either ovary or uterus. In our study, we investigated the role of carcinomatous and sarcomatous component on response to chemotherapy and disease outcome. We retrospectively analyzed 25 patients with MMMT who were treated in our outpatient clinic from 1998 to 2003. All the paraffin specimens were reevaluated according to the histopathologic features (primary site and percentages of carcinomatous and sarcomatous component) and the effect of predominant histologic type on response to treatment. Primary tumor sites were ovary and endometrium in 36% and 64% of patients, respectively. Ten of 25 patients (40%) were treated with a combination chemotherapy regimen of cisplatin-ifosfamide (PI) and 7 patients (28%) were treated with paclitaxel-carboplatin (PC) protocol. Despite chemotherapy, 17.6% of patients had progressive disease. The remaining 13 patients (54.2%) responded to chemotherapy. Response rates of patients treated with PC (100%) were remarkably higher than the response rates of patients treated with PI (66.6%). Moreover, patients with predominating carcinomatous component had a higher response rate (87.5%) than patients with predominating sarcomatous component (66.6%). MMMT are highly chemoresponsive tumors, irrespective of primary site. One of the best predictors to response is the histologic pattern. Predominating histopathologic feature (carcinoma or sarcoma) should be taken into consideration in predicting the response and planning the chemotherapy regimen.

Endometrial carcinoma and an unusual presentation of bone metastasis: a case report.

BACKGROUND: Although metastasis to bone is common in solid tumors, it seldom occurs in endometrial carcinoma. It is usually seen together with abdominopelvic recurrences and/or other organ metastases. Furthermore, bone metastases involving only the lower limbs are seen extremely rare. CASE: 67-year-old woman was referred for a vaginal recurrence from endometrial carcinoma. Pelvic irradiation and intracavitary brachytherapy failed to control the disease. Subsequently, she was presented with swelling of her left foot resembling an abscess, and bone scan revealed an increased uptake in both lower extremities below the knees. Furthermore, biopsy showed metastatic disease. She died 2 months after palliative irradiation with progressive disease. CONCLUSION: It should be remembered that bone metastasis at unusual sites might be seen in endometrial carcinoma.

Nasopharyngeal carcinoma in childhood: long-term results of 32 patients.

PURPOSE: To evaluate treatment results and prognostic factors, pediatric patients with nasopharyngeal carcinoma were reviewed. MATERIALS AND METHODS: Thirty-two patients at the age of 16 and younger were treated for nasopharyngeal carcinoma. One patient had WHO type I, 15 had WHO type II, and 14 had WHO type III histology. All patients were treated with radiotherapy, median dose to nasopharynx and involved nodes was 70 Gy (range 60-70.4 Gy), three patients received intracavitary booster dose of 24 Gy in three fractions, 12 patients were also given from two to four courses of platinum based neo-adjuvant chemotherapy. RESULTS: Twenty-three patients are alive and well with a median follow-up of 107 months. Ten and 15 years loco-regional control (LRC) and overall survival (OS) rates were 82.5, 68.7 and 72.7, 62.4%, respectively. Patient age, size of the lymph node and prolongation of overall external radiotherapy time were found to be the prognostic factors in univariate analysis, however the only factor remained significant after multivariate analysis was the size of the lymph node on LRC. Almost all long-term survivors experienced moderate to severe complications yielding complication free survival rate of 10.9% at 15 years.

Effect of fibrin glue on irradiated colonic anastomoses.

INTRODUCTION: The present study was planned to research the effects of fibrin glue on irradiated colonic anastomoses. METHOD: The effect of fibrin glue on irradiated colonic anastomoses was investigated in four identical groups of rats. In Group I (control group) colonic anastomoses were performed without radiotherapy; in Group II, colonic anastomoses were performed five days after radiotherapy; in Group III, fibrin glue was applied to anastomotic line without radiotherapy; in Group IV, fibrin glue was applied to anastomotic line with radiotherapy. The healing of left colonic anastomoses was evaluated through the bursting pressure of the anastomotic segment and the hydroxyproline contents of the anastomosis. RESULTS: Measurements done on the fourth postoperative day revealed that anastomotic healing was impaired in rats that underwent radiotherapy (P < 0.001); fibrin glue had no effect on anastomotic healing in groups with or without radiotherapy. CONCLUSION: In the early phases of anastomotic healing, fibrin glue cannot help remove unwanted effects of preoperative radiotherapy.

A randomised study of ornidazole as a radiosensitiser in carcinoma of the cervix: long term results.

This paper presents long-term results of a randomised study of ornidazole as a radiosensitiser in locally advanced carcinoma of the cervix. A total of 76 patients were randomised and followed-up with a median of 85 months. All patients were treated with external and intracavitary irradiation. The 10 year actuarial local control rate was 61% in patients receiving ornidazole, compared with 50% for placebo group. This difference was not statistically significant. Ten year actuarial overall and disease-free survival rates were also similar in the two treatment groups. Although, when analysed by stage, there was a significant advantage in the local control (54% vs 15%; P = 0.044) and disease-free survival rates (37% vs 8%; P = 0.047) in ornidazole group for stage IIIB cases, its implication is obscure because of the small number of patients. In this study moderate and severe complication rates were found to be 30%. These results suggest that ornidazole seems to have relatively weak sensitisation and it may show a possibility of a marginal benefit with unconventional irradiation using relatively large radiation doses. However, the results are insufficient for a real gain in the probability of local tumour control and survival.

Postoperative radiotherapy in carcinoma of the cervix: treatment results and prognostic factors.

In order to assess the role of postoperative radiotherapy and prognostic factors, 126 patients who were treated with radiotherapy after surgery for clinical early-stage carcinoma of the cervix were reviewed. All patients received external pelvic radiotherapy and 37 patients were treated with additional vaginal cuff irradiation. The 5-year overall survival, disease-free survival and locoregional control rates were 71.1, 69.9 and 78.1%, respectively. The 5-year disease-free survival rates were 40% for grade 3 vs. 75.4% for grade 1 tumours (p = 0.05), 76.5% for pathological stage IB versus 54.1% for pathological stage IIA (p = 0.04), 36.6% for node-positive patients versus 82.5% for node-negative patients (p = 0.0017), 54% for full thickness cervical invasion versus 100% superficial cervical invasion (p = 0.01), 34.8% for positive margins versus 78.1 for negative margins (p < 0.0001). After a multivariate analysis, tumour grade (p = 0.026) and presence of positive margins (p = 0.006) were found to independently influence the outcome. Grade II and III complication rate was 5.5% in all patients. In conclusion, postoperative radiotherapy should be used in patients treated with simple hysterectomy as well as those treated with radical hysterectomy with unfavorable pathological findings.