Body mass index as a prognostic factor in endometrioid adenocarcinoma of the endometrium.

OBJECTIVE: To determine if body mass index (BMI) influences tumor expression of HER-2/neu, estrogen and progesterone receptors (ER/PR), and survival in women with endometrial adenocarcinoma. METHODS: Patients diagnosed between January 1992 and December 2001 with endometrioid adenocarcinoma of the uterus were identified. Clinical and pathologic data were retrospectively collected. HER-2/neu, estrogen and progesterone receptor expression were determined by immunohistochemistry. Differences in these variables and other prognostic factors were analyzed and correlated with effect on survival. RESULTS: One-hundred-sixty-five patients were included in this analysis. Lower BMI was associated with high stage (p=0.04) and HER-2/neu expression (p=0.04). Black race, high grade, high stage and lack of ER/PR expression were all associated with decreased survival. Despite having better prognostic factors, women with a BMI >25 had a lower survival than women with a BMI <25 (p=0.36). When five-year survival rates were calculated for BMI category and stratified by prognostic factors, for almost every high risk factor, survival was lower in overweight patients. CONCLUSION: In patients with endometrioid adenocarcinoma, low BMI is associated with high stage and tumor expression of HER-2/neu. Despite better prognostic factors, overweight women experience poorer survival.

Mesonephric adenocarcinoma of the cervix: a case report and review of the literature.

BACKGROUND: Malignant mesonephric tumor arising in the uterine cervix is an exceedingly uncommon variant of cervical adenocarcinoma with only 30 well-documented cases in the literature. CASE: We present a case of a 54-year-old woman with postmenopausal vaginal bleeding who was found to have a stage IB mesonephric adenocarcinoma of the cervix. CONCLUSION: At present there is no consensus on a standardized treatment protocol for malignant mesonephric tumors of the cervix. The present case suggests that a favorable outcome may be achieved for patients with stage IB tumors with aggressive initial therapy.

Racial and ethnic disparities in cancers of the uterine corpus.

Survival after diagnosis of cancer of the uterine corpus is significantly worse in black women as compared with white women. The etiology of the racial and ethnic disparities that exist in endometrial cancer incidence and outcome is multifactorial and complex. Potential explanations include cancer biology, differences in access to care, sociodemographic characteristics, response to treatment and comorbid factors. In this article, a review was performed to assess the magnitude and reasons for the observed disparity in endometrial cancer mortality. Strategies and recommendations to reduce or eliminate differences in endometrial cancer outcome are explored. These include advocacy for more research to clarify the underlying causes of cancer disparities at all levels, including the molecular basis of disparate outcomes, improving access to quality healthcare services, establishing culturally competent models of healthcare delivery, and developing novel cost-effective screening and early prevention methods.

Innovations in fertility preservation for patients with gynecologic cancers.

OBJECTIVE: To review options for fertility preservation in women with gynecologic cancers. DESIGN: Literature review. RESULT(S): We discuss the data regarding cancer treatment and fertility outcomes and current controversies for women with gynecologic cancers. CONCLUSION(S): Gynecologic cancers represent 12%-15% of cancers affecting women, and 21% of these are diagnosed in women of reproductive age. Current advances in our understanding of these diseases, along with improved multimodality treatment, allow for consideration of fertility options. For some women with gynecologic cancers, fertility-sparing treatment might be appropriate.

Intraoperative radiation therapy in recurrent ovarian cancer.

PURPOSE: To evaluate disease outcomes and complications in patients with recurrent ovarian cancer treated with cytoreductive surgery and intraoperative radiation therapy (IORT). METHODS AND MATERIALS: A retrospective study of 24 consecutive patients with ovarian carcinoma who underwent secondary cytoreduction and intraoperative radiation therapy at our institution between 1994 and 2002 was conducted. After optimal cytoreductive surgery, IORT was delivered with orthovoltage X-rays (200 kVp) using individually sized and beveled cone applications. Outcomes measures were local control of disease, progression-free interval, overall survival, and treatment-related complications. RESULTS: Of these 24 patients, 22 were available for follow-up analysis. Additional treatment at the time of and after IORT included whole abdominopelvic radiation, 9; pelvic or locoregional radiation, 5; chemotherapy, 6; and no adjuvant treatment, 2. IORT doses ranged from 9-14 Gy (median, 12 Gy). The anatomic sites treated were pelvis (sidewalls, vaginal cuff, presacral area, anterior pubis), para-aortic and paracaval lymph node beds, inguinal region, or porta hepatitis. At a median follow-up of 24 months, 5 patients remain free of disease, whereas 17 patients have recurred, of whom 4 are alive with disease and 13 died from disease. Five patients recurred within the radiation fields for a locoregional relapse rate of 32% and 12 patients recurred at distant sites with a median time to recurrence of 13.7 months. Five-year overall survival was 22% with a median survival of 26 months from time of IORT. Nine patients (41%) experienced Grade 3 toxicities from their treatments. CONCLUSION: In carefully selected patients with locally recurrent ovarian cancer, combined IORT and tumor reductive surgery is reasonably tolerated and may contribute to achieving local control and disease palliation.