A novel model to estimate lymph node metastasis in endometrial cancer patients

OBJECTIVES: To evaluate the postoperative pathological characteristics of hysterectomy specimens, preoperative cancer antigen (CA)-125 levels and imaging modalities in patients with endometrial cancer and to build a risk matrix model to identify and recruit patients for retroperitoneal lymphadenectomy. METHODS: A total of 405 patients undergoing surgical treatment for endometrial cancer were retrospectively reviewed and analyzed. Clinical (age and body mass index), laboratory (CA-125), radiological (lymph node evaluation), and pathological (tumour size, grade, lymphovascular space invasion, lymph node metastasis, and myometrial invasion) parameters were used to test the ability to predict lymph node metastasis. Four parameters were selected by logistic regression to create a risk matrix for nodal metastasis. RESULTS: Of the 405 patients, 236 (58.3%) underwent complete pelvic and para-aortic lymphadenectomy, 96 (23.7%) underwent nodal sampling, and 73 (18%) had no surgical lymph node assessment. The parameters predicting nodal involvement obtained through logistic regression were myometrial infiltration >50%, lymphovascular space involvement, pelvic lymph node involvement by imaging, and a CA-125 value >21.5 U/mL. According to our risk matrix, the absence of these four parameters implied a risk of lymph node metastasis of 2.7%, whereas in the presence of all four parameters the risk was 82.3%. CONCLUSION: Patients without deep myometrial invasion and lymphovascular space involvement on the final pathological examination and with normal CA-125 values and lymph node radiological examinations have a relatively low risk of lymph node involvement. This risk assessment matrix may be able to refer patients with high-risk parameters necessitating lymphadenectomy and to decide the risks and benefits of lymphadenectomy.

Clinical assessment of 252Californium neutron intracavitary brachytherapy using a two-channel Y applicator combined with external beam radiotherapy for endometrial cancer

OBJECTIVE: The aim of this study was to determine the efficacy of 252Californium neutron intracavitary brachytherapy using a two-channel Y applicator combined with external beam radiotherapy for the treatment of endometrial cancer. METHODS: Thirty-one patients with stage I-III endometrial cancer were recruited for this study. The stage I patients received only 252Californium neutron intracavitary brachytherapy with a two-channel applicator. The stage II and III patients received both 252Californium neutron intracavitary brachytherapy using a two-channel applicator and parallel-opposed whole pelvic radiotherapy. RESULTS: The five-year local control rate was 80.6% (25/31), the overall survival rate was 51.6% (16/31), and the disease-free survival rate was 54.8% (17/31). The incidence of serious late complications was 12.9% (4/31). CONCLUSIONS: 252Californium neutron intracavitary brachytherapy using a two-channel applicator combined with external beam radiotherapy was effective for treating endometrial cancer and the incidence of serious late complications related to this combination was within an acceptable range.

Linfadenectomía lumboaórtica sistemática: Unidad de Ginecología Oncológica, Hospital Carlos Van Buren de Valparaíso / Systematic lumboaortic lymphadenectomy: Oncological Gynecology Unit of Hospital Carlos Van Buren, Valparaiso

Objetivo: Dar a conocer la técnica de linfadenectomía lumboaórtica sistemática (LLS) en el cáncer de endometrio y ovario, así como los resultados quirúrgicos obtenidos con ella en éste grupo de pacientes. Método:Se presenta una cohorte prospectiva de pacientes portadoras de cáncer de endometrio y ovario que requieren LLS entre agosto de 2005 y marzo de 2008. Se describe la técnica empleada y los resultados obtenidos. Resultados: 76 pacientes portadoras de cáncer de endometrio y ovario son sometidas a LLS. La edad promedio es de 57 años; 40 pacientes (52,6%) presentan cáncer de endometrio y 35 (46%) cáncer de ovario. El tiempo operatorio promedio fue de 55 minutos y el sangrado estimado de 120 ml. Se obtiene un recuento ganglionar promedio de 25,4 ganglios. Fallecen 2 pacientes y otra debe ser intervenida en el postoperatorio por hemoperitoneo. Conclusión: La técnica descrita es fácilmente realizable, con mínimas complicaciones y con una adecuada exposición del retroperitoneo, lo que permite obtener un número de ganglios necesarios para la etapificación del cáncer de endometrio y ovario.

Objective: To reports and describes the results of the paraaortic lymphadenectomy technique in the management of endometrial and ovarian cancer. Methods: We report a prospective cohort of patients with diagnosis of endometrial and ovarian cancer that required a systematic paraaortic lymphadenectomy, between August 2005 and March 2008, describing the surgical technique and the main results. Results: During this period seventy-six patients carrying endometrial or ovarian cancer are submitted to a systematic paraaortic lymphadenectomy. The average age was 57 years; 40 patients (52.6%) diagnosed with an endometrial cancer and 35 (46%) with an ovarian one. The average surgical time was 55 minutes, with an estimated bleeding of 120 ml. We obtained an average of 25.4 lymph nodes. Two patients deceased in this cohort and one was reintervened for a hemoperitoneum. Conclusion: The described surgical technique is feasible, with minimal complications and allows an appropriate exposure of the retroperitoneum to obtain an adequate number of lymph nodes for endometrial and ovarian cancer staging.

Características clínicas e histologia endometrial na hemorragia pós-menopausa / Clinical aspects and endometrial histology in postmenopausal bleeding

Neste estudo objetivou-se a avaliaçäo das características clínicas, etiologia, fatores de risco associados à perda sangüínea na pós-menopausa. Foram avaliadas 83 pacientes submetidas à curetagem fracionada devido à hemorragia pós-menopausa. A média de idade foi de 61,5 anos (+ 10,6 anos), com 90 por cento de multíparas. Os fatores de risco mais freqüentes associados à patologia do endométrio foram a obesidade e a hipertensäo, em 51,8 por cento. As alteraçöes ultra-sonográficas foram encontradas em 76,5 por cento, sendo a mais comum o espessamento do endométrio. Os achados histológicos obtidos através da curetagem fracionada diagnosticaram patologias endometriais em 60 por cento das pacientes: adenocarcinoma em 15,4 por cento; leiomiossarcoma, 1,2 por cento; sarcoma de endométrio, 1,2 por cento; adenofibroma uterino, 2,4 por cento; carcinoma epidermóide de colo uterino, 4,8 por cento; hiperplasia endometrial, 8,4 por cento; pólipos endometriais, 24,1 por cento, endometrite inespecífica 3,6 por cento. Na pós-menopausa, a hemorragia genital constitui-se um importante sintoma que deve ser sempre investigado, especialmente quando surge após dez anos de menopausa. A ultra-sonografia mostrou ser um bom método de triagem para avaliaçäo endometrial. O exame histológico do endométrio deve ser realizado em todas as pacientes com hemorragia na pós-menopausa, para possibilitar a detecçäo de lesöes pré-malignas ou malignas.