Treatment of recurrent and metastatic adenocarcinoma of the endometrium with cisplatin, doxorubicin, cyclophosphamide, and medroxyprogesterone acetate

Article Abstract:

The prognosis for patients with metastatic endometrial cancer is poor. The five-year survival rate for stage IV disease is only 10 percent. Chemotherapy with cisplatin, doxorubicin, and cyclophosphamide, alone or in combination, and hormone therapy with progestogens been shown to have varying degrees of effectiveness in treating this type of cancer. This study examined the effectiveness of combination therapy with cisplatin, doxorubicin, cyclophosphamide, and medroxyprogesterone acetate in treating metastatic or recurrent adenocarcinoma of the endometrium. Forty-four women, 36 who had metastatic disease and 8 with recurrent disease, were treated with this chemotherapy regimen. Results showed that the median (midpoint) survival time was 31 months, and the two-year survival rate was 56 percent. When the groups were divided by initial extent of disease, 12 patients had only peritoneal cells involved; microscopic involvement was found in 11 patients; macroscopic involvement of less than 2 centimeters was found in 6 patients; and macroscopic involvement of greater than 2 centimeters was found in 15 patients. The two-year survival rates for these groups were 81 percent, 90 percent, 33 percent, and 17 percent, respectively. The median survival times for the latter two groups were 15 months and 10 months, respectively. Tumor grade was not predictive of survival, but volume of disease was highly predictive of survival. Side effects from the chemotherapy affected all the women. The results indicate that volume of disease must be carefully evaluated so that patients who need adjuvant therapy can be identified. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prognosis, Endometrial cancer, Chemotherapy, Chemotherapy, Combination, Combination chemotherapy

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Repetitive conservative surgery for recurrence of endometriosis

Article Abstract:

Endometriosis is a disease in which tissue that normally lines the uterus (endometrial tissue) appears in other parts of the body, usually within the pelvic region. The condition can be eliminated by surgical removal of the uterus (hysterectomy), but the ability to bear children is also sacrificed and so this is rarely the chosen treatment in young women. The current trend in treating endometriosis involves conservative surgery (laparotomy, surgical opening of the abdomen), which is used to preserve or improve the patient's ability to become pregnant while treating the disease. However, little information is available on the effectiveness of repeated conservative surgeries for recurrent endometriosis. Forty-two women between the ages of 23 and 43 years (average age 31 years) were observed for an average of 42 months (range was 12 to 119 months) after their second conservative laparotomy for recurrent endometriosis. The relief of pain symptoms and subsequent fertility were evaluated. Eight women (19 percent) had a recurrence of dysmenorrhea (painful menstruation), and seven women (17 percent) had a recurrence of pelvic pain. Of the 28 women who tried to become pregnant after their second laparotomies, eight women (29 percent) became pregnant (a total of 13 pregnancies were achieved in this group). Six of the patients had to undergo a third operation after an average of 35 months because of recurrent symptoms and clinical signs of the disease. It is concluded that conservative surgery allows for pregnancy in some patients and is an effective treatment for patients with recurrent endometriosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Surgery, Endometriosis, Reoperation

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Late recurrence of clear-cell adenocarcinoma of the cervix: case report

Article Abstract:

Young women whose mothers used diethylstilbestrol (DES) during pregnancy are known to be at risk for clear-cell adenocarcinoma (a type of cancer) of the cervix and vagina. In several cases, long disease-free intervals have been noted between the initial tumor and its recurrence after treatment. The case report is presented of a 31-year-old patient who had undergone radical hysterectomy (removal of the female reproductive organs) and removal of associated lymph nodes at age 14 because of a diagnosis of clear-cell adenocarcinoma of the cervix. The patient underwent radiation treatment, and had no signs of disease during the intervening years. Seventeen years later, she developed shortness of breath, dizziness, and headaches, and was found to have metastases (cancer spread) to her lungs and brain. One year after this diagnosis, the patient died. The very long time before recurrence associated with this type of cancer indicates that metastasis can take place even when the region surrounding the original tumor is free from disease. In addition, this possibility should alert clinicians to the importance of long-term follow-up. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Development and progression, Cervical cancer, Metastasis, Cancer metastasis, Adenocarcinoma, Diethylstilbestrol

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